By Neeraj Bhala, Gwnetta Curry, et al., The Lancet, May 8, 2020
Tackling injustices, including those that result from prejudice and racism globally, is essential in the response to the coronavirus disease 2019 (COVID-19) pandemic. Here, we focus on UK South Asian and Black and African-American populations, using internationally recognised terminology and definitions, and consider the UK and the USA as globally relevant examples. We recognise other minorities also need consideration in the COVID-19 response, and we hope our principles apply broadly. Given their settled status either after migration or by birth in the country, ethnic/racial minority populations should experience health-care outcomes equal to those of others. Sadly, this seems untrue.
Data on COVID-19 cases and deaths are plentiful, but detailed data on COVID-19 by age, sex, or ethnicity/race are scant but should be available routinely and automatically. In the UK, collection of data by ethnicity in hospitals is mandatory and in the USA the National Institutes of Health Revitalization Act requires the publication of data by race/ethnicity and sex by federal agencies. The UK's Intensive Care National Audit and Research Centre reported on May 1, 2020, that 2300 (34%) of 6770 critically ill COVID-19 patients were from ethnic/racial minority groups. For comparison, the 2011 census shows that ethnic minority groups made up about 14% of the UK population. Additionally, National Health Service (NHS) health-care staff from ethnic minority groups seem to have died in disproportionate numbers from COVID-19, even when accounting for the high proportion of people from these groups who are employed in the NHS and work on the front line. These matters are being investigated in a UK Government-initiated inquiry by Public Health England and have been highlighted by health-care workers, advocates, the UK's Chief Medical Officer, and politicians. Detailed scrutiny with accurate counts of numerators and denominators together with understanding explanatory factors and accompanying health-care environments will be required to interpret the findings of the inquiry.