36 year old woman dies of coronavirus after being deprioritized by emergency services: is race a factor?

[WombOfOnesOwn]

www.theguardian.com/world/2020/mar/25/london-woman-36-dies-of-suspected-covid-19-after-being-told-she-is-not-priority

When I saw this story I couldn't help but wonder. I live in the US, where black women are at far higher risk during pregnancy, birth, and with illnesses and injuries because hospitals simply do not take their pain and suffering seriously.

Do you believe black women in the UK are potentially at greater risk in a pandemic situation where prioritization must occur? I think this will certainly occur in the US, and that younger black women will be ignored in favor of older white people, but I wanted to hear the British opinion -- maybe it is less dire there?

I had always hoped so, but this story made me so terribly sad. A mother of three -- I'm about to be a mother of three myself, and this story has made me think deeply about how much more terrifying this time must be for black women, who already know they are seen as lesser by many healthcare providers and must navigate without even their family to advocate for them in the hospital.

Men are twice as likely to die of Covid 19 than women, does that mean sexism is happening? Not necessarily. It’s the same with black women in the US dying in childbirth. Yes they have a higher risk of death but it does not automatically follow that it is due to racism. For example, black women are more likely to have a high risk pregnancy due to higher rates of diabetes and obesity. In addition, if it were racism you would think that white women have the lowest risk of dying in childbirth, when they don’t. They are the second highest with Asians and Hispanics have the lowest death rates.

Oh please

This is offensive

Of course racism doesn't come into it. Even more so I'm London

Why oh why would you try to start a race roe now

Asking a question about possible bias is not “trying to start a race row”.

I went in search of figures to back up my post about diversity in the NHS in London. I have only found UK wide statistics and they do support my experiences.

www.ethnicity-facts-figures.service.gov.uk/workforce-and-business/workforce-diversity/nhs-workforce/latest
See the charts in Section 3.

45% of medical staff are ‘non-white’ compared to 13% of the general population. The NHS is known as a diverse employer. 18% of non-medical staff are ‘non-white’, again in comparison to 13% in the general population.

London is significantly more diverse than the rest of the country so I would expect greater diversity in London NHS trusts. My own experience in London is that more that 50% of frontline/medical staff are not white. I have no idea about non-medical staff.

I really don’t think racism was a factor here.

If this had happened somewhere else they might have a point, but London? If it's a majority white city it's only barely. The health service there is at least 50% non-white. Maybe triage could have been handled better, and it's possible that the advice given about if and when to call for an ambulance again wasn't clear, and if so hopefully they'll review procedures based on that. But I think we will unfortunately be seeing quite a few cases like this where people's condition deteriorates so rapidly from feeling not great to critical that they won't make it to the hospital in time.

This little nugget (also from section 3) may explain the problems within the NHS:

as at March 2019, around 9 out of 10 people employed by NHS trusts and clinical commissioning groups in England were working in non-medical roles (and 1 in 10 were in medical roles)

WTF? How many administrators can they possibly need?

I think it may be a subtle race and class issue. Races and classes have shown statistically to have different ways of communicating and different attitudes towards the NHS and towards resisting/defending/speaking up for themselves. Different attitudes and methods of challenging authority.

NHS told her: call us if your symptoms worsen. It looks from the initial news reports like her symptoms worsened and shedid not call them. Was this because they worsened too quickly? Was it because she has been told ‘you don’t need to come to hospital’ and certain groups, as a cultural issue, just do what they are told and don’t insist on things? Certain other mindsets might have called the hospital and said persuasively ‘it’s got worse, much worse, we need an ambulance now’. Other mindsets will go ‘I feel worse but should I call? Not sure. They said I was fine. I don’t want to look like I’m wasting their to time again’. Are those different mindsets linked statistically to race and culture?

There's good evidence that people find it hard to believe women when we say were suffering, and if we're black then even more so. The judgement that she wasn't ill enough to need care might well have been different if she had been a white man of the same age.

With structural racism it’s embedded into the social codes do it really doesn’t matter if the workforce itself is diverse. Bit like the cultural idea that women gossip about each other that you might hear both men and women buy into (linguistic analysis of conversations indicate men and women gossip at the same rate - very human trait). But with embedded patriarchal structure, women are seen as less serious and bitchy by men and women.

So very possible race and other unconscious biases played a part - for example we think covid-19 is an old person’s disease so then we downplay the risk in other age groups.

And in the UK, didn’t they control for pre-existing conditions and weight and still found black women died more in pregnancy/childbirth?

I could absolutely believe that the fact that doctors don't take women's pain as seriously as men's pain, and as a result we're socialized not to complain until it's really bad, could be factors.

I also think that we'll see more cases of young people whose symptoms were taken less seriously because they were young and triage is going to be done on the assumption that younger people are less at risk. I wonder if how quickly symptoms accellerate varies by age or other factors. I know with cancer it's often much more aggressive in younger people.

No 🙄

Yes 😐

It is never offensive to ask the question, ‘Was this in any way part of institutional racism?’

I do wonder if we will be looking at disproportionately high numbers of sufferers/hospitalised from BME communities.

Look at diabetes figures:

www.diabetes.org.uk/research/our-research-projects/london/black-african-ethnicity-and-type-2-diabetes-risk

No I don’t think race was an issue here , maybe age .

."i believe there was some structural racism in the government's failure to protect Londoners"

Eh?

The government is in London. Normally the complaint is spending vastly vastly more on London than other parts of the country.

New York has the same issue as London - due to population density, public transport and high levels of international travel, it is experiencing much worse than somewhere rural.

This is inevitable and reflects the fact if you go out of your flat to the park in say Hackney it's going to be full of people, whereas in say rural Surrey there are just not that many people.

It's maths, essentially, and it's why historically people sought to move out of London. And, incidentally it's the sort of thing that the green types want - higher density living, population much more susceptible to pandemics.

I think it’s very possible, though we don’t know the other details such as the race of the first aid responder, so I wouldn’t jump to conclusions. However it has been well documented and the consequences proven in studies (such as the childbirth one) that in the U.K. black women tend not to be listened too by HCPs as much as white women.

What @iguanadonna said

Clearly in London you'd expect more triage than in say West Sussex, because there are more ill people as a result of London being crowded.

It's entirely an error to describe this as structural racism as in normal times I imagine London has more beds per person than Sussex, BUT this is a pandemic event which arguably is inappropriate to plan for - it would not be fair to give Londoners vastly better medical care than elsewhere on the basis of once in a century pandemics

More realistic is to note that in pandemics cities will suffer more and do what you can to ramp up, but that can never involve providing a health system that is designed for many times normal need.

The upshot of course is that some people die, which by some values could be avoided, but that happens every day for all reasons- if the police took your licence away instantly for speeding then many of the 1800 annual road deaths would be avoided.

You cannot take one death and use it to argue for X, unless you consider the reality that avoidable death is in fact built into our society. No we are not willing to increase booze taxes to save thousands of lives, so why should we take a single failure of triage as meaning the system is fundamentally racist when those doing the triage were likely not even white!?

Btw related but do note that for example there are massive differences in maternal characteristics between races - a high % of mothers from certain non white backgrounds are geriatric pregnancies, so merely observing a difference doesn't prove your desired causation....

Adding to that, if people reach the point of illness where they need intensive care they're probably more likely to survive in London or a similar city, in that there are multiple world class hospitals and more facilities overall, but they're also more likely to catch anything that's going around. The Londoners who've fled to, say, Cornwall, have lost their damn minds, imo, since not only are they likely to contribute to the spread of the virus, if they do become critically ill the chances of there being no facilities available to treat them are much higher.

Trying to paint the ambulance service as racist when they are risking their lives to save people in a time of crisis (and all other times). Typical guardian, full steam ahead smearing our welfare state. C4 did the same thing recently with the fire service over Grenfell. Discusting really, these pampered 'journalists' have no shame.

Not once in that article does the Guardian suggest the ambulance service was racist. Not once. It simply reported what the family and said, and then what the ambulance service said in response.

Shame on you for being too lazy to read the story properly and then smearing journalists doing their job.

Overt personal racism and institutional racism aren’t really the same thing. No organisation can feel they simply don’t have any vestiges of IR. it has been too ingrained for too long. It’s refusing to review it, explore it and work on it which is the immoral action.

People can be so defensive about this when there is no need to be so. IR is like a big, undeniable wound from which we are still healing.

I think class might have had something to do with it - feeling you have the right to call for more help.

Race and sex may well have come into play - women don't seem to die as much although that could be because smoking is less acceptable amongst women in the societies that were first hit.

I would also add that the local hospital, King's College has had at least eight Covid-19 deaths, and an intensive care nurse committed suicide there a couple of days ago, so triage is very clearly essential.