The long read: Asians high on UK’s Covid grim list

People with sub-continental and non-white origins have been significantly more impacted by Covid than others. What are the reasons for this vulnerability?

Scratch the surface, or read between the lines, and a different picture emerges. The grim headline that is better known across the globe refers to the United Kingdom suffering one of the worst impacts from Covid-19: over 150,000 deaths and more than 4.3 million cases. But less known outside the country is the disproportionately high impact of the virus on non-white communities comprising large numbers of people with origins in the Indian sub-continent. It is not only Rajesh Jayaseelan, 45, who moved to the UK from Bengaluru a decade ago and made a living in London as a taxi driver, but also several respected doctors such as Abdul Mabud Choudhury, 53, Poornima Nair, 56, or Anton Sebastianpillai, 70, who passed away after contracting the virus.

Last week, the UK observed the anniversary of the first lockdown imposed on March 23, 2020, but the day also marked the metaphorical tombstone of some of the first Covid-19 casualties from non-white communities. The country has gone through two waves. According to the latest official data based on a comparison of the first wave in 2020 and the early second in February, the figures have improved for some ethnic groups including Black Africans, Black Caribbean, Chinese and Indians but have worsened for Pakistanis and Bangladeshis, prompting more action from the Boris Johnson government to deal with the issue.

Known in official UK parlance as BAME (black, Asian and minority ethnic) communities, its members have been dealing with the pandemic at various levels. The largest numbers of doctors working in the National Health Service (NHS) who gained qualifications outside the UK are those from India, from where professionals have historically arrived to train and gain higher qualifications since the NHS was founded in 1948. The grim list of such doctors categorised as ‘Indian’ in Covid-19 death records include Jitendra Kumar Rathod, Krishan Arora, Rajesh Kalraiya, Pooja Sharma, Jayesh Patel, Vivek Sharma, Kamlesh Kumar Masson, Amarante Dias, Sophie Fagan, Hamza Pacheeri and Amrik Bamotra. There have been many more from other parts of the sub-continent.

But Asian casualties in the medical profession tell part of the story. The BAME communities constitute 13 per cent of the UK population, but are disproportionately represented in the high numbers among the dead, those admitted in intensive care units or in the number of new cases. In England alone — the largest and the most populated of the four constituents of the United Kingdom — latest figures show that the ‘Indian’ category has the highest number of the dead within the BAME group, constituting 3 per cent of the casualties, followed by the ‘Pakistani’ group at 2 per cent. The grim figures are: Indian: 2,202; Pakistani: 1,796; Bangladeshi: 688; any other Asian background: 1,184; Caribbean: 1,339.

The community factor

Several studies by government departments, think-tanks and charity organisations have highlighted the high impact on close-knit BAME communities. The reasons include socio-economic status, cultural practices and environmental conditions (largely influenced by structural biases based on ethnicity) collectively driving inequalities; existing co-morbidities (such as diabetes); as well as wider social and structural disparities such as racism, deprivation, living conditions, nature of employment. They have a large presence in public-facing employment roles in transport, hospitality, airline and other sectors. The challenge of dealing with the virus in BAME communities includes the larger incidence of multi-generation households compared to the white community. The impact has been felt at various levels due to restrictions, including financial (job losses), inability to join family events (such as funerals, marriages), mental health issues due to prolonged isolation and increase in domestic violence. London-based wedding planner Saheli Mirpuri says the industry has been severely hit, with tens of thousands of weddings cancelled. Some studies also suggest that in the early stages of the pandemic key public messages (for example, ‘Stay home. Protect the NHS. Save lives’) did not reach sections of the non-white communities who are not familiar with the English language.

Says Chand Nagpaul, council chair of the British Medical Association: “Covid-19 has had a devastating and disproportionate impact on people from black and ethnic minority communities. Progress in both, recognising and then tackling this, in order to stop more BAME people becoming ill and dying, has been far too slow. It’s positive to see the steps the government now appears to be taking. Of course, the success of this work can only be judged by the impact it is having on the ground, closing the gap between the way Covid affects different communities. Black and minority ethnic people still account for 28 per cent of people within critical care with Covid-19. BAME people are over-represented in frontline occupations, low-income jobs and many are self-employed or gig economy workers. They must be provided with better protection from the virus, as well as financial support — including for those asked to self-isolate — to ensure people are not risking their lives and those of their family simply to put food on the table.”

A new report of workforce race equality standard in the NHS concluded that Covid-19 did not create race inequality, but the pandemic has thrown it into sharp relief. The report found that BAME staff in the NHS is 2.5 times more likely to have personally experienced discrimination at work from a manager, team leader and/or colleagues compared to their white colleagues.

Says Prerana Issar, NHS chief people officer: “The country and the NHS have been challenged like never before by the Covid-19 pandemic, a disease that has been shown to disproportionately affect black and minority ethnic people. The murder of George Floyd in the US spurred an immediate and long-overdue global conversation about race inequality. Attention has not been so sharply focussed on this agenda for decades, and it is right that we examine these findings with a view to quickening the pace of change, against this backdrop. This year’s (workforce race equality standard) report shows that, at the point at which the pandemic struck, inequalities were already present in the NHS.”

A complex Asian matrix

If the picture of the impact of Covid-19 on non-white communities based on data from the Office for National Statistics or Public Health England — ‘from above’ — is stark, similar is the situation ‘from below’ in areas such as Ealing Southall, Brent, Leicester and Birmingham, which have a large population of Asian origin.

In Southall, the complex matrix of job cuts, restrictions on movement, school and workplace closures has led to an increase in domestic violence, among other issues. Says Virendra Sharma, senior Labour MP from Ealing Southall: “In London, the number of Covid-19 cases has been the highest in Ealing Southall, but now the people understand the importance of following official guidance. There has been an increase in mental health issues, also domestic violence. For example, earlier a typical family’s day would be the husband and wife going for work in the morning, kids in schools, and all returning home in the afternoon or evening. Their interaction was less; now they are together 24 hours at home, which leads to friction. This is not the situation in every household in my constituency, but in many of them. The stress level is high, also because houses are small and the numbers of living in them are more.”

The situation is not too different in the east Midlands city of Leicester, which has the unfortunate distinction of being the only British city that has endured Covid curbs for the longest period, since June last, even when restrictions were eased elsewhere in England. It has witnessed waves of migration over the decades, including in the early 1970s of people with origins in the Indian sub-continent expelled from Idi Amin’s Uganda. The migration has since rejuvenated local economy — the arterial Belgrave Road is also known as ‘Little India’ — and the city is now held up as a symbol of the success of Britain’s policies of multiculturalism, but continues to face challenges, as the pandemic highlighted. There have been reports of workers infected with the virus not reporting it for fear of losing work and wages, while cases continued to rise in the city faster than elsewhere until recently.

Trisha Hazarika, the Leicester-based sister-in-law of Indian cultural icon Bhupen Hazarika, says: “Most people in our communities live in extended families, with elderly parents who are more vulnerable to the virus. Cases have been going up in areas such as Highfields and in lanes around Belgrave Road. There are also those who break rules. The police are now strict and fine people found organising parties. Many doctors who had retired came out and volunteered to help in hospitals, but contracted the virus and died after a few months. Those in lower-paid jobs in the NHS did not have PPE in the early stages, but were reluctant to complain for fear of losing jobs if they complained.” Her husband Prabin Hazarika, younger brother of Bhupen Hazarika, has hardly stepped out of home for months, following advice to ‘shield’, with limited contact with children and their families.

Responding to new research on the Covid-related challenges facing BAME communities, the UK government put in place several measures, including working with the BBC World Service to produce videos on key questions in Urdu, Punjabi, Tamil, Gujarati, and Sylheti; working with over 50 ethnic minority publications across 10 different languages, and partnering with 43 ethnic minority TV channels within a combined reach of 9 million and 14 community radio stations that broadcast in 13 different languages and reach 881,000 people every week; new guidance to private hire vehicle and taxi drivers on how to protect themselves from the virus (53 per cent of such drivers are from an ethnic minority group and 98 per cent are men); and providing additional funding to public health campaigns to target Black African, Black Caribbean, Indian, Bangladeshi and Pakistani groups to reduce obesity and other comorbidities.

The vaccine pushback

A key area of concern is vaccination and its uptake in the BAME communities. The Office for National Statistics revealed on Tuesday that people aged 70 and over of black African heritage in England are 7.4 times more likely not to have received the first dose compared with their white British counterparts. The lowest uptake rate was among people identifying as black African (58.8 per cent), followed by those of black Caribbean (68.7 per cent), Bangladeshi (72.7 per cent) and Pakistani (74.0 per cent) heritage, prompting concerns that the lower uptake could jeopardise the integrity and effectiveness of the UK’s rollout of the vaccine. Health officials and community leaders have been grappling with waves of false information about its contents and the adverse impact it would allegedly have on those who take it. Sharma says he has often highlighted the many unfounded claims in social media posts, and encouraged people in his constituency to take the vaccine: “Such posts in social media need to be questioned; they are sent from fake IDs by people intent on mischief. I will be raising it in Parliament. This has caused huge problems, because our communities are closely knit, we interact more with others and respect more what elders say. But if the elders themselves float such rumours based on such posts that have been convincingly refuted by doctors and scientists, it becomes a major challenge.”

Religious leaders have also joined health officials in campaigns seeking to dispel rumours about the vaccine, but resistance continues in several areas, including in Leicester and areas with large concentration of people of Indian sub-continental origin. But dubious posts on social media alone are not responsible for the hesitancy.

According to an official assessment, barriers to vaccine uptake in BAME communities include perception of risk, low confidence in the vaccine, distrust, access barriers, inconvenience, socio-demographic context and lack of endorsement, lack of vaccine offer or lack of communication from trusted providers and community leaders. Asian celebrities such as Adil Ray, Sanjeev Bhaskar, Meera Syal and Romesh Ranganathan came together earlier this month in a video to urge others to take the vaccine, besides London mayor Sadiq Khan and former Conservative chairperson Sayeeda Warsi.

Caroline Noakes, chair of a parliamentary committee on women and equalities, says the problems in vaccine rollout in BAME communities were predictable due to historic and pre-existing health inequalities and access: “The reasons for disparities in vaccine uptake are complex. Some of the groups with lower uptake rates are also among those who are at greater risk from Covid, which is especially worrying. The government must improve its understanding of why this is happening — and then take action to support more equal uptake. This problem must be solved urgently, or there is a real risk that existing health inequalities will be further exacerbated,” she wrote in a letter to vaccine deployment minister Nadhim Zahawi this week.

(Prasun Sonwalkar is a London-based journalist.)