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The waiting game

Some Covid-19 victims are more equal than others

Dr Shaba Nabi

The Covid-19 quarantine has brought out all the narcissistic celebrity virtue signallers, with Madonna tweeting from a luxury bathtub full of rose petals, about how this virus is ‘the great equaliser’.

I’m sorry, Madonna, but you are wrong.

This pandemic is highlighting and amplifying inequalities like nothing else before it.

This crisis, which has already affected my own family, has placed everything into sharp perspective for me. On a personal level, I am no longer interested in whether people share my world view. Professionally, I am done with the incessant bean-counting our role has become. I wish only to follow a purpose that aligns to my values; that of actually making a difference to patients’ lives.

But my patients are mainly black and Asian – the ones most likely to be impacted by this virus. A report on 10 April by the Intensive Care National Audit and Research Centre confirmed that black and minority ethnic (BAME) patients make up 35% of deaths even though they represent only 14% of the population.

At the time of writing, 11 NHS doctors have died from this virus – all male, middle aged and from a BAME background. No doubt the number of NHS staff deaths will be even higher once this column is published.

We are not equal and to pretend otherwise is highly disingenuous

Following the sad news of a Covid-19-related death in my own family, I am left reflecting on why this virus is even more lethal for certain populations and what we can do proactively to manage this.

Much has been written about the myocardial injury associated with Covid-19 infection, which could unmask undiagnosed coronary artery disease. The typical metabolic syndrome phenotype is much more prevalent in the South Asian community, which could represent a significant risk factor for the infection.

But we can’t dismiss the significant social and psychological factors of poverty, deprivation and culture. Doctors aside, people from minority backgrounds are more likely to be living with extended families in overcrowded housing. Language issues and deprivation may result in them struggling to access healthcare, which is even more challenging since our practice doors closed. Children from less affluent backgrounds will not experience the same privileges as my children during lockdown; country walks and all the books money can throw at them.

We are not equal and to pretend otherwise is highly disingenuous. Certain populations need additional resource but years of underfunding for multicultural, deprived communities is now coming home to roost.

My big job on Easter Monday was to validate the list of shielded patients, which arrived more than two weeks late. But nowhere in this list does it ask me to proactively shield middle-aged BAME men with comorbidities – who are at significant risk of dying from this condition.

I am left wondering what this façade is all about.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs online at pulsetoday.co.uk/nabi

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Readers' comments (30)

  • Covid 19 can affect absolutely any individual human being and family. For everyone affected it is a tragedy. Thank you

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  • The chances of obtaining a diagnostic test appears to be highest for white males, particularly politicians or members of the Royal Family: not egalitarian.

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  • Whatever happened to the Black report?

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  • I note that you are not outraged that men are twice as likely to die as women?

    Funny that

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  • RIP to your relative Shaba - sorry in advance that this entirely reasonable article will attract the "but what about men/white patient" brigade but unfortunately I know you probably expect that by now. In Glasgow there's a definite similar trend and an undeniable skew towards BME patients ending up needing higher levels of care. I think you've summarised the uncertainty and the potential biological and socio-economic factors very concisely and it echos what our ITU colleagues are telling us up here. Hope you're keeping well yourself.

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  • Merlin - the article has the sentence:

    "But nowhere in this list does it ask me to proactively shield middle-aged BAME men with comorbidities – who are at significant risk of dying from this condition."

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  • If you’re dead as a result of Covid 19, that’s pretty much equal whoever you are...

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  • please ensure all BAME take adequate vitamin D. And especially so in North Scotland.
    Fresh air and healthy living but only so-so for sunlight.

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  • “No one” IE the evidence based community is believing the Vit D story BUT as it is a cheap OTC/ Amazon product taking some seems sensible esp if you have a dark skin and live in the UK . So please get the family on it !?
    Does anyone know if Germans and South Koreans either take it or have diets with more in than other countries ? Do they eat more old fashioned margarine where it was added ?

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  • Such a great take down of the "we are all equal" brigade. Yet another great article Shaba. Keep it up.

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