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.

@tryingtoprep you should be really ashamed of yourself- it was financial special measures to do with how they manage their money not how they treat people.
And bollocks to rich people in London don't use the NHS. Foreigners in London go private and the occasional 'for convenience or reassurance' Londoner- most 'Rich Londoners' use the NHS most of the time.

Of course wealthy people (foreign or British) use the NHS. Many also have private healthcare as a backup. Why wouldn't they if they can afford it. The NHS is struggling. I have private health insurance and it saved my life. Several NHS consultants misdiagnosed me. I'm aware I'm very lucky I had the option of private.

I'm not knocking King's. The healthcare staff, with a few exceptions, are fantastic. Hardworking, dedicated, doing their best in a very challenging environment of insufficient resources and over capacity. A family friend had a dreadful time there. As you say, financial resources are very limited - and this impacts patient care. Especially those who for whatever reason are less able to advocate for themselves.

Successive governments, Labour and Conservative, have run the NHS down. Underfunded but also poorly managed. We have a growing population yet hospitals have been closed! I hope the silver lining of Covid-19 will be a nationwide improvement of the NHS. Well funded, well managed. We can but hope.

We know black people have worse outcomes in the UK for many diseases and especially childbirth.
It is possible that there are different crisis points for Black people with the virus, but it hasn't hit enough yet to know. As it spreads here, in France and the US we'll likely find out more.

For crying out loud! We are going through a national emergency and someone is trying to stir up racial problems. I don't know what happened, I wasn't there, but very many of GB's DoctorsNurses are not white so why throw a spanner in the works. We should be helping one another not trying to stir up trouble.

That's interesting - given the group which gets most criticism for being older mothers is white, middle - class women supposedly delaying motherhood for career advancement.

I guess rich white middle class women are just more noticeable. Clearly they don't in fact form a significant constituency in numbers, even if they do get a lot of attention.

Nobody is trying to stir up ‘racial problems’. They are just asking questions. Often, people ask those questions because they have had negative experiences themselves due to their ethnicity, which makes them concerned. Please bear that in mind before concluding that they have an agenda.

That story is tragic but I can cite four non-Covid cases in my own family over the last 10 years, all white:

• one male and one female in their early 60's and in good health who ended up on intensive care and very nearly died in similar circumstances to the case described (male pneumonia, female sepsis)

• one female in her 70's with COPD who lived alone, sent home in the middle of the night with tablets for a chest infection after three previous admissions in the preceding two weeks, who the next day collapsed with encephalitis and died as a result

• one male aged 50 taken off a ventilator to die because someone else needed it and he "had had it a week already" (less, actually).

The male with pneumonia was at home after being discharged too soon, having had to wait during that previous admission for an intensive care bed as his condition deteriorated. This was when ambulances were queuing outside hospitals during previous "winter pressures" (due to the usual flu epidemic) because hospitals were unable to admit new patients. He was discharged, with poorly-controlled diabetes and prone to hypo's (never obese BTW, different type of diabetes) to where he lived alone because, again, someone else needed the bed.

He was only saved because a relative who is a nurse called to see him, found him confused, collapsed and realising he was on death's door argued (argued, not asked) to have him re-admitted.

The NHS has been in a state of near collapse during the winter months for years.

In the tragic case of Kayla Williams, the young woman who died in London, it is possible to understand why she was not admitted. There is question mark before the suspected diagnosis of Covid19 in the article: the lack of tests is one factor but still probably not the most significant.

I strongly suspect that the most important factor was that she was so young. She died on 21 March when the official line was still that Covid19 was only really dangerous for the over-70's and younger people with pre-existing medical conditions.

25 March

"Doctor Shares The Biggest Lie About COVID-19 | UK Data"

"There has been a particularly harmful misconception which has led many to believe coronavirus is a trivial problem that won't affect them.

These are results from the first 775 patients admitted to intensive care in the UK, with COVID-19.

Time to put the misconception that this disease only preys on the elderly and those with significant medical conditions, to rest.

Erratum: Thanks to a couple of friends who pointed out that I should've been clearer with the deaths statistic - when saying around half have died, that refers to those with outcomes recorded, ie patients who have either left ICU alive or dead. Many of these patients are still in ICU right now, so the rate may change however if you click the link below you can see a steady state emerging between discharge alive and dead, suggesting the 52:48 ratio is probably about right.

Link to ICNARC report:
www.icnarc.org/About/Latest-News/2020/03/27/Report-On-775-Patients-Critically-Ill-With-Covid-19

3 April

"'All our ICU patients are in their 50s or younger' - frontline Welsh doctor recovered from virus"

"A critical care consultant in the Royal Gwent Hospital in Newport is urging the public to keep listening to government advice.

Earlier this week, Dr David Hepburn warned the hospital had run out of space in intensive care and had moved into operating theatres. This - in an area which has seen the highest levels of confirmed Covid-19 cases in Wales. "

I do not think it is unreasonable for the OP to have asked the question about possible racism, given all the reasons cited in the OP and in previous posts above. I do hope that the OP is also reassured that racism is highly unlikely to have been a factor as there are far more plausible explanations.

The most important is the lack of NHS resources that requires patients to be prioritised for admission. It is not unreasonable to suppose that if there had been no pressure on NHS beds that she would have been admitted "just in case".

The "precautionary principle" went out of the window when the best available information was that Covid19 (just a tentative diagnosis in this case) with severe and painful symptoms would still be very unlikely to be life-threatening for a young, fit woman.

There is a dawning realisation in the last few days that, in the UK at least, the main victims of Covid19 are are not, as expected, the same people "who would have died anyway" but are younger and fitter than those who usually end up on intensive care in flu epidemics.

If someone young, fit, female, black and working class like Kayla Williams falls ill with the same symptoms next week and is not admitted to hospital, then it would be reasonable to wonder if this was on purely clinical grounds - but unhelpful to view the circumstances through the lens of USA mores and politics.

That breakdown of the maternity mortality stats is really interesting shoots. I had heard the 5x higher mortality rate for black women stat and was horrified but took it at face value. Your breakdown puts it in context and reminds me to be more careful with this sort of information.

I don’t doubt there is a race element in many parts of Health care. We know that women are taking less seriously than men and I’m sure a similar thing goes on through the lens of race. But I am very glad to know the outcomes are not what they at first appear to be.

Subconscious bias is so hard to shift for even the best professionals. I've got a lot of Asian friends who anecdotally tell me that some Asian male doctors treat them more dismissively that they treat white women.

How would anyone have known her ethnicity? I’ve never been asked my ethnicity when I’ve phoned 111 or 999 (and I’m not white btw).

Sorry. I misread, I didn’t realise they had actually been to her home.

Until a few years ago when I went with my non-white husband to minor injuries I’d have said it was unlikely to be an issue. Now I’d say it is probably a problem.

5zeds you would have to compare your experience with the experiences of people who are white to draw any conclusions that might be based on skin colour.

Please can we stop the ridiculous generalisations based on individual cases where skin colour is a factor but not necessarily a relevant factor?

This is as insane as someone saying, "Based on my mother's experience of being treated by Dr Harold Shipman, I'd say that it is probably a problem that white, male GPs are psychopathic murderers who target the elderly and elderly white women in particular."

5zeds you would have to compare your experience with the experiences of people who are white to draw any conclusions that might be based on skin colour.
I am

Given that London has a large non-white population, wouldn't we expect that a large number of the people who die in London from the pandemic would be non-white? If we said 50% of Londoners were non-white, just to choose an easy numbers, pure chance would be that there is a 50% chance that the first person to die would be non-white.

I am really not seeing a pattern shown here that this was a race issue.

The priorities will change on a daily even hourly basis I would imagine.

A lot can happen in the 31 hours after she was seen.

So sad anyone should be dying of this.

I think it is more likely that her age and lack of pre-existing conditions were the main factors in not admitting her.

Anyone who has had a proper bout of seasonal flu will tell you that it is a hideous experience but not life threatening if you are young and healthy.

Paramedics are having to prioritise people likely to need life saving interventions and statistically she was not in that group. This case ended in tragedy and under normal circumstances she would absolutely have been admitted to hospital.

It is awful that this is our reality but I fear that many people are going to fall through the cracks during this crisis.

5zeds how can you possibly do that? If you are talking about other personal experiences that still does not tell you anything about typical experiences that would justify generalities.

I was talking about my own experience. What is it you don’t understand?

The thing about triage is that it will have to be based on things like age, health, as well as the symptoms themselves. They can impact risk. Sometimes the criteria won't be as good as it might be if we don't have a perfect picture of the illness.

It's true that things like class or culture can affect how people communicate or what decisions they make, which in turn will impact how they are responded to. I don't think I'd call that racism or classism though, even systemic racism - I think that gives an inaccurate impression of the cause and what to do about it.

I don't think I'd call that racism or classism though, even systemic racism - I think that gives an inaccurate impression of the cause and what to do about it. I think that’s exactly what racism is. If your colour impacts your treatment and outcome then surely that’s racism.

5zeds

No, I think that's using the word where it doesn't apply. Racism implies a sort of bias help by people or within the systematic elements because of that bias. Conscious or unconscious bias.

But societies, particularly complex ones, are full of different kinds of social and cultural preferences, communications styles, traditions, etc, that lead to different outcomes in those communities. Sometimes positive, sometimes negative, sometimes neutral, or either depending on circumstance. Those things aren't necessarily "isms" classism, racism, etc.

But societies, particularly complex ones, are full of different kinds of social and cultural preferences, communications styles, traditions, etc, that lead to different outcomes in those communities. so are you saying if outcomes based on race (or sex even) aren’t racist (or sexist) if they are endemic to that society/community? I think they’re harder to talk about but definitely there.

5zeds - "I was talking about my own experience."

And extrapolating from one experience to claim, " I’d say it (racism) is probably a problem" in the NHS - is completely unjustified.

What is it you don’t understand?

You perceived that your non-white husband experienced racism during that experience. I genuinely hope that he didn't, for his sake.

I am not so blinkered as to assume that no one ever experiences racism in accessing NHS services. That would be ludicrous. However, it is impossible to seriously entertain the idea that one example proves that the NHS as an institution has "a problem with racism", not least because such a large proportion of the NHS workforce is not white.

As I and others have pointed out repeatedly, poor treatment and bad behaviour can occur for many reasons, as can legitimate clinical decisions which turn out to have bad outcomes. That the patient is black does not mean that this is necessarily due to racism or has anything whatsoever to do with skin colour.

You seem determined to believe that racism is the only possible explanation, flying in the face of all logic. Maybe it was in the case of your non-white husband. That is horrible and it should not happen.

Ghastly treatment is also meted out to others who are not black. There are nasty people everywhere, some of them are bound to work for the NHS and some of them are racist - or racism is just one aspect of their abuse of power.

Nobody should be treated badly accessing NHS services but it would be more productive to root out all bad behaviour and focus on the perpetrators, whatever their motivation - and this is far more likely to be abuse of power in general.

Eradication of every incident of racism would address a symptom, not the cause. The NHS would better serve non-white people but, as an institution, the NHS would be no better overall. It would still have a problem because people who abuse their power will always find an outlet.

That said, the vast majority of people working for the NHS do not do so in order to be nasty to other people or to provide them with a poor service. Quite the reverse.

I think my impression changed. I would previously have believed that it was unlikely to impact care, now I believe the opposite. At no point have I expressed any definitive knowledge. I believe there have been many studies (though to be fair I haven’t read one), on the impact of sex, race etc on outcomes. I think someone mentioned one up thread.
So if there IS evidence that race does influence access to treatment, and if people who have experienced it are expressing their impressions, and neither of those things would make you even question if this was an issue, what would?

Just to correct an assumption, the individual who we were treated by was not trying to be unpleasant. Not all racism is meant unkindly or even a conscious stance, in the same way not all sexism is.