Continuing our series on race and migration and the virus crisis, today’s post is by Farjana Islam and Gina Netto. A final version is forthcoming in Radical Statistics and is posted here with permission.

A myth has been popularised in the UK that the ‘the virus does not discriminate’[1] rich or poor, powerful or powerless, however, the emerging evidence suggests otherwise. In the UK, early analysis of critically-ill COVID-19 patients indicated not only that older people, particularly men and those with underlying conditions were more likely to be affected, but that Black, Asian and Minority Ethnic (i.e. BAME) groups might be disproportionately affected by the pandemic.[2] Initially, the Intensive Care National Audit and Research Centre (ICU) revealed that 35% of the first 3883 critically-ill Coronavirus patients identified as BAME, while they comprise 14% of the population in England and Wales. A similar trend has also been reported in US cities like Michigan, Louisiana and Chicago, where people from African American groups disproportionately died from the COVID-19 infection. In the UK, the Department of Health and Social Care, Runnymede Trust, New Policy Institute[3] and The British Medical Association[4] concurred in attributing the over-representation of BAME groups in mortality rates to underlying health conditions, overcrowded housing conditions, and other ethno-cultural factors such as multi-generational households. At the time of the writing (21 April 2020), the number of deaths among those affected by the disease have continued to increase. Given the scale of the pandemic and the low likelihood of a vaccine being developed in the near future, it is important to develop further understanding of factors contributing to the high mortality and morbidity rates among these groups of people.

This applies particularly to the large global cities in which such groups are concentrated, particularly London, the worst affected area with the highest COVID-19 death toll. The city – which displays acute fragmentation and spatial concentrations of poverty, particularly along ethnic lines (Cox and Watt, 2002; Hamnett, 2003) – contains the major share of BAME people living in the UK. This includes 58.4% of Black people and 35.9% of Asian people.[5] Drawing on recently completed doctoral research, we turn the spotlight on Black African Carribeans and British Bangladeshis living in two London boroughs to consider the impact of COVID-19 on these communities. These are the London boroughs of Tower Hamlets and Hackney area where British-Bangladeshis (32%)[6] and Black African Caribbean (23%)[7] people are concentrated, respectively. We argue that while underlying health conditions, overcrowding and multi-generational households are indeed important contributory factors, there are other socio-economic factors which have not yet been captured statistically that are important to note. Greater understanding of the socio-structural problems arising out of poverty and deprivation which result in the greater vulnerability of these groups to contracting the disease is needed in order to formulate appropriate policy interventions to control the spread of the disease. This is likely to become increasingly important as the UK begins to consider a staged recovery period from the pandemic and the need for an approach which is more responsive to geographical variations in the spread of the virus.

The majority of the ethnic minority people in these areas are composed of post-war Commonwealth immigrants and their descendants who initially settled in cheap key industrial areas. The first generation of Asian and Black African people were hit hardest by gradual decentralisation and closure of docks and experienced poverty, deprivation and unemployment (Davis, 2012). It is estimated that the London Docklands borough lost 150,000 jobs between 1966 and 1976 and by 1981 the unemployment rate in the London Thames Gateway area was at 9.6%, almost a quarter higher than the regional average (MacRury and Poynter, 2009). In 2015, the deprivation in Tower Hamlets and Hackney boroughs remained widespread as the figures in English Index of Multiple Deprivation (IMD) 2015 suggest these boroughs contain some of the most highly deprived areas in England (see Tower Hamlets Corporate Research Unit, n.d., p-2)[8]. The quotes below from a first generation British-Bangladeshi resident in Tower Hamlets clearly illustrates this:

“I used to work in a garment factory in Bethnal Green during the 80s and the 90s. I had to work so hard those days which deteriorated my physical and mental health. Later, the factory was closed and I lost my job. I am still suffering from mental illness as I remained unemployed for decades.”

More recently, the Tower Hamlet and Hackney boroughs used the Olympic momentum to improve the housing stock in the area with modern buildings. However levels of deprivation remain similar. At borough level, the Tower Hamlets borough in particular scored worse in IMD2015 (published after the Olympic Games) in comparison to IMD2010 (published before the Olympic Games) [9]. The Government figures[10] show that 30% of Bangladeshi and 28% of Black African Caribbean household were more likely to be overcrowded in contrast to 2% of White British households. In the case of individuals showing the COVID-19 symptoms, it is likely that the sick person cannot isolate himself/herself from rest of the family due to a lack of room in the household.

Moreover, 12% of Bangladeshi and 10% of Black African households were more likely to have damp problems.[11] People who are living with poor indoor ventilation in a shared or overcrowded accommodation, are more at risk for COVID-19 transmission with deadly consequences since damp may contribute to diseases like asthma. Our conversation with a Bangladeshi lady living in a shared accommodation with a damp problem reflects both the seriousness of the problem as well as the difficulties that legal status can pose to overcoming its damaging effects:

“Ms Amina: This is a two-bedroom flat, we (couple and a child) share with other three people. We are living in the flat’s living room; the room is not well ventilated. Walls are damp and causing breathing problem to my son”

Researcher: Did you consult with council or housing agency about damp?

Ms Amina: We contacted the Housing Agency, they tried to fix the damp. I did not contact the council because they only listened to and supported the people who owned a red[12] passport” (Ms Amina, a Tower Hamlets resident living in the UK for 9 years, interviewed in 2015)

Other ethno-cultural factors, such as language barriers and religious activities could also contribute to the disproportionate impact on BAME people. Fieldwork suggests that some first and second generation Commonwealth immigrants and a few Portuguese-speaking African Caribbean people have low levels of proficiency in English. Bangladeshi women (who were born and brought up in Bangladesh and had immigrated through marriage) also face difficulties in understanding English and seek help from charities, interpreters or family members to understand written communication in English. It is thus reasonable to assume that it would be difficult for some BAME people to understand the technical terms surrounding the COVID-19 pandemic, such as ‘quarantine’, ‘social distancing’ and ‘flattening the curve.’ Also, there is evidence that critically-ill patients with language barriers faced difficulties in describing their illness because they could not get the help of an interpreter or family member in the pandemic situation.[13] Further, government instructions which involved adhering to two-meter social distancing rules would have been difficult to observe given the presence of narrow footpaths and stair-cases in many housing estates.

Further, until the lockdown came into effect on 23rd of March, many people routinely participated in religious mass gatherings, for example, Christians go to church once a week while some Muslim men go to the mosque five times a day, which could increase risk of disease transmission. These religious gatherings serve an important function in enabling first generation and elderly BAME people to routinely meet and socialise with friends from the community. Following the lock down, it is likely that there is a risk of declining mental wellbeing among these groups because they are not proficient in using the internet and social networking sites that enable others to remain socially connected.

The Black and Asian population are among the post-industrial ‘working class’ (Watt 2008), who are undertaking many of London’s low-paid or manual or key-frontline jobs, and include those working in transport and delivery, health care assistants, hospital cleaners, adult social care workers, and supermarket workers. For example, Government figures[14] show 18% of Black workers were employed in ‘caring, leisure and other services’ jobs and 38% of Bangladeshi workers were employed in the three least skilled types of occupation combined (‘elementary’, ‘sales and consumer services’ and ‘process, plants and machine operatives’ jobs). Moreover, NHS workforce figures[15] shows that 34.5% of senior doctors and 34.9% of junior doctors are most likely from BAME groups, while Asian people made up a higher percentage of medical staff (at 29.7%) as of March 2019. The BBC news aired on 21st April 2020 at 10am reported that 58 out of 84 (69%) NHS staff who lost their life to coronavirus in hospital are from BAME groups. The disproportionately high mortality rate of BAME groups within the health service provides further evidence that BAME front-line key workers, are at high risk of contracting the virus. Besides, it is emotionally more challenging for recent immigrants, including NHS doctors, nurses and those working in care homes, to face the increased pressures related to COVID 19 with limited or no support from family or next to kin.

The COVID-19 pandemic demonstrates that ethnicity-based data is largely missing from some important datasets such as health and medical records. Since the pandemic started in the UK, it has become clear that the daily mortality figures published by Public Health England do not reflect the actual number of COVID-19 death toll as these only capture the deaths which occurred in NHS settings. The undercounted COVID-19 deaths in the community (i.e. at home), care homes and hospices has made the public sceptical about the actual death toll and raised questions relating to the Government’s transparency in daily publication. An analysis by The New York Times shows that death rates are at least 33% higher than the usual in England and Wales during 7th March to 10th April 2020[16]. From 16 April 2020, Office of National Statistics (ONS) started to publish more accurate figure of COVID-19 related deaths by age, sex and region based on the information stated in the death certificates, however, ONS data is subjected to around two weeks delay from real time. Except for the demographic data collected by ICU for first 3883 critically-ill patients, none of the official COVID-19 death records (i.e. ONS and Public Health England) captured ethnicity of the deceased persons in England and Wales. Consequently, there is an urgent need to record COVID-19 patients and deaths by ethnicity in the hospitals, care homes and in the communities in order to capture the impact of the pandemic across ethnicity.

At the time of writing (21.04.2020), The NIHR and UK Research and Innovation (UKRI) are jointly calling for research proposals[17] to increase understanding of potential differences in risk for ethnic groups and how to reduce morbidity and mortality from COVID-19 in groups identified at greater risk. It has also called for research to distinguish between an innate susceptibility (for example, genetic) and socioeconomic, lifestyle and environmental factors. This is intended to complement a rapid review by Public Health England of how COVID-19 affects people differently according to ethnic group, age and gender. Public Health England will also analyse numbers and rates of confirmed cases, hospitalisations and mortality by ethnicity, while also reviewing cases by age, sex and geographical region. It is unclear whether the review will include care homes and local communities as well hospitals.

Our research emphasises the value of collecting local authority data, and where possible, fine-grained spatial analysis of housing and neighbourhoods which are particularly densely populated. At the neighbourhood level, important factors which need to be taken into account include the extent to which the design and layout of neighbourhoods facilitate social distancing and safe access to essential food and other supplies. At the level of the household, important variables are the nature of household (for example, single, multigenerational), housing type and conditions and housing tenure (for example, social/private rented housing). At the level of the individual, in addition to age, gender and ethnicity, other important variables are length of residence in the country, legal status, level of education, languages spoken, type and sector of occupation and earnings. Analysis of such information will play an important role in assessing the extent to which ethnicity interacts with other important variables related to socio-economic status and environmental factors to increase vulnerability to COVID-19. Such knowledge will not only help debunk the myth that the virus does not discriminate, but will help build the evidence base for formulating effective policy interventions to reduce the disproportionate impact on some ethnic groups.

References:

Cox, R., Watt, P. (2002). ‘Globalization, polarization and the informal sector: the case of paid domestic workers in London’, Area 34(1), pp.39–47.

Davis, J., 2012. ‘Urbanising the Event: how past processes, present politics and future plans     shape London’s Olympic Legacy’, PhD thesis, The London School of Economics and Political Science, London. http://etheses.lse.ac.uk/382/, last accessed 18/07/2019.

Hamnett, C., (2003b), Unequal City: London in the Global Arena. London: Routledge.

Islam, F., (2019). ‘The impact of Olympic-led urban regeneration on ethnic minority residents in London: A right to the city perspective’, PhD thesis, Heriot-Watt University

MacRury, I., Poynter, G. (2009). London’s Olympic Legacy A “Think piece”, report prepared for the OECD and Department of Communities and Local Government, London East Research Institute.

Watt, P. (2008). ‘The Only Class in Town? Gentrification and the Middle-Class Colonization of the City and the Urban Imagination’, International Journal of Urban and Regional Research. 32(1), pp. 206–211. doi.org/10.1111/j.1468-2427.2008.00769.x

[1] https://news.sky.com/video/coronavirus-virus-does-not-discriminate-gove-11964771

[2] https://www.icnarc.org/About/Latest-News/2020/04/10/Report-On-3883-Patients-Critically-Ill-With-Covid-19

[3] https://www.theguardian.com/world/2020/apr/12/virus-hitting-hardest-modern-equivalent-victorian-slums

[4] https://www.theguardian.com/society/2020/apr/10/uk-coronavirus-deaths-bame-doctors-bma

[5] https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/national-and-regional-populations/regional-ethnic-diversity/latest

[6] https://www.towerhamlets.gov.uk/Documents/Borough_statistics/Ward_profiles/Census-2011/RB-Census2011-Ethnicity-2013-01.pdf

[7] https://drive.google.com/file/d/1DKoNRHkaygyaz1s12ksjsGzdt7iXdeF3/view

[8]https://www.towerhamlets.gov.uk/Documents/Borough_statistics/Income_poverty_and_welfare/Indices_of_Deprivation_Low_resolution.pdf

[9]https://www.towerhamlets.gov.uk/Documents/Borough_statistics/Income_poverty_and_welfare/Indices_of_Deprivation_Low_resolution.pdf

[10] https://www.ethnicity-facts-figures.service.gov.uk/housing

[11] https://www.ethnicity-facts-figures.service.gov.uk/housing/housing-conditions/housing-with-damp-problems/latest

[12] Red passports mean the UK and EU passports. In the UK, red passport holders are entitled to receive state benefits including housing benefit, income support, child tax credit, etc.

[13] https://www.bbc.co.uk/news/uk-52255863

[14] https://www.ethnicity-facts-figures.service.gov.uk/work-pay-and-benefits/employment/employment-by-occupation/latest

[15] https://www.ethnicity-facts-figures.service.gov.uk/workforce-and-business/workforce-diversity/nhs-workforce/latest#main-facts-and-figures

[16] Reported by Jin Wu, Allison McCann, Josh Katz and Elian Peltier, see details https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html (last accessed 21.04.2020)

[17] https://www.nihr.ac.uk/documents/highlight-notice-covid-19-and-ethnicity/24657

***

To cite this piece:

Islam, Farjana, and Gina Netto (2020) “‘The Virus Does Not Discriminate’: Debunking the Myth: The Unequal Impact of COVID-19 on Ethnic Minority Groups.” Radical Statistics Journal, no. 126.  https://www.radstats.org.uk/journal/issue126/

Farjana Islam has recently completed a PhD in Urban Studies at Heriot Watt University.

Gina Netto is a Reader in International and Forced Migration at The Urban Institute, Heriot Watt University.

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