CONFERENCE REPORT
Covid-19: Disparities and Lessons Learned
BAPIO midyear virtual conference 2020
JS Bamrah (Chair, BAPIO); CR Selvasekar (Chair,
NW BAPIO); Parveen Sharma (Hon Secr NW BAPIO); Kantappa Gajanan (Social
Secr, NW BAPIO); Samir Shah (Hon Treasurer, NW BAPIO); Executive members, NW
BAPIO: Kailash Chand OBE; Coumarassamy M.; Sanjay Arya; Roshelle Ramkisson;
and Rajiv Sethi
ABSTRACT
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 North-West 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 reiterated that Manchester was working closely with the Health Secretary
in sharing the lessons learned from Manchester, in the use of digital
technology and isolation measures, for the benefit of the rest of the UK. He
praised the Devolution health and social care model in Manchester
2 and its contribution during the pandemic
in managing the demand for personal protection equipment (PPE) and human
resources across Manchester. He reflected on his experience of the
‘
Manchester – India partnership”,
3 which was working to support healthcare initiatives in
India and recognised BAPIO for its contribution to healthcare in the UK.
Sir Simon Stevens, the Chief Executive of the UK National Health
Service (NHS), delivered a video message thanking all the frontline staff
for their efforts in fighting the Covid-19 pandemic. He acknowledged the
deep-seated inequalities and injustice in the UK healthcare system, which
the Covid-19 pandemic had exposed. He praised the efforts of BAPIO in
helping the healthcare professionals of Indian origin.
PUBLIC HEALTH INNEQUALITIES AND RISK
The session chaired by Parag Singhal and
Parveen Sharma, heard from Professor Kevin Fenton, who shared the public
health recommendations following his review on the impact of COVID-19 on the
British population.
4 He explained that the
risk of Covid-19 is strongly associated with age, male gender, deprivation,
South Asian origin (Bangladeshi have 1.5 to 1.9 times higher risk), poor
socio-economic status, presence of long term medical conditions and the type
of occupation. He appealed to key stakeholders for provide targeted advice
to their staff during risk assessments and the need to develop a culturally
competent system for all institutions. He also mentioned that the Equalities
minister Kemi Badenoch, has announced the remit of the newly constituted
Commission for race and ethnic disparities
5
will be investigating all aspects of inequalities in the UK society.
COVID-19 IN
INDIA
Professor Anupam Sibal gave an
overview of the Indian scenario during the pandemic, where approximately 75%
of the healthcare is delivered through private/ independent providers and
recognised the partnership with the public sectors. Currently, in India,
more than one million Covid-19 tests are performed, every day. He mentioned
the ongoing trials for two indigenous vaccines and participation in
international trials. He mentioned ongoing treatment trials with
Hydroxycholorquine and Remdesivir.
6 He recognised that the overall COVID-19 mortality rate was
indeed comparatively very low in India.
7 He
mentioned that India was the second-largest manufacturer of PPE.
8
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 session chaired by
Professor Dame
Parveen Kumar and
Roshelle Ramkisson, started with a keynote
video recording from
Soumiya Swaminathan, who presented an overview
from the World Health Organisation (WHO) in the pandemic, and her role as
the chief scientist for WHO. She reported that the world had witnessed the
spirit of global collaboration. She urged for the need for a global
behaviour change to limit the further spread of Covid-19. She asserted the
need for ensuring the safety of health workers, as they had been
disproportionately affected by the pandemic. She mentioned the WHO health
worker safety charter
(protect health workers, improve mental health,
health worker safety policy and patient safety policy).
14 She concluded by saying that the
governments around the world, need to make tough decisions to combat the
Covid-19, and to maintain essential health services.
Nivedita Gupta, senior scientist at Indian Council of Medical
Research (ICMR) shared her experiences on the diagnostic capacity for
Covid-19 across India. She said that India is trying to upskill and extend
the testing facilities to each district in India. Out of 735 districts, 572
districts have Covid-19 testing laboratories. She acknowledged some
geographical challenges especially in Ladakh, North East and Andaman
Islands. She acknowledged the challenges in private laboratories as
accreditation was only optional, and that the prices varied among the
private providers. She praised the partnership working arrangements with the
aviation sector to assist in transporting the kits and samples as the tests
increased from 10/day (in Jan 2020) to 1.15 million/ day (Aug 2020).
Aseem Malhotra, Cardiologist explained the serious impact of obesity,
hypertension, diabetes, coronary heart disease and chronic obstructive
pulmonary disease on patients with Covid-19 . He explained the effect of
unhealthy diet, vitamin-D deficiency, and physical inactivity in the
population, that is known to increase the risk of Covid-19 morbidity and
mortality. He emphasised the increased risk of the association between
metabolic syndrome and Covid-19 complications.
15 He concluded by asserting the need for healthy eating and
regular exercise in the fight against Covid-19.
RESEARCH
SYMPOSIUM
This was organised by Samir Shah,
Kantappa Gajanan and Rajiv Sethi. The panel of judges consisted
of Raj Murali, Roshelle Ramkisson, Kamal Sidhu, Geeta Menon and Ananta
Dave. National and international medical students, trainees,
Specialist and Associate Specialist (SAS) doctors, researcher students,
nurses, allied health professionals presented their research and innovation
work in the form of abstracts and virtual posters that were displayed at the
conference. There were 49 entries from UK, India, South Africa, Pakistan,
Sudan and many other nations making this a truly international event. The
top nine abstracts were chosen for oral virtual presentation on the day of
the conference. At this conference, there was a new category on narratives
and life experiences demonstrating Covid-19 resilience. 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.
Mahendra Patel, University of Bradford, outlined the current research
on COVID-19 vaccines in progress across the globe with 142 pre-clinical
vaccines, 29 vaccines in phase 1, 18 vaccines in phase 2 and 9 vaccines in
phase 3. However no vaccines had been approved till date. He appealed to
fight against the myths about vaccines and insisted on following the PHE
guidelines on protection were the only measures to reduce spread, until an
effective vaccine was available.
Prashant Patel described the seroprevalence of COVID-19 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. Sero-prevalence 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.
The
POST-COVID WORLD
This session chaired by Joydeep
Grover and Raj Kumar discussed with Professor Christopher
Harrison NHS England’s National Clinical Director for Cancer and
Medical Director (Strategy) for The Christie NHS Foundation Trust in
Manchester, the challenges related to normalising clinical services focusing
on cancer, which had been significantly affected and a growing number of
patients were waiting for diagnosis and treatment. He also explained about
the cancer hubs in the Greater Manchester area were engaging directly with
patients to avoid any delay in surgery. In addition, he urged on
consolidating the learning from Covid-19 and following a comprehensive
strategic response.
In a focus on mental health services,
Neil Thwaite, Chief Executive of Greater Manchester Mental
Health, explained the diversity of services in Greater Manchester. He
reflected on various changes that has been made during pandemic period
including staff wellbeing, remote working and innovative approaches in
various services including substance misuse and prison services. He
explained the priorities for the trust in returning to normal and dealing
with the back log of interventions, in addition to preparing for the second
wave.
Helena McKeown, Chairperson of BMA, discussed the challenges and
opportunities for primary care. She asked the stakeholders to embrace the
positive changes that happened recently as a response to Covid-19,
especially innovations in digital health, and highlighted the need to
address inequalities in digital consultations. She appealed for more funding
to the health care system and insisted on tackling the inequalities, as well
as gaps in the workforce.
Research Prizes
First Prize
Lin A, Tokell M, Dave M, Abraham S, Ramkisson R,
Mahalingappa S, Pillai S, Matheiken S, Iliani Y, McNally
R, and Bamrah JS.
Second Prize
Akbar S, McNally S. Recording & Evaluating Affect
and Coping during COVID19 in Healthcare-workers
& outcomes (REACCH-OUT)
Third Prize
Pervez A., Selvasekar C.R. Retrospective analysis of
robotic resections for locally advanced rectal
cancer with subset analysis of robotic posterior
pelvic exenteration – a single centre experience of
9 years
Gire N, Mohmed N, Caton N, McKeown M, Duxbury
J, Naeem F, Chaudhry IB, and Husain N. The Views and Perspectives of Mental
Health Professionals in The Development of A Mobile-assessment and Therapy
App For Psychosis (Techcare)
Cultural programme
Delegates were entertained Kailash
Chand, himself a connoisseur of shayari and ghazals, and the special
guest of the evening, Radhika Chopra, famed Indian ghazal singer from
New Delhi. This was a fitting finale.
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