All the doctors dying are Asian - what’s going on?

[MMXVi]

And why is nobody asking questions about this?

I’m over-invested in the answer because my sister is a doctor very much on the frontline, and we’re of Indian ethnicity. I want her to be protected and if she’s facing some sort of additional genetic, behavioural or dietary risk I want that flagged up to her and other doctors PDQ, not to mention their patients of the same ethnicity.

If I see another glib and possibly slightly racist response about BAME people being poorer and therefore more prone to underlying conditions I’ll flip my lid totally by the way. There’s a world of difference between an Asian hospital consultant on £150k in stockbrokerville and someone Asian on the breadline in an overcrowded council flat, and it isn’t helpful to lump them together in this instance.

So far, I’ve seen a thread about Vitamin D3 deficiency making darker-skinned people more susceptible to respiratory illness. That makes sense to me, and I’ve already ordered some from Amazon for my sister as well as the rest of our family.

My mother (not medically qualified) has a touching belief in the anti-inflammatory and anti-carcinogenic powers of turmeric so I’m making daal as we speak.

My dad (retired very senior doctor and the veteran of more than one pandemic) says probably multi-factorial, but as he’s currently recovering from cancer and therefore very high risk, I’m not going to make him elaborate.

Any other ideas and theories?

Anyone else concerned about why the press have neglected to mention this glaringly obvious information?

I think there's been some studies into Ace2 gene expression and how that varies due to ethnicity. It's possible that could be a factor.

I realise I have made an error in using the term ‘Asian’ as an umbrella word to describe a very disparate group of people.

Hindus have a completely different diet to Muslims, and different social habits. We don’t have consanguineous marriage, at least not in the north of India.

Ugandan Asians are a very different beast to Indians from Britain. This is where socio-economics plays a big explanatory role.

Exactly. And it's quite frustrating to not have the figures broken down within ethnic groups in the UK but just lumped together as BAME, because it doesn't us give any clues about whether it's a specific group most at risk, or just all dark skinned people., be they Nigerian, Somali, Sri Lankan or Arab. But BAME also includes Jews and Irish Travellers who will almost certainly present as white. Are they disproportionately represented in the numbers of people seriously ill or dead? It's important to understand whether the aggravating factors are social, cultural/religious, environmental, dietary or just purely genetic bad luck.

If it is all dark skinned people affected roughly equally across the board, then the most obvious (and only obvious) link would appear to be a lack of efficiency at absorbing Vitamin D, as there is precious little else that might affect most non-white people equally, irrespective of their specific race/heritage/culture as far as I can tell.

It would appear that globally, not just in the UK, BAME people are still more likely to die of Covid than their white neighbours. There will be many convoluted reasons for this, but if you look at the USA for example, the worst hit group by far is African American. They are pretty likely to be obese and therefore also type 2 diabetic with hypertension (along with white Americans it must be said) but they will also I am guessing, have the Vitamin D issue as well. They are certainly be more likely to be poor and therefore have substandard access to medical treatment/insurance.

Someone upthread said that Asians in the USA are under-represented in the death figures, but which Asians? There are not very many Asians of Indian subcontinent descent in the USA as far as I am aware. Canada, yes but not USA. The Asian heritage people in the US tend to be south east Asian - Chinese, Korean, Vietnamese and I suppose Arab and Middle Eastern if we are lumping them in loosely as 'Asian.'

I would say it was a reflection of the ethnicity of the majority of doctors in this country.

It doesn't. The NHS publishes those stats and it's nowhere near representative.

www.ethnicity-facts-figures.service.gov.uk/workforce-and-business/workforce-diversity/nhs-workforce/latest#by-ethnicity-and-type-of-role

I work for an NHS department where 90% of the consultants and speciality doctors are BAME. If this sort of percentage is reflected in other departments including ICU it would help to explain why a higher percentage of BAME doctors are being infected.

Thanks Hear My oxygen levels are similar, so I'll need to investigate further.

@justdontatme (ironic ). I had just done a quick google of ethnicity of doctors in the UK, because of my recent hospital experience where all of the doctors and consultants I saw were white British. Yet everyone else seemed to be saying 'of course Asian doctors are dying, it's representative'. (I'm not British myself btw.) Anyway, I hope research is done to find out why and if Asian doctors are proportionately more at risk than their colleagues, as it currently appears that they are.

All very interesting about Finland, especially their recovered cases versus ours.

I know it’s hard to compare countries as we all have different populations and population densities. Then cultural and societal differences come in to play too.

I hope more research is done in to the vitamin D aspect.

I think its down to lots of Asian doctors and nurses.

Surely more than 135 people have recovered and left UK hospitals? This must be a reporting anomaly. Does anyone know why it is so low on Worldometer?

We dont report it.

What is recovered? Recovered enough to go home? Back to pre virus health? While can prove that. There could be health implications down the line. It's been 135 for weeks on worldometer.

As covid was startin in the UK my dd had a blood test and the doctor said she was vitamin d deficient.

He told us it was really important to get her on a VIT d3 supplement and recommended it for the rest of the family, because of covid. Both ne and my son had just recovered from a virus (doctors silent believe it was covid, but not 100%) I ended up with a chest infection as well.

We have all been taking it since late February.

Interesting post @AnnUumellemahaye.
I would also be interested to see a breakdown based on ethnicity.
Furthermore, BAME encompasses many ethnic minorities.
Therefore, within those groups will be people with different cultures and socioeconomic backgrounds.
I often have issues with blanket terms used to describe some groups, for example ‘Asians ‘to describe a particular group or ‘black’ to describe another group, because these terms give the impression that these groups are monolithic.
As others have said , there are many factors to explain why many doctors who have died are ‘Asian ‘ or ‘black ‘some of which have been explained
One must thing I must say, is that in my experience ethnic minority doctors are more likely to take on roles that are less ‘glamorous’ and therefore more likely to be at the forefront when it comes to being put at risk.

Just as the BMI margins are probably wrong, IME anyway
Definitely in mine. I have a very high genetic predisposition to diabetes and have been told that to avoid it my him should be below 22 which i m finding incredibly difficult. I think dark skintones mean a higher level of vit d is needed which again is different as in North Indian and North African skintones are much.lighter than South Indian and southern African skintones in general.

@EthelMayFergus- You May have to narrow your search to larger cities where one is more likely to find ethnic minority consultants.

If it is to do with vitamin d deficiency then the government needs to amend its guidance immediately. If we're spending most of our time indoors the number of highly people vulnerable to covid-19 is going to skyrocket when lockdown finally ends. Perhaps it should be "stay home, sit in your garden if you have one, and take vitamin d".

The gov in Scotland and Ireland are recommending supplements of Vitamin D now.

Maybe need to change the rules in sitting in the sun too, if it is at a distance.

I wonder if one part of the puzzle may be that there may be for some more of a Trust in authority? We know that staff are being misled about necessary PPE because the WHO recommendations are of higher protection that PHE. When I worked in a department with predominately South Asian colleagues I found them more respectful of rules and authority than myself who is from a very questioning, rebellious culture. I can't image one of those colleagues would have come to work in their ski goggles if told not to by management, whereas some with a different attitude to authority might.
Also, as mentioned above, it is often discussed that some ethnicities have higher cholesterol and may be on cholesterol reducing drugs. High cholesterol although considered bad for the damage it can do later in life, does apparently have some immune enhancing properties.

DH struggles with his Vit D levels possibly because he is North African. Luckily he had it tested just before lockdown and was put on a loading dose. We are fortunate to have a garden so he can get some sunshine.

Or a reflection of the ethnic backgrounds of medics in the UK?

Entirely anecdotal but this is my experience. DD has seen dozens of specialist doctors in her life. Over half of them have been from the same ethnic background.

Sudanese and Nigerians arent Asian

I don't think Asians are more likely to catch up but there are a lot of Asians in the b
Health service so it probably is skewed

It's difficult to get sufficient vitamin D when you stay indoors all the time. Perhaps supplements should be given out at pharmacies, free. The people cooped up in flats with no access to safe outdoor space where thet can socially distance easily are the least likely to be able to afford to pay for supplements.

It's often said that in our northern hemisphere with short daylight hours and generally cloudy weather that we are most at risk of Vit D deficiency but actually I think in some ways we are less so than other parts of the world. When the sun does shine, so long as we are careful not to burn, most of us like to get out in it and expose our arms, lower legs and faces.

Take the middle east for example, as often as it's too dark and cold for us to want to go outside in Northern Europe, it's too hot and humid there for people to be able to spend much time outside from around May to October. The religious culture dicates that people expose very little skin anyway, particularly for women. Even lower arms, ankles and throats are fully covered. Some women fully cover their face (niqab) and wear gloves too, whenever they leave the house. This means that even when the weather is pleasant they are just not getting sufficient exposure to sunlight full stop. In some cultures the women are discouraged from leaving the house at all.

Any Vit D deficiency will have far more to do with that than with an inability to absorb sufficient vitamin D because of dark skin.

I the case of Somali women in Sweden as someone upthread mentioned, they aren't experiencing a problem with Vitamin D deficiency because they are in Sweden, in spite of the long winters and lack of sunshine - they are experiencing a problem because of their dress code wherever in the world they are.

@EmpressMcSchnozzle the figures coming out of the US are almost certainly to do with poorer health generally due to a lack of effective public health and the low coverage of healthcare insurance. The ethnic groups being hardest hit in the US will be at the top of every chart of who is most affected. It is unlikely to be a specific issue with CV19

Probably mutifactorial (over-represented in medical profession in UK relative to general population, may work to older ages for cultural/work-ethic reasons, more diabetes etc). Does anyone know about numbers of medical professionals dying in India/Pakistan/Sri Lanka/Bangladesh etc.

Hugely tragic and we are of course all indebted to these doctors, nurses and healthcare assistants.

My SIL in North Africa wear the hijab so will only have their face and hands exposed. The big difference is that they live semi rurally and have plenty of outside space at home. Consequently, they spend most of their time in outside in short sleeved dresses.
The difficulty is when you live in a flat in a big city the only time you access outside space is when you are covered up.