Ethnic minorities ‘should be considered clinically extremely vulnerable’

Racism is a “root cause” and “major driver” of ill health in general and increased mortality rates from Covid-19, researchers from UK and US universities say.

Where risk of exposure to the virus is high, they recommend that ethnic minorities should be supported at work into “non-public facing roles” and “away from Covid-19 areas wherever possible”.

And those who are at high risk should be prioritised to receive a vaccine, said Dr Mohammad Razai, first author on the paper from St George’s, University of London.

He told the PA news agency: “Alongside risk factors including age, gender, pre-existing health conditions and occupational risk, ethnicity is an independent risk for Covid-19, with people from ethnic minority backgrounds more likely to have poor outcomes if they are exposed to the virus.

“Therefore, any meaningful risk assessments should take ethnicity into account in combination with these other factors, and where it has been assessed that their risk is high, ethnic minority groups should be prioritised for Covid-19 vaccination.”

The authors, also from Harvard University, the University of Manchester and Imperial College London, say every day discrimination, people’s implicit biases, and cultural and structural racism lead to worse health outcomes.

Exposure to discrimination over time, known as weathering, has been shown to lead to stressors that accelerate biological ageing, they add.

Ethnic minority groups are more likely to live in urban, overcrowded, and more deprived communities and to work in jobs that put them at higher risk of being exposed to Covid-19, according to Public Health England.

A report it published last year found that racism and social inequality have contributed to the increased risk of black, Asian and minority ethnic communities (BAME) contracting and dying from Covid-19.

According to analysis by the Office for National Statistics in October, all ethnic minority groups other than Chinese had a higher mortality rate from Covid-19 than the white population across both genders.

While black and Asian staff represent only 21% of the NHS workforce, early analysis showed that they accounted for 63% of deaths among health and social care workers, the authors said.

The paper, published in the BMJ, is calling for recognition of the key role of racism in driving ill health and for leadership from the Government and public health bodies on tackling this.

The authors recommend resources and support for businesses so they can ensure workplace safety, including through legally-binding risk assessments, and a financial package to help ethnic minority groups in low-paid, insecure employment.

The authors write that a lack of health and social care data on ethnicity in the UK is hindering an understanding of the extent of inequalities that exist.

They are calling for mandatory and routine data collection on ethnicity, through a health observatory or similar body.

The October announcement on plans for ethnicity to be recorded as part of the death certification process is a “major step forward”, they add.

The paper reads: “Covid-19 should be seen in the wider context of ethnic disparities and not treated in isolation.

“The mitigation measures must redress the root causes of these disparities as well as the more urgent task of protecting those ethnic groups most at risk of adverse outcomes from Covid-19.”

A Department for Health and Social Care spokeswoman said: “The list of conditions used to identify individuals who may be clinically extremely vulnerable to Covid-19 is agreed by the four UK chief medical officers on the basis of the latest available evidence.

“Clinicians in the NHS are able to add any patient to the shielded patient list, based on clinical judgment and an assessment of their needs.”