Being “BAME” doesn’t automatically increase your risk of infection and death from C19

[User26272829]

I have a personal interest in this because I’m a black woman. I keep reading that BAME(can’t stand this terminology which basically shoves very different groups into one mass) communities are at higher risk of infection and death from Coronavirus. When you look closer into the available data, there is nothing conclusive to show a link to ethnicity. It’s based on environmental factors such as housing, underlying conditions, deprivation, types of jobs and exposure to the virus/viral load.
I work from home, never use public transport, l’m under 50, fairly fit, don’t have any underlying conditions, don’t live in a deprived area and don’t live in multi generational housing. So how would I be higher risk than a white woman with the same characteristics? So AIBU to think that classing BAME people as higher risk is inaccurate and deeply flawed?

A recent programme on radio 4 discussed the fact that black women are 4 times more likely to die in childbirth than white women in the UK. Black babies are also more likely to die.
Suggested reasons included structural racism in the sense that black people are more likely to suffer certain conditions for which UK medical staff aren't properly trained to deal with, black people may not show as obvious signs of illness due to e.g. jaundice or pale or bluish tinges not being as obvious on their skin and again UK medics aren't adequately trained to know about this.
Another issue was to do with black people not being listened to or taken seriously when asking for medical assistance. (Obviously poor care in labour and postnatally is a common complaint from.white women too, but apparently black women were a lot less likely to get pain relief than white women. This was thought to be due to stereotypes about them being tougher than white women)
I expect a lot of the covid risk is related to the same factors.
Another aspect could be some BAME people having mistrust of health services or finding it harder to access them.
I doubt it's to do with any inherent difference in susceptibility.

I would say that you as an individual are not more at risk OP, but as a group BAME people are more at risk. Individuals are not important in statistics. The government is not interested in individuals and the NHS is not interested in individuality - I found that out all through my pregnancy.
I would recommend taking vitamin d though, I've just got some myself.

@Linning

YANBU that it has more to with socio-economic status and living condition than race (aka you won’t die of Covid because you are black) nut YABU to seem to imply that socio-economic status and living status don’t have a lot to do with race. Not sure about stats in the UK but I am in the US, here there isn’t an ounce of doubt that people of color die at a higher rate than their counterparts because they tend to live in poorer conditions than their white/Caucasian counterparts. It’s not being black that kills them but it’s definitely being black in America and what that implies and what that usually mean that have put them in a situation where they are statistically more at risk of dying of COVID. So yes, BAME are more at risk of dying of COVID-19 NOT because of race but because of the link between race and sociology-economic status and therefore health.

Structural racism.

OP what I've learnt engaging with the health service is that until they realise you are well educated and doing a skilled job some staff, particularly if they are white, will treat you poorly.

My own family and close friends who are doctors and nurses have their own experience of poor treatment by white healthcare professionals when they were junior/less experienced. Now they will simply pull rank if they are treated like crap.

In regards to Covid they are simply grouping people of non-western European ethnicities together regardless of job, place of birth, etc. They actually seen to presume that all non-white people are recent immigrants or are poorly educated so you work in people facing jobs. If you don't fall into those groups then for some other reason you work in a people facing job. Grouping people together of completely different ethnicities and socioeconomic statuses like this is simply racism.

@Loopyloututu

I agree, I’ve always thought the correlation is more to do with societal conditions (ie living in closer quarters, multi-generational living) than the actual colour of your skin/ethnicity. It’d annoy me being all lumped in together like that too. YANBU.

Yes it's this All lumped in together why?

I believe it is also linked to vitamin D deficiency? Have a look at Dr John Campbell on YouTube, a few of his videos cover this. Essentially, D deficiency causes immune dysfunction, and D deficiency is a real risk factor for severe covid. And the darker your skin tone, the less vitamin D your body can make from exposure to sunlight.

In Northern hemisphere areas with much less sunlight than warmer climes, people with darker skin tones tend to get vitamin D deficient, particularly in the winter.

Hence, if we know that BAME people in the U.K. have higher rates of vitamin D deficiency than Caucasian people, it follows that their risk is higher - I agree with you though that there is a weirdly disproportionate focus on ‘lifestyle factors’, though those do of course also affect risk.

I really don’t understand why the media haven’t been shouting about the Vitamin D evidence from the rooftops, it’s such a simple and easy protective measure.

@User26272829 As a scientist, I agree with you. It's not an increased risk based on ethnicity itself.

A personal perspective. My whole family had COVID last year (Spring). DP is black. I am white children are mixed race. DP was much much sicker than the rest of us. I was probably the least sick (although have long lasting arthritis I think is connected).

He does not tick any of the other risk factors e.g. he is slim, not exposed through work, no underlying conditions not old etc...

I wonder about Vit D as I routinely take it following severe deficiency a few years back. I think DP likely low in Vit D but I don't know.

No idea if that is of any use or interest to you.

@MindTheRiskPlease

But that's the problem isn't it? People just state 'BAME people are more at risk'. Full stop. And either willfully or unknowingly omitting the full sentence, which is really 'BAME people in such and such conditions are more at risk' or even better, 'People in such and such conditions are more at risk'.

The first statement is unhelpful and causes unnecessary panic among BAME people, not to mention being suddenly seen as one who likely has Covid by non-BAME people just for being BAME. And as you know, some people will quickly start treating others as leprous given half a chance. This is one of those.

If the second or third statement was what was floating around, things would be clearer and people might even start asking questions such as 'why are BAME people in the US or UK in these conditions?' But I'm sure the government wouldn't want that to take over the general panic of all BAME people taking the jab just so they can get on with things and not have to sift between which ones are actually in more-at-risk conditions and which ones aren't. They may need to have a deeper, uncomfortable discussion if incomplete yet blanket statements weren't made.

This.

I really don’t understand why the media haven’t been shouting about the Vitamin D evidence from the rooftops, it’s such a simple and easy protective measure.
Scared to be accused of racism (despite the fact that care home residents have also been found to have a Vitamin D deficiency).

I really don’t understand why the media haven’t been shouting about the Vitamin D evidence from the rooftops, it’s such a simple and easy protective measure.
Scared to be accused of racism (despite the fact that care home residents have also been found to have a Vitamin D deficiency).

A high proportion of white people are also vitamin d deficient - including those who are young, healthy and outdoors a lot. Too much suncream.

However I don't think there is any evidence that vitamin D supplementation is protective against covid. If there was it would be up to the government to promote that. The media just print interesting stories, it's not up to them to create public health messages

So does BAME include white ethnic minorities such as Chinese, gypsies, Jews, white Asians such as Iraqis, Syrians etc?

I don't think it's a useful grouping for health purposes. It might have uses for politics I guess.

"African American" I do find very annoying. Most black people in the US have no connection with Africa, and to imply that they have just because of their skin seems explicitly racist. You don't really hear about white Americans being referred to as European Americans. White people are just considered to be American.

If everyone in the UK got their vitamin D levels into the optimum range (say 50-70). Then we'd have a level playing field between ethnicities to monitor other factors.

But we don't know anyone's level and the UK isn't tracking it for admissions and Covid deaths.

The differential I suspect if we were all vitamin D sufficient, would primarily be age, obesity, diabetes and metabolic disorder.

There have been plenty of examples of people from advantaged backgrounds becoming seriously ill with Covid. Boris Johnson for example.
Dense housing and job type (frontline workers and food processing plants) no doubt increase transmission creating spikes for those demographics.

Regarding the poster who mentioned black women at increased risk of death during childbirth. You didn't mention that black people in the UK are 3 times more likely to develop diabetes than European white people (from diabetes.org website). That should be evaluated as a risk factor in childbirth in my opinion.

@MedSchoolRat
If poor housing-education-deprivation-air quality-job types-multi-gen families are the actual explanation for apparent covid&BAMEness relationship, why aren't they just as important to covid as they are to flu and other respiratory viruses.

They are. Suggest you look into mortality rates due to other infectious diseases by ethnicity both before and after adjustment for these confounding factors.

But then white people have had a lot longer in cities with the diseases that entails so maybe there's something to it.

@Sapho47

What kind of white supremacist history have you been reading? White people were the last of all the races in the world to start living in cities.

@DianaT1969

Regarding the poster who mentioned black women at increased risk of death during childbirth. You didn't mention that black people in the UK are 3 times more likely to develop diabetes than European white people (from diabetes.org website). That should be evaluated as a risk factor in childbirth in my opinion.

Consideration of ethnicity and gestational diabetes has been very well documented. It is considered but other issues appear to be causative of outcome inequality. There’s probably numerous factors involved, some are known others are less recognised.

www.ncbi.nlm.nih.gov/pmc/articles/PMC4180530/

You don't really hear about white Americans being referred to as European Americans. White people are just considered to be American.

No, but you do often hear them call themselves “Irish American” “Italian American” “Polish American” “Pennsylvania Dutch” “Greek American”
You know, because white people are not one monolith either.

@SnackSizeRaisin
So does BAME include white ethnic minorities such as Chinese,

Did you really mean this? I’m of Chinese ethnicity and never been called “a white minority” before....

As already mentioned, Vitamin D could be a factor and I’ve been taking it well before Covid arrived.

DeeCeeCherry "I've not seen a single shred of proof. No concrete evidence. & this society/government has form for scapegoating and gaslighting Black people."

Interesting take on it. You thought the government were blaming 'bame' for getting sick?

Can you tell us how you come to that conclusion? Did you read it on Facebook?

DeeCeeCherry "I've not seen a single shred of proof. No concrete evidence. & this society/government has form for scapegoating and gaslighting Black people."

Interesting take on it. You thought the government were blaming 'bame' for getting sick?

Can you tell us how you come to that conclusion? Did you read it on Facebook?

PPs were querying why relatively affluent BAME NHS staff are also disproportionately affected by Covid. Dr Chaand Nagpaul, the chair of the council of the BMA was interviewed and said that in several surveys the BMA conducted last year, 3 times as many doctors from a “BAME” background compared to those from a white background, said they felt under pressure to see patients without adequate protection. Structural race inequality within the NHS, bullying and a lack of equality of progression within the profession were given as some of the reasons people were afraid to speak out.

Last year’s Public Health England report stated that structural factors that resulted in race inequalities played a part. However the government denies it.
These inequalities are exacerbating the experience of Covid for people from a BAME background.
As they say, we’re all in the same storm but not all in the same boat.

The levels at which Vitamin D3 is deemed sufficient assume that the patient is white.

They’re also based on the prevention of rickets in growing children, not in optimum health in adults.

I have an endocrine disorder and have very regular blood tests. Some years ago I was assigned a new consultant who is Pakistani (note not British Pakistani). He told me to maintain Vit D3 of 70 nmol/L, and when I gasped (no doctor had suggested such a thing in the previous decade) told me that was the minimum he would accept as “healthy” in Pakistan; if I were dark-skinned it would need to be 100 nmol/L.

Within a year, many of my symptoms had stabilised and I was able to reduce much of my medication. Vitamin D3 is magical stuff but UK-trained doctors seem to know precious little about it.

@User26272829

I have a personal interest in this because I’m a black woman. I keep reading that BAME(can’t stand this terminology which basically shoves very different groups into one mass) communities are at higher risk of infection and death from Coronavirus. When you look closer into the available data, there is nothing conclusive to show a link to ethnicity. It’s based on environmental factors such as housing, underlying conditions, deprivation, types of jobs and exposure to the virus/viral load. I work from home, never use public transport, l’m under 50, fairly fit, don’t have any underlying conditions, don’t live in a deprived area and don’t live in multi generational housing. So how would I be higher risk than a white woman with the same characteristics? So AIBU to think that classing BAME people as higher risk is inaccurate and deeply flawed?

In addition to lifestyle BAME people are more likely to have genetic conditions that cause huge problems when there is an increase in inflammation. These conditions are tested for and treated in places like India and Nigeria but because they’re often limited to BAME people they haven’t been in the UK.

For example I have a rare clotting disorder that causes my blood to clot dangerously when blood inflamation levels are high. It’s rare here but common in parts of India and over there once you get to a certain age you are often automatically prescribed blood thinners to counter the risk.

Same with pcos - only treated reactively on the NHS if you have symptoms. But in parts of India and Nigeria it’s so common girls are proactively examined and treated when they start their periods. So that girl might not develop diabetes during pregnancy in the same way a BAME girl in the UK might. Same with autoimmune thyroiditis and graves disease - another disease really common amongst BAME women but not tested until it causes serious symptoms. Untreated thyroid problems weaken hearts and cause thyroid problems but if you’re BAME and pregnant you’re more likely to get preclampsia anyway - add the flu or covid to the mix things really get dangerous. I know several black and Indian women who developed preclampsia as a result of catching covid. Luckily doctors knew it was a risk and they were ok.