Nina Fortune explains the reasons for the prevalence of BAME deaths in the Covid-19 crisis.
24 April 2020.
The faces of some of the victims.
Mere days into the lockdown and news headlines proclaimed the novel coronavirus as the great equaliser. The notion that ‘we’re all in this together’ has been parroted from the deep enclaves of middle-class neighbourhoods, where a vast majority of families can mercifully wait out the pandemic while working from home. It has been pedalled as fact that the coronavirus does not discriminate, and the cases of both Prince Charles and Boris Johnson testing positive for the virus has been used to bolster the claim.
But this lie discounts the reality that Boris Johnson and Prince Charles were tested for the virus, at a threshold where most citizens and frontline NHS staff would not be permitted a test, and therefore, granted timely life-saving interventions. But the lie is also more insidious, in that it distorts the reality that the coronavirus is not an equal-opportunity killer. In fact, this virus, far from killing indiscriminately, is laying bare society’s racial and socio-economic inequalities, with it killing along the very lines of our collective prejudice.
As I write, the pandemic still rages across the globe, with the UK projected to have the highest number of deaths in Europe. Across the pond, the US has overtaken Italy as the new epicentre of the disease. But buried within the daily death toll published each evening is an emerging trend: namely, BAME (Black, Asian, and Minority Ethnic) people are over-represented in the people being infected and subsequently dying from Covid-19.
In the UK, BAME make up only 14% of the population and yet 34% of those critically ill and in hospital with Covid-19. It is also well to note that although only 20% of NHS staff are identified as BAME, 67% of those who have died at the frontlines within the NHS are BAME staff. These figures should give us pause, because it is not by accident that Covid-19 appears to be killing those who belong simultaneously to the most marginalised groups in society.
Killing the marginalised
BAME people form a high proportion of those now re-classified by the government as ‘key workers’. This painful euphemism reminds us that without those formerly branded as ‘low-skilled’, society as we know it would grind to a halt. At a time when most are retreating to the comforts of their homes, and the more privileged are fleeing off to second homes to gain social distance, there is no exit for Black and Minority Ethnic people who are thrust into the line of fire as bus drivers, custodians, delivery people, security guards, shop assistants, Uber drivers, and other customer-facing professions.
This increased exposure is undergirded by structures and systems that are already calibrated to undermine their life chances, exacerbating pre-existing social and racial inequalities that lead to higher infection and death rates from Covid-19. BAME migrant workers in particular are vulnerable because they feel forced to work, as they are not entitled to government benefits. This has seen to the deaths of several Uber drivers and those working in the gig economy.
Overcrowding and inter-generational living also factors into the increased deaths from Covid-19 for BAME people. The most densely populated inner-city areas of London, for example, often have a high BAME population, some living in conditions that are deemed overcrowded and unfit. Surveys have found that people of Bangladeshi origin are particularly likely to suffer from overcrowding, while homelessness among the African-Caribbean population has risen two and a half times as fast, compared to the general population. Crowding, both in homes and on the streets, creates the perfect vector for viral transmission.
Poverty and active exclusion have necessitated multiple generations crowding into one household. As a result, older BAME people who are vulnerable to severe Covid-19 illness are often unable to self-isolate in these communities, and consequently are falling ill at higher rates. BAME people are also more likely to live in precarious housing conditions, which may lead to greater vulnerability to landlord abuse.
In the latest tragedy, Uber driver Rajesh Jayaseelan died alone from Covid-related complications, as he starved himself quietly inside the room of a rented lodge. He was afraid to leave for fear that his landlord and others would notice he had Covid-19, and he would be thrown on the streets. Rajesh had already been evicted from previous lodgings at the start of the pandemic, over landlords’ fear that his public-facing job would bring the infection back.
The fear of losing one’s rented abode is not unfounded, since, in a stunning dereliction of duty to protect the vulnerable, the UK’s Covid-19 aid pack, announced by the Chancellor a month back, contains scarce protection for renters and those in insecure housing.
A toxic cocktail
The toxic cocktail of poverty and systemic discrimination gives rise to yet another aggravating factor in the critical path of Covid-19, namely, poor health outcomes for BAME people. The rate of heart disease, stroke, and diabetes is higher among BAME populations in the UK.
It is already well-established that Covid-19 manifests more severely amongst those with underlying health conditions, and with higher incidents of these underlying health factors, BAME people are rendered especially vulnerable.
Moreover, poverty not only limits access to nutrition, it also makes those within its strata less trustful of authorities within the healthcare system, due to cycles of overt discrimination and patterns of silence. Studies have found the NHS to be institutionally racist, and this is borne out not only in the higher proportion of death amongst BAME medical staff, but also published research detailing markedly poorer outcomes for BAME patients, with pregnant women from Asian, African, and Caribbean backgrounds experiencing higher death and infant mortality rates during childbirth.
Surveys have also revealed a deep-rooted culture of bullying and discrimination against BAME staff within the NHS, both from colleagues and patients. Amongst the non-medical workforce, BAME staff make up a smaller number of those at senior grades of employment and the ‘very senior manager’ grade than at the support and middle grades. Additionally, a higher percentage of junior doctors were from the Black, Chinese, Mixed, and Other groups, than senior doctors.
This implies a power imbalance all too familiar, which results in BAME being less likely to speak out against unsafe working practices, such as working on Covid frontlines without adequate PPE. The latest victim in a growing trend of BAME NHS staff death is Mary Agyeiwaa Agyapong, who, despite being in her third trimester of pregnancy and therefore one of the identified vulnerable groups, was working in a ward that saw her exposed to Covid-19. Mary was just 28 years old.
On the other side, the widespread mistrust that follows from discriminatory conduct means many BAME people might not feel safe enough to seek help as readily when confronted health issues, be it Covid-19 or the underlying conditions that exacerbate it.
Some are also caught in the wider net of systemic racism, such as the hostile environment policy, which often sees immigrants being deported when they make themselves known to authorities, meaning many health issues within this group go unreported.
But lastly, let us not forget good old-fashioned racism. During this outbreak, I often hoped that if I came down with Covid-19, it would not be during the peak, since the combination of government inaction and a growing eugenicist bent to healthcare provision could see someone like myself, a minority, at the bottom of the totem pole for critical life-saving treatment.
The National Institute of Health and Care Excellence has recently distributed guidelines on how to ration ventilators, when inevitable scarcity arises. The NHS have been instructed to give priority to the young and those without pre-existing conditions. But in an institutionally racist organisation, it does not take much before those playing God decide who is indeed worthy and desirable, when the option is between two equally afflicted people of different races.
Such liberties have already been taken. They saw to an untimely end to the life of 36-year old BAME woman Kayla Williams. When an ambulance arrived at her house to find her breathless, vomiting, and suffering from severe Covid-19 symptoms, she was not taken to hospital, despite her spouse’s plea. Kayla was told that she was not a priority, and a few hours later, she was dead.
One wonders who was prioritised in her stead. Those of us who are BAME understand the danger that vulnerability before a racist healthcare system carries, and know all too well why Kayla Williams was deprioritised. It starts with refusing treatment to people deemed ‘undesirable’, which has already been seen in examples of DNR letters sent to care homes for those who do not have underlying conditions as defined by current government guidelines.
When guidelines are being stretched in this way they inevitably take on a racial bent, so that those whose lives are already deemed disposable are told they are not a priority for scarce, life-saving intervention. Therefore, far from being the great ‘equaliser of people’, Covid-19 appears to be travelling the path of least resistance, the one carved out by generations of active racial discrimination, social exclusion, and subjugation.
There is still much we do not understand about the novel coronavirus, but the numbers do not lie: BAME people are dying at a disproportionate rate to the rest of the population, and this pattern is recreated at the frontlines of the NHS.
The alarm bells have now been sounded, with the government and the NHS officials both vowing to investigate this phenomenon, but there are already attempts to downplay the culpability of the government’s decisions and societal structures as a whole. Some media outlets are already trying to blame BAME ‘cultural practices’, therefore taking the onus away from society and its structures. But we must strongly resist this narrative and a political agenda that tries to minimise or whitewash the links between racial inequality and Covid-19 deaths.
In the aftermath of this pandemic, there will be tough questions to answer, the least of which will be how ethnic minorities in Britain were let down and abandoned in the ravages of this disease. It is unsurprising that the novel coronavirus has arrived in our lands and exploited established fault-lines rather than prove to be some ultimate equaliser, as middle-class idealism imagines.
In truth, such equality is not a possibility in our current societal setup. The ability to isolate on a grand country estate with months of food is a privilege most cannot afford. The ability to work from home, rather than having to go to low-paid and public-facing jobs, is not a possibility open to many. The ability to maintain your mental wellbeing indoors, in a large house with a garden, is not a privilege afforded to most either.
And when the calculus of affordability is adjusted for race and ethnicity, BAME in this country still end up at the bottom. Covid-19, far from showing us that we are all equal in the face of social calamity, has torn open the fetid wounds of racial inequality in the UK, and should remind us that much work still needs to be done to achieve this elusive equality.
Nina Fortune is a West London author and activist.