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 thought the figures were about 45% of NHS medical staff are BAME (not any type of NHS staff but medical staff). At our 4 closest and large GP clinics, all the medical staff are BAME, and similarly at our local hospital. Maybe the very sad death rates reflect this reality.

MMXVi

I understand you are scared for your family, but posters have given you rational, evidence based reasons explains why deaths among BAME people as a whole are higher than for Caucasians, a trend that is mirrored amongst health service employees.

The causes are likely to be multi-factorial with age, medical history, obesity and vitamin D deficiency all having a bearing.

I also happen to agree with you that racism is most definitely present in the Health Sector. However, I don’t believe racism accounts for the higher deaths from Covid 19 and I think it is offensive to suggest that there is “shit job allocation” and lack of PPE for BAME staff at the current time when teams are working really hard together to get through this.

I would be interested in the prevalence of TB / BCG (Bacillus Calmette-Guerin) vaccine in the older (60plus) Asian and BAME groups in NHS

Most doctors are asian. Therefore if any are infected, they are more likely to be asian. Coronavirus can't exactly be racist

@Al1Langdownthecleghole There are no “evidence based” explanations of this situation - currently they’re just suppositions based on anecdata, and we MNetters have apparently managed to unpack the multi-factorial elements more thoroughly than anyone at PHE.

You might not like acknowledging the layperson’s awareness of allocation injustice, but any medic speaking off the record is aware of it. I grant you, in normal circumstances, the medics who usually come off the worst on the rota are the juniors, who take it on the chin.

@Victoria6386 Really? RTFT.

They're not all Asians - 2 of them were Sudanese.
BAME people doctors do seem to be over-represented, even when you consider that a third of drs in the UK are migrants.
I agree it can't be socio-economic when you're talking about very well off people.
I don't agree with the vitamin D theory because doctors would know to take a supplement - many doctors recommend this now.

"diabetes and heart disease does seem much much more common in his extended than it is amongst my family, who are white British."

This might be something. It's down to a combination of genetics and culture I've been told. South Asians living in Asia don't seem to have the same problem.

This is interesting www.cnn.com/2020/04/11/uk/coronavirus-uk-minorities-death-intl-gbr/index.html

"I would be interested in the prevalence of TB / BCG (Bacillus Calmette-Guerin) vaccine in the older (60plus) Asian and BAME groups in NHS"

Why? What would be the connection? Many countries don't vaccinate for TB any more.

@Gwenhwyfar One of the hypotheses up the thread is that the vitamin D3 supplementation protocol assumes a Caucasian patient - in other words, the levels are too low to be protective.

MMXVi - OK, thanks, but wouldn't an Asian doctor know that?

You’d think so, wouldn’t you? But I’ve been lurking on the Vitamin D3 thread and it appears there’s precious little research or agreement as to what a safe level of supplementation is, for any group. IIRC someone posted that the current UK prescribing guidelines are based on the prevention of rickets, not optimal health.

It's an interesting discussion. But there is an ever more stark disparity in the deaths statistics - men are dying in far higher numbers than women. Are you suggesting that this is down to reverse sexism?
www.statista.com/chart/21345/coronavirus-deaths-by-gender/

I’m not a scientist @FiveFootTwoEyesOfBlue but spending on men’s health is prioritised over women’s in nearly every culture, and yet the mortality figures are usually worse I understand.

Dr Simon Lennane who I followed today on Twitter has similar thoughts, @mous . He’s just been retweeted by India Knight and some of his followers have tagged in the BMA. Maybe their scrutiny will bring us closer to better protection for BAME HCPS and guidelines for the general public, faster.

I don't know the figures, but I would be surprised if more was spent on men's health over women's in the UK. Widespread breast cancer and cervical cancer screening must eat a chunk of the budget compared to spending on 'male cancers'. Although heart surgery is expensive and that is probably performed more on men.

@Gwenhwyfar

Labs currently researching possible efficacy of BCG in relation to secondary infections caused by c19

So BCG (TB) vaccine in adults is a bit uncertain - more effective in babies and youths - so if the vaccine is promoted it's usually in younger groups

However, in 1970s and 1980s NHS nurses and clinicians in England and Wales had to have (or encouraged to have) the BCG vaccine for work. This led has led to large group of retired or older NHS workers who once had this vaccine - you know if you have had it as leaves as faint round scar on upper arm with two / three tiny pinpricks in

I was wondering if Asian and BAME NHS workers in same age group (60plus now) and who are more likely to be first gen immigrants, and so will have missed that big 1970s-1980s NHS drive for the BCG shot in its workers, despite the questions over more ambiguous efficacy in adults. I think they stopped it for (obviously adult) NHs workers in1980s. I'm going on oral histories for this from retired / older NHS workers by the way the history of this is not so clear or absent online.

It's just a wandering thought and researching it in my spare time. I don't think the BCG is an effective or uniformly effective vaccine btw for Corona (TB is bacterial for one thing) and there must be a fatality rate for those who have had the vaccine, including older people who have had it as an adult.

However there is possibly something in the mechanic of the vaccine that might be helping protect against the secondary infection in lungs that Corona is causing. Secondary infections can be bacterial in nature, even if primary infection viral. This needs a lot of research from clever science sorts (not me) but scientists are finding that groups with higher rates of BCG (TB) vaccine seem more protected against covid19. And the UK has gone through stages of having BCG vaccines for population, if not uniformly and consistently.

We also saw a resurgence in TB in 1980s and 1990s in Asian first and second gen immigrant groups in northern cities in the UK - could this also have led to weaker lung capacity / pre existing pneumonia scarring in these groups?

Just some things been pondering, nothing certain.

@MMXVi

Really, thanks for letting me know! I'll take a look

Would love a good data set for this - just a basic indexes of ethnic group, age, sex and historic BCG vaccine. I wonder if could do an outreach in Mumsnet or other forums?

The more info and transparency we have the better, and the disproportionate impact on UK Asian and BAME groups a research priority

I think it's a bit racist to suggest Asian people have some sort of deficiency that makes them more susceptible to dying than white people.

Why? White people’s greater ability to acquire vitamin d from sunlight is also the reason white people are more likely to die from skin cancer.

@KathyBriggs360 I don't think that's a fair way of putting it. If people's genetics and dna make them more susceptible to certain viruses or more prone to particular deficiencies or illness then that's very important and needs to be looked into properly so it can be preempted or treated effectively - everyone deserves the best medical care which research can provide regardless of their genetics or ethnic origin

If all those dead doctors were white, Matt Hancock would be getting annihilated.

This is just racism in another form. The immigrants and their kids are expendable.

I’m sorry but youdo seem determined to find a racist angle now, in a way that you didn’t at the beginning of the thread. I have read the thread from the beginning and I was one of the people citing multiple possible factors from the beginning.

To say that BAME victims are considered expendable To the rest of us is very offensive. If this were something killing white medics at the same rate as BAME ones they would still be having to work through it, in spite of that, because it’s an occupational hazard of the job they signed up for. Please don’t think that BAME are being used as cannon fodder - they are not.

It’s the fact that HCP’s very lives are in danger that we need to ask questions and implement changes to medical advice and practice if needed.

This is working on the assumption that people in the profession aren’t bothering to investigate this. Just because they are not officially communicating findings at this point doesn’t mean it’s being ignored. It’s not really done to throw out hypotheses willy nilly, rather certainties which take time to establish. The idea no one is bothering and instead relying on mumsnet to come up with the answer and maybe post it off to someone as the cure all answer quite frankly seems insulting.

I think it's a bit racist to suggest Asian people have some sort of deficiency that makes them more susceptible to dying than white people.

Hogwash. Certain races have different genetic make ups which affects forms of pathways etc. That’s why you aim to get a decent cross-section in clinical trials so sub-groups can be assessed, Caucasian, Asian, Hispanic etc. There is nothing racist about it, it’s about ensuring you have relevant information to treat people optimally taking racial differences into account.

Asian people tend to have a lower lung capacity that white and black people, if you are ding lung function tests you input race to get the correct results.

It is no more racist to look at this than it is to say white people sun burn more easily than black people (yes black skin can burn).

I think it's a bit racist to suggest Asian people have some sort of deficiency that makes them more susceptible to dying than white people.

I don't think anyone is saying that. There are differences, it's rare to find a white person with sickle cell disease, diabetes has a different pattern across different races as I said above there are differences in lung capacity. Lactose intolerance is common across the world but rare in white people.

I think lung capacity may make a difference because this disease affects the lungs, it's also possible that a ventilator is harsher on people with different lung capacities. Sorry I know next to nothing about ventilators.

Unfortunately it is a difficult thing to discuss because of the shadow of eugenics.

There are also cultural / religious practices and beliefs that may have an impact on the way someone cares for themselves or their family. Many Hindus and Sikhs are vegetarian, many Caribbean people distinguish between carbohydrates grown under ground or above ground.