How is race affecting COVID-19 outcomes?

Anastasia Tsirtsakis

14/05/2020 4:57:07 PM

The pandemic has been referred to as the ‘great equaliser’ – but data emerging from the US and UK shows that is not necessarily the case.

Coronavirus and the globe
Data from around the world has shown the virus disproportionately affects people from minority ethnic backgrounds.

‘The slogans are interesting – “We’re all in this together”.
‘In some ways it’s a positive sense of social cohesion and cooperation that we do want to foster. But the reality is that some people are really suffering a lot more both from the lockdown and the virus.’
That is Professor Yin Paradies, Chair in Race Relations at the Alfred Deakin Institute.
As the pandemic continues, there is growing evidence of the disproportionate effect coronavirus has on ethnic minorities.
New data on coronavirus-related deaths in the UK shows that people who are of black or Asian background are more likely to die from COVID-19 compared to those of white ethnicity.
Figures from the Intensive Care National Audit and Research Centre in the UK reveal that one third of the 6574 intensive care COVID-19 patients to 30 April were from non-white ethnic groups – a disproportionately high figure given ethnic minorities make up just 13% of the population in England and Wales.
The trend extends to health workers. Out of 106 health-worker COVID-19 fatalities to 22 April in the UK, 63% were either of black, Asian or a minority ethnic background. The number rose to 94% for doctors.
Meanwhile in the US, an analysis showed that black or African American people in New York accounted for 92.3 deaths per 100,000 in the city, and Hispanic or Latino people for 74.3 – considerably higher than white people (45.2). In Chicago, 72% of people who died of coronavirus up to early April were black, despite only representing 30% of the city’s population.
‘I wasn’t surprised to see those figures, unfortunately,’ Dr Kate Walker, Chair of the RACGP Refugee Health Specific Interests network, told newsGP.
‘Especially in the American context, where there are so many barriers to accessing healthcare according to socioeconomic status. As we know, [the US has] a lack of public access to medical care, especially for those at a socioeconomic disadvantage.’
Other demographic variables that put ethnic minorities at a greater risk of COVID-19 include a higher prevalence of chronic disease, working in high-risk professions, income inequality and overcrowded living conditions, as well as access to resources, including social support.
‘These will all impact on how well we deal with viruses and other conditions,’ Professor Paradies explains.
‘But mostly it’s a matter of disadvantage and the level of control that people have over their lives – these things all relate to your race and ethnicity. So that’ll have an effect on how well you cope with the virus.’
When it comes to Australia, the data around COVID-19 and ethnicity is limited. But Professor Paradies says similar trends are not out of the question.
‘It’s quite possible that these sort of similar effects could occur if we see further spikes in numbers, and it might be minority groups, migrant groups, Aboriginal and Torres Strait Islander people, [or] people on visas,’ he said.
There is considerable concern over the prospect of the virus making its way into Aboriginal and Torres Strait Islander communities, given the higher burden of existing chronic health conditions.
The latest epidemiology report released by the Department of Health shows that, to 26 April, a total of 52 cases out of Australia’s 6711 were of Aboriginal or Torres Strait Islander background; however, the median age of these patients was 36, lower than non-Indigenous Australians’ median age of 48.
Professor Paradies commended Australia’s swift action in restricting travel to certain zones to protect remote communities.
‘That is something that I think the Government has done a good job with,’ he said.
‘A lot of states having additional restrictions within certain zones has been largely successful and we need to keep that going because if the virus gets into remote areas it could become very problematic there.’
But other issues remain, with Aboriginal and Torres Strait Islander people five times more likely to live in overcrowded accommodation compared to non-Indigenous Australians, which can make it difficult to self-isolate if a resident is unwell.
Meanwhile, racial discrimination and unconscious bias both have severe consequences on health outcomes.
‘It’s really just a matter of understanding that culture has a real impact on people’s worldviews, behaviours and priorities,’ Professor Paradies said.
‘[Having an] understanding of their own cultural perspective and then trying to engage in effective cross-cultural communication with everyone who comes through their doors. Trying to understand where those people are coming from and how their cultural background might impact on their health.’
Dr Walker says the first step is recognising the barriers that exist for many communities regarding health literacy and access to health services.
‘There are much higher incidences of chronic disease in low socioeconomic communities and there’s less accessible primary care,’ she said. ‘This makes our patients at higher risk of severe consequences of COVID-19, and also at risk of presenting later and spreading the infection.
‘Refugee and asylum seeker seeker patients have multiple barriers around making appointments, and also language and health literacy barriers within the consultation.

‘It is critical GPs take the time to explain how to self isolate if patients need COVID-19 testing. GPs can easily access interpreters for on site appointments and telehealth through [Translating and Interpreting Service] if this is needed.

‘CALD patients may need extra assistance to make appointments in the pandemic environment, particularly when using telehealth. Reception staff may need to work with interpreters to explain changes to appointment procedures. Patients also may require extra reassurance it is safe to attend in person when they need to.’
As Australian governments move to lift restrictions and reopen their economies, people have been urged to work from home if they can. But for ethnic minorities from low socioeconomic backgrounds, this is often out of reach. 
‘It’s well-established that the capacity to work from home is very much a privilege of those in jobs that are more in the knowledge economy or managerial jobs,’ Professor Paradies said.
‘People who work in the service industry or labour industry and so forth are more likely to be migrants, people of colour or people who are of non-white background. 
‘They can’t work from home; therefore their exposure will be greater.’
To reduce the risk, Dr Walker says workplaces need to ensure there are safety measures in place.
‘A critical thing to think about in Australia is that we ensure all our healthcare workforce has access to adequate PPE [personal protective equipment] and doctors and healthcare workers of diverse ethnic backgrounds are not pressured to see patients in high-risk settings,’ she said.
‘We also need to make sure that both inside and outside of the healthcare setting those who don’t feel safe are able to raise their concerns about their personal safety in the workplace.
‘People in the UK from black, Asian or minority ethnic backgrounds are two times less likely to raise concerns about safety in their workplace – and that was doctors. They’re quite vulnerable if they can’t raise their safety concerns.’
To better understand the impact of ethnicity on pandemic outcomes and beyond, Dr Walker says the first step is accounting for it in the data.
‘The real barrier in Australia is the lack of capturing ethnicity and country of origin in our healthcare data,’ she said.
‘That’s something our network has been advocating for; to collect that in the practice software and for that to be mandatory.’
Professor Paradies agrees there needs to be a greater focus on ethnicity, and for discussion around policymaking to be had through a cultural lens.
‘Traditionally in Australia we have been very good at promoting the benefits of multiculturalism, but we need to incorporate that into our policymaking,’ he said.
‘That applies in times of crisis, too.
‘We are all in this together, but we need to understand that some of us will need more support than others and that’s part of that sense of cooperation.’
The RACGP has more information on coronavirus available on its website.
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Dr Elias Youssef Samaha   15/05/2020 8:30:44 AM

Interesting finding: going to either explained by:
1. Genetic vulnerability
2. Patient vulnerability
3. Environmental hazard exposure

My view it’s a social problem : most of it May all be explained by Inc. exposure to hazards. I.e. look at the cruise ships , the more overcrowded a space the worse the spread , and in turn the infectious loading and death

I think Minority of it is explained by increased health vulnerability / possible genetic vulnerability

Dr Franziska Levin   15/05/2020 10:55:50 AM

Australia has a large migrant population who live here on temporary visas. Whilst contributing to society through work/ university fees and paying taxes those migrants have no access to the Medicare healthcare system or Centrelink. This leads to people continuing to work rather than self isolate if symptomatic because they would otherwise not be financially supported, as well as not seeking medical advice or care due to cost issues.
It is surprising that such discrimination and inequality exists in a wealthy country like Australia.

Dr Ian Mark Light   15/05/2020 1:11:33 PM

Very likely Covid 19 spreads much less in the outdoors and in fresh air ventilated rooms .
This has relevance for the loosening of lockdown with schools reopening and clinics taking more patients as the fear of Covid 19 recedes to a degree International Nurses Day was celebrated on Tuesday May 12 in honour of Florence Nightingale who advocated compassionate care hand washing fresh bandages fresh air and sanitation way back then in 1855 during the Crimean War .
A prefabricated hospital was sent from England .
She advocated not only in hospital but in society and for the poor .

Dr Susan Chambers   15/05/2020 7:05:06 PM

The effects of overcrowding and less access to healthcare are certainly important but do not explain the figure of 94% of doctors who died in UK. I think maybe the role of Vitamin D should be further investigated as low Vitamin D is known to give adverse outcomes in COPD.

A.Prof Jane Smith   17/05/2020 10:09:57 PM

This information is making Vitamin D look more important, and in need of better analysis as a potential contributer

Dr Gary Ronald Franks   23/05/2020 9:07:02 AM

the socio economic conditions understandably contribute and should be thought about and addressed by us all, but the increase in ethnicity related deaths in doctors in the UK suggests there is more going on-? vit D levels.? disparity of ACE receptors in caucasian versus non caucasian ,similar to thoughts about children not being so susceptible to Covid-19 thought due to less ACE receptors in their lungs .