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Focused action is required to protect ethnic minority populations from COVID-19 post-lockdown.
journal contributionposted on 02.02.2021, 09:39 by Kamlesh Khunti, Ash Routen, Kiran Patel, Sarah N Ali, Paramjit Gill, Amitava Banerjee, Amal Lad, Vinod Patel, Wasim Hanif
Since the association between COVID-19 and ethnicity was first noted in April (1), numerous large-scale national datasets have been analysed (2-6). The evidence is clear - ethnicity is a key risk factor for adverse COVID-19 outcome, alongside age, male sex, obesity, deprivation and comorbidities (7). There are significant ethnic inequalities in the risk of hospitalisation and risk of death from COVID-19. Black and South Asian ethnic groups are at greatest risk, although most ethnic minorities have been shown to have increased risk when compared to White populations (7). Beyond hospitalisation and mortality risk, there is also concern over longer term impacts i.e. Post-acute COVID-19 (8), which could significantly impact ethnic minority populations. As a result Public Health England (PHE) released two evidence reviews and recommendations to address the disparities in COVID-19 outcomes in ethnic minority populations (9, 10). PHE made only seven recommendations and these were lacking in detail, featuring issues that were already well articulated in minority health literature. The recommendations gave limited attention to the wider determinants of health that underpin ethnic disparities in COVID-19 outcomes, and gave no indication of time frames for delivery or methods of implementation (10). In addition, the recommendations did not address how ethnic minority populations could best protect themselves during the pandemic. This was a significant oversight since personal and community responsibilities are imperative social determinants to protecting the health and well being of ethnic minority communities when national (and regional) lockdown(s) is eased.
Subsequent to the PHE report there was an inevitable resurgence in COVID-19 cases over the summer months in areas with a high density of ethnic minorities such as Leicester (11), Blackburn and Oldham. From mid-September local COVID-19 restrictions were introduced across parts of the North West, North East, Midlands and West Yorkshire. As cases rose nationally a growing list of localities were placed in a three tiered restriction system, before a second nationwide lockdown was implemented from November 5th. In late October the UK Government published a summary of work completed since the initial PHE reports, and a further 13 recommendations for addressing COVID-19 health inequalities (12). Like the initial PHE report there was limited attention on wider structural determinants of inequality in COVID-19 outcomes, and the recommendations are largely related to data monitoring, evidence reviews and broad policy consideration. However, importantly the government has made headway in enhancing community communication strategies (for the most at risk) with the introduction of the new Community Champions scheme.