Opinion | Are race and ethnicity relevant to a person's covid vulnerability?
4 min read . Updated: 27 May 2020, 09:10 PM ISTData may suggest so but let’s rid our analysis of social biases before we arrive at such a conclusion
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Opinion | Are race and ethnicity relevant to a person's covid vulnerability?
Northwick Park Hospital in Harrow is about 15km from my home in London. In April, the hospital gained some notoriety because of the disproportionately large number of deaths due to the pandemic now known as covid-19. Harrow is a sylvan, leafy suburb, where the wealthy live in quiet homes with manicured lawns along winding roads. Jawaharlal Nehru studied at a famous school in Harrow, whose playing fields are adjacent to the hospital. Many London boroughs have extreme wealth and squalor, but Harrow is not the borough you’d name first if you were to list places of deprivation.
But covid is not necessarily seeking out the better-off. The rich have the means to leave disease epicentres. In New York, where I now live, fatalities are higher in poorer neighbourhoods. Many of those living in the wealthier parts have left for safe places, where they can isolate themselves.
Explaining the Harrow spike, officials said the area has more elderly people and more people with pre-existing conditions such as diabetes. Here’s what we also know: Of the 248,750 people who live in Harrow, 62% are described as “ethnic minorities", making Harrow among the London boroughs where the Caucasian population is in a minority. Indians form 26.4% of the population in Harrow. Initially, the British government had not released any data on the ethnic composition of covid deaths, which meant journalists and researchers began building hypotheses drawing on anecdotes and partial information.
But data has emerged since. The UK Intensive Care National Audit and Research Centre reports that about a third of patients receiving advanced respiratory support are non-White, even though the non-White population nationally is about 14%. Early analysis by the UK Office for National Statistics of NHS England data suggests that once you adjust for age, some socio-demographic characteristics, and measures of self-reported health and disability, people of African ethnicity were almost twice as likely as Whites to have a covid-related death. Meanwhile, in Chicago, where the African-American population is 30%, a report in April said that they accounted for 70% of covid deaths.
Other explanations are offered: Maybe it is economics, and not all Asians are well-off; those who run pharmacies and grocery stores (and many do) or drive buses (many do) are likely to encounter more people than those who can isolate themselves. Asians (a term in the UK for people from South Asia) tend to live in multi-generational homes, which means higher density and a greater likelihood of the vulnerable elderly getting infected by younger family members who may be more mobile and active, since the British lockdown was rather inchoate. Asians are also more susceptible to diabetes and heart disease, given their dietary choices and lifestyle—so ran another explanation.
But Ben Goldacre, a physician and writer who has campaigned for greater reliance on science and data, says we still don’t know enough. He is part of the OpenSafely Analytics platform, one of the largest studies of publicly-available National Health Service data. The platform looked at anonymized data of 17.4 million adults, including 5,683 hospital deaths over 85 days starting 1 February, and framed that hypotheses, saying that deprivation, co-morbidity or pre-existing conditions only offer a partial explanation of the deaths.
And yet, those of African and Asian lineage were at higher risk of dying from covid-19 than Whites, data showed, even after adjusting for risk factors. Much more research was needed to understand the disease pathway—if it is due to access to testing, treatment or to intensive care. Angela Saini is the author of two recent books that highlight systematic biases in the politics around science, how our ideas of patriarchy and perceived hierarchies influence how we think of women’s contribution to science, and how science is misused to turn spurious racist ideas into “objective facts". Writing this week in Lancet, she urges caution before we reach sweeping conclusions. She notes that 44% of the NHS medical staff on the front line of virus exposure is non-White. We separately know from the media that among the early deaths of doctors known publicly, almost all were non-White.
The unasked, uncomfortable question is whether there is any racism in healthcare, even if unintended. To know that, we need to ask if ethnic minority patients are given different care. Do they get tested less frequently or later, and are they late in getting aggressive treatment, such as through ventilators in intensive care units? We don’t know.
The idea that genetic factors explain susceptibility to covid assumes that patients receive similar care. Some genetic factors do affect some diseases, but to suggest that they wholly explain vulnerability is an unproven assertion. Saini has shown that ethnicity is an artificial, socio-demographic construct. For example, different treatment prescribed for those of African lineage and other patients of hypertension, she writes, does not make sense.
Our appearances are deceptive. What causes death may lie outside the body. By removing biases, we may be able to look at the world differently.
Salil Tripathi is a writer based in New York. Read Salil’s previous Mint columns at www.livemint.com/saliltripathi
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