Covid-19: Disparities and Lessons Learned

The first virtual mid-year conference organised by the British Association of Physicians of Indian Origin (BAPIO) was held on the 19 September 2020 hosted by the BAPIO NorthWest regional chapter. The conference digital platform used was Gurukul Education (https://gurukuleducation.online/). There were 736 registrations and 178 attended through the virtual conference hall and 803 attended the live streaming viewing facility. The conference was focused on aspects of Covid-19, from the current status in the UK and India, public health aspects of the pandemic, vulnerability of Black, Asian and Minority Ethnic (BAME) population, initiatives taken to reduce the impact on general practice or mental health services and routine non-Covid care. Strategies on reduction of risk in the workplace, formal risk assessments, promotion of a healthy lifestyle and wider societal education initiatives were incorporated. The need for ongoing research in differential adverse outcomes in BAME population was evident, as well as in prevention measures such as vaccination.


INTRODUCTION
There was a preconference Hatha Yoga workshop by Hemalatha Dadi who took the participants through an awareness session including the basics of yoga, as practiced by the Isha Foundation 1 , setting a relaxing atmosphere for the rest of the conference. The conference participants were welcomed by the Chair of the British Association of Physicians of Indian Origin (BAPIO) JS Bamrah followed by a traditional Indian lighting of lamp by Ramesh Mehta, President of BAPIO. In his introduction, Ramesh Mehta described the challenges faced by Black, Asian and minority ethnic (BAME) healthcare workers during the Covid-19 pandemic and praised the efforts of BAPIO Institute for Health Research (BIHR) for their engagement with the frontline BAME healthcare workers. He recognised the work of BAPIO in engaging with various stakeholders in ensuring the safety of the frontline healthcare workforce and the new efforts to address the differential attainment (DA) in medical professions. He announced the formation of British Indian Nurses Association (BINA) and its official launch on 20 Nov 2020, during the BAPIO Annual Conference 2020.

INDO-UK RESPONSE TO COVID-19
Keynote Speeches Andy Burnham, the elected Mayor of Greater Manchester, in his keynote speech, acknowledged the impact of Covid-19 on the BAME population and paid respect to frontline warriors, who had lost their lives during the pandemic. He  Professor Sir Michael Marmot opened his session by acknowledging that Covid-19 has shone the limelight on, and amplified the inequality on BAME populations, who had a higher risk as well as mortality. He included factors such as age, gender, type of occupation (frontline), poor housing affected BAME population more, compared to their white counterparts. He urged the nation to address ingrained structural and systemic racism, and to implement his recommendations in "building back a better society with sustainable equality in health". 9,10 One minute's silence. Ramesh Mehta asked delegates to remember all those who had lost their lives fighting the pandemic and helping make the NHS sustainable.

HEALTH CARE WORKFORCE AND COVID-19
In the session chaired by Neena Modi and Jagtar Singh, Habib Naqvi explained the role of new Race and Health Observatory in the NHS. 11 He acknowledged that systemic issues of inequality existed in the society, and that efforts to address these issues were often very fragmented. The Race and Health Observatory's role was to commission high quality, innovative research on disparities and formulate strategic policy recommendations, in addition to facilitating the implementation of solutions.
The NHS Chief People's Officer Prerana Issar, thanked the entire healthcare workforce for the fight against Covid-19. She shared her personal experience of facing discrimination and affirmed that she took over the role to address the inequality in the NHS. She described the components of the NHS People Plan 12 and acknowledged its importance in the current situation. She insisted on the importance of promoting health and wellbeing of NHS staff, and the need for a meaningful risk assessments for all front line workers. She pleaded to all health care leaders for an effective Freedom to Speak Up system 13 and requested everyone to reflect on the challenges faced, and to focus on a new commitment to look after our staff and patients.
Chaand Nagpaul, Chair of the British Medical Association (BMA), discussed the challenges experienced by the medical profession including the increased rates of stress, depression and suicide, compared to the general population. He acknowledge that BAME doctors experienced more bulling and harassment and were reportedly asked to see the patients without adequate PPE. Furthermore, he said that many BAME professionals were not confident to raise the concerns, as they felt that they would not be listened to. BMA has been campaigning for PPE, highlighted the disparities for BAME and international doctors, and the need for Covid-19 testing for all doctors. In addition, he said that the BMA has been successful in securing death in service benefits. He acknowledged the future challenges with the expected second wave, winter pressure and back log of work from the first wave. He requested the system to implement the lessons learned from the first wave, prioritise and invest in a sustainable medical workforce and pleaded to improve the working culture with a supportive Covid-19 secure environment.

A SYSTEMS APPROACH TO COVID-19
The Awards and certificates were presented to the top three oral presentations, with third award shared between two presenters.

ETHNICITY AND COVID-19
The session chaired by Professor Ged Byrne and Abrar Hossein, heard from Sanjay Arya, Cardiologist discussing the relationship between BAME ethnicity and disproportionately increased critical care admissions and mortality rates, due to Covid-19 infection (with data from the North-west region). Furthermore, the high incidence of Covid-19 in BAME population was due to presence of other chronic conditions such as cardiovascular diseases, diabetes, hypertension and chronic obstructive pulmonary disease, etc. He said that Covid-19 was a wake-up call for BAME communities and recommended that necessary actions are taken before the second wave.
Manish Pareek from University of Leicester, discussed the UK-REACH study on BAME mortality, which aims to encapsulate various aspects of risk into BAME health care workers, linking data to heath care outcomes to understand the risk of infection, critical care admissions and death by ethnic group, employment etc. He said that the questionnaire covers range of topics including behaviours, work circumstances and discrimination. He appealed to various stakeholders for their support to encourage their BAME healthcare workers to participate in the study.

Professor Anuj Kapilashrami, Senior Lecturer in Global
Health Policy, University of Edinburgh, explained the differential risks in relation to race and ethnicity as important markers of infections and health. She mentioned that the disparities are mainly due to genetic reasons, metabolic issues, cultural language barriers, socio economic disadvantage, work and living conditions. Furthermore, she emphasised on the vulnerability of healthcare workers and over representation of BAME in fatalities and infection risks. She also shared her unhappiness in relation to the failure of the public health authorities to tackle the pandemic at the earliest.

THE PANDEMIC: TREATMENT AND PREVENTION
Session chaired by Kailash Chand and Binita Kane, heard from John Ashton an independent public heath consultant from Liverpool, on protective measures, social distancing against Covid-19. Prof Ashton opened the session registering his unhappiness on the UK government's efforts to tackle Covid-19 pandemic. He said that the Public Health England (PHE) had failed in registration, notification and effectively protecting the public. He insisted that PHE should provide the needed assurance to the public and rebuild the trust with the communities. He compared the social practices in UK with other countries and explained about the risks in some of our cultural practices. He appealed for coalition across the country instead of blaming and manipulating the data. in healthcare workers and its implications. He said that there was an overall 10.8% sero-prevalence, with both genders being equally affected. The study revealed that nurses were more affected and there was a 25% seroprevalence in Afro-Caribbean staff. Seroprevalence increased with deprivation within BAME groups. Among the medical group, the sero-prevalence was high at 21% among foundation doctors, compared to consultants (7%) with healthcare workers in medical specialities more likely to be affected. This was a fitting finale.