Why are people from BAME background more affected by COVID-19?

Trisha Banerjee

The risk of mortality from COVID-19 is higher in Black, Asian & Minority Ethnic (BAME) people, which is confirmed by the Public Health England review. Indian, Pakistani, Chinese, Caribbean and other communities of Asian and Black ethnicity have a 10% - 50% higher risk of death compared to those who are white British. It was found that people from Bangladeshi ethnicity are twice as likely to die from COVID-19 compared to white British people. Moreover, in healthcare, a majority of the doctors that have tragically died from COVID-19 have been from BAME backgrounds. 33% of ICU patients are from BAME backgrounds, whereas BAME people only make up 14% of the population of England and Wales. There have been many explanations proposed to explain the disproportionate effect on BAME people. 

From a scientific perspective, genetic factors predispose people of BAME backgrounds to COVID-19. Data from the National Diabetes Audit shows that there is a higher prevalence of Type 2 diabetes among people of Asian backgrounds compared to people of white backgrounds. Co-morbidities such as diabetes, cardiovascular disease and hypertension increase the risk of COVID-19 among BAME people. Moreover, it is speculated that Vitamin-D deficiency is linked to susceptibility to COVID-19. Vitamin-D deficiency is linked to the poorer function of the immune system and linked to increased susceptibility to viral infections. People with darker skin produce less Vitamin-D, and studies have shown that people with darker skin need to spend more time in sunlight in order to get the same amount of Vitamin-D as a person with lighter skin. There is also some evidence to suggest that BAME groups have higher levels of the ACE2 cell surface receptor which can predispose them to higher death rates from COVID-19.

From a sociological perspective, structural racism and socio-economic inequalities play a significant role in the increased susceptibility of BAME people to COVID-19. People from BAME backgrounds face more unemployment and poverty. They are more likely to live in overcrowded housing in urban deprived areas and have jobs that expose them to a higher risk of COVID-19 than people from white backgrounds. BAME people are over-represented in low-income groups and a larger proportion of the BAME population is employed in key worker and healthcare roles than that of the white population which increases their risk towards COVID-19. Moreover, diseases such as diabetes that predispose BAME people to COVID-19 are strongly linked to social factors that are affected by economic wellbeing. With regard to structural racism, the British Medical Association has suggested that BAME doctors may feel less able to complain about inadequate protection from COVID-19 such as insufficient PPE. Moreover, BAME people could face barriers towards accessing services such as healthcare due to cultural and language differences. Many also believe that the relationship between ethnicity and COVID-19 is complex and that it is a combination of genetic and socio-economic factors. 

It is important that as a community, we encourage and support further investigations and research towards why people from BAME communities are disproportionately affected by COVID-19. It is only then, we can recommend and support changes that reduce social and health inequalities and also protect those who are predisposed to COVID-19 by genetic factors. It is essential that we increase public understanding so that measures can be taken to lessen the risks BAME people face at the hands of COVID-19.

References:
https://www.theguardian.com/commentisfree/2020/jun/04/genetics-bame-people-die-coronavirus-structural-racism
https://www.theguardian.com/commentisfree/2020/may/07/the-guardian-view-on-bame-death-rates-inequality-and-injustice
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/892085/disparities_review.pdf

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