2nd Edition April 24th, 2020 Sweta Rajan-Rankin

Is Covid-19 an “equal opportunity disease”?

Why BAME communities are among the hardest hit 

The Covid-19 pandemic has brought an interconnectedness amongst peoples across the globe. When else would China, Iran and South Korea be of such intense interest to understanding how to slow the spread of the virus in the UK? When music playing from balconies in Italy, chime with the sound of #ClapforCarers across the UK, and thalis banging in unison across India. The collective threat posed by the virus have created a shared sense of vulnerability. It would not be surprising if the very commonalities around the frailty of the human condition mean that “we are all in it together”. After all, this is a disease that has claimed as victims, both the wealthy and the poor. If Prince Charles and Boris Johnson can both contract Covid-19, then surely this is an equal opportunity disease? 

There are dangers to falling into the trap of thinking that Covid-19 affects everyone in the same way. As of the 21stApril 2020, there have been 124,743 confirmed cases and 16,509 deaths reported in the UK (Public Health England, 2020). A recent study by Intensive Care National Audit and Research Centre (INARC) based on a sample of 285 critical care units in England, Wales and Northern Ireland indicates a disproportionate effect of coronavirus on patients from ethnic minority backgrounds. Analysis published in the BMJ suggests that of the 3,883 patients who tested positive for Covid-19, 486 (14%) were Asian and 402 (12%) were Black: nearly double the 14% ethnic minority population in the UK. Even more worrying, the first 10 Covid-related fatality amongst doctors have all been from Black, Asian and Middle-Eastern backgrounds. This has sparked anger in the health and social care community, with the British Medical Association (BMA) asking for an urgent investigation of Covid-related deaths among BAME health workers. As Dr Chaand Nagpaul notes, “We have heard the virus does not discriminate between individuals but there’s no doubt there appears to be a manifest disproportionate severity of infection in BAME people and doctors”. Yasmin Gunaratnam draws attention to this in her article “when doctor’s die”, highlighting the vulnerabilities both minority doctors and patients face in the wave of increasing xenophobia and racist attacks on the front-line. The appalling lack of personal protective equipment (PPE) for nurses, doctors, social care workers and social workers; and callous remarks from the Secretary of Health and Social Care Matt Hancock, asking frontline staff not to overuse PPE equipment, signals a consistent trend of lack of care for front-line workers. 

In order to fully understand how and why minority communities are disproportionately affected by Covid-19, we need to analyse the historical legacies of austerity and the stripping of NHS funds on the one hand, and the deepening of social inequalities among BAME groups on the other. These are not separate, but interconnected issues. The volte face evident in the Conservative government sending impassioned pleas to “Save the NHS”, needs to be read alongside the same government’s attempts to dismantle the welfare state and underfund the health and social care sector. It is no wonder that Matt Hancock’s remarks have been met by anger and outrage by front-line staff: he is asking them to treat personal protective equipment as a “precious resource” while completely overlooking the most precious resource we have, our frontline staff themselves.

Similar contradictions are evident in immigration policy. In February 2020, Home Secretary Priti Patel’s released a statement denying visas to “low skilled workers” based on a points-based system. Foreign workers account for one-sixth of the 840,000 social care workers in the UK, and many who are low-paid (not low-skilled) would not qualify for visa status. A bare two months later, the same category of “low skilled workers” are being celebrated as “key workers” within the heroic rhetoric of “saving the NHS”. The vital work they do, and have always done has been to protect the most vulnerable. What has not changed is their pay, their material circumstances, their career prospects (the most recent government mandate has been that it is not the right time to consider increasing nurses pay) or the backgrounds they come from which can heighten the level of risk experienced by ethnic minority groups.

Research has shown that ethnic minority social care workers, health workers and nurses are more likely to face abuse during their work, tend to be low-paid and come from socio-economically disadvantaged backgrounds. Environmental factors such as living in crowded housing spaces, with multi-generational families, as well as having pre-existing health conditions such as diabetes and hypertension can also increase the  risk of contracting and dying from the coronavirus. Rather than locate these risk factors as individual pre-dispositions to the disease, it is important to recognise, how institutionally structured racism and racial discrimination impacts on health, education and employment outcomes in these communities. As Bècares and Nazroo (2020) note, racism is a root cause of ethnic equalities in Covid-19. The hyper-vigilance of Chinese bodies and increased xenophobia during the pandemic is also testament to this.

In a recent piece, Arundhati Roy described the “pandemic as a portal” in which the effects of coronavirus thus far experienced by the wealthiest nations has brought capitalism to a juddering halt. However, it is also a fallacy to assume this inversion of power has created a bizarre form of equality. BBC journalist Emily Maitlis nailed this point in her observations that the disease was not a great leveller, it just enhances vulnerabilities based on existing social inequalities. 

Social work as a profession has always been alive to the structural nature of social inequalities and how this plays out in struggle in the lives of individuals, families and communities. We must be cautious about being swept away by rhetoric, and hold fast to anti-discriminatory ways of working, for it is in this value-based terrain, that lasting change can happen. There are a number of ways in which we can promote an anti-racist social work during Covid-19.  We need to remember that behind the multi-ethnic solidarity of the social work workforce, there remains a gulf between the anti-racist practice we aspire to, and wider contexts and policies that can be profoundly racially discriminatory. As Mosacha et al (2019) note, anti-racist practice requires us to interrogate racist policies and policy-making. We can do this by demanding accountability from the government in reporting the scale and scope of ethnic minority fatalities and investigating circumstances where disproportionate impacts are felt. We need to be vigilant about individualising discourses around risk among ethnic minority groups, remembering that health inequalities are influenced through social and economic inequalities. We need to recognise that our BAME social work students, practitioners and services users and carers, face stigma and discrimination in everyday life; and this can become heightened under the current crises. Recognising the profoundly unequal ways in which social risk is experienced by ethnic minority groups, and how race and racism shape the wider contexts of social work practice, are key steps in understanding how and why BAME communities are worst hit during the Covid-19 crises.

Dr Sweta Rajan-Rankin, Senior Lecturer in Social Work at the University of Kent. Her interests are in anti-racist social work interventions, race and racialisation, migration and belonging.