“The pandemic has highlighted and amplified inequalities in our society that lead to inequalities in health.”
This is according to Professor Sir Michael Marmot, director of the Institute of Health Equity at University College London.
And he is not alone. Public Health England, a government agency, recently published a report based on a descriptive review of data on disparities in the risk and outcomes from Covid-19.
The largest disparity found was by age. Among people already diagnosed with Covid-19, those who were aged 80 or older were 70 times more likely to die than those under the age of 40. The risk of dying among those diagnosed with Covid-19 was also higher in males than females, higher in those living in the more deprived areas, and higher in those in black, Asian and minority ethnic (BAME) groups than in white ethnic groups.
The most striking finding that caught my eye was the fact that, even after accounting for the effect of sex, age, deprivation and region, people of Bangladeshi ethnicity had around twice the risk of Covid-19 death when compared to people of white British ethnicity. People of Chinese, Indian, Pakistani, other Asian, Caribbean and other black ethnicity had between 10 and 50 per cent higher risk of death when compared to white British. Bangladeshis are one of the largest immigrant communities in Britain. Among many other Southeast Asian migrant populations, why Bangladeshis are a particular target of the coronavirus needs a thorough scientific examination.
Being a Bangladeshi-Irish man, I panicked. I thought let’s look for some clues as to why this is happening in England. What better source can one imagine other than looking into Marmot’s famous report – Health Equity in England: The Marmot Review 10 Years On?
Search for Bangladesh in this 172-page report and the following comes up.
1. Bangladeshi ethnicity has the lowest life expectancy while non-British whites have the highest.
2. Asian and mixed ethnic groups had significantly lower disability-free life expectancy (DFLE) at birth than white British men or women. The lowest DFLEs observed were for Bangladeshi men. DFLE is the average number of years an individual is expected to live free of disability.
3. Analysis of inequalities among people aged 60 and over shows that, even after accounting for social and economic disadvantage, minority ethnic groups (including Bangladeshis) are more likely than white British people to report limiting health and poor self-rated health in this age group.
4. On the graph for “average health-related quality of life score” for people aged 65 and older, by ethnicity, 2012/13 to 2016/17, Bangladeshis are one of the low scorers.
5. There are wide variations in poverty rates by ethnic groups. In 2018 33 per cent of people living in households headed by someone of Bangladeshi ethnic origin were in the most deprived quintile, compared with 15 per cent of the white population (housing costs raising poverty rates considerably).
6. Overcrowding is more likely to be experienced by minority ethnic groups in all socio-economic groups: only 2 per cent of white British households are overcrowded, compared with 30 per cent of Bangladeshi households and 15 per cent of black African households. Overcrowding might occur as a result of multiple generations of a family residing in one home.
I did not have the heart to find out more about what has been described in the report for the Bangladeshi ethnicity living in the UK. But you can see for yourself, all the ingredients you need for the coronavirus to attack the most fragile and vulnerable population are there already, pre-existing over a long period of time.
In the Public Health England report, special categories of occupation that carried more risk of Covid-19 death were also predominant in the ethnic minority groups. These professions included nursing in the hospitals and care homes, taxi driving, and many more.
So far, we don‘t have information on the possibility of any biological factors as yet. Is there any particular predisposing biological condition/genetic susceptibility that Bangladeshi ethnicity carries that made them a soft target for the Covid-19? No one knows as yet.
Vitamin D deficiency, for example, has been proposed as an independent risk factor for Covid-19 death. It is crucial for the immune system to act properly, especially in the elderly population. Numerous studies have shown that vitamin D deficiency leads to increased susceptibility to respiratory infections and taking the vitamin in supplement form has been shown to protect elderly people from having flu and chest infection.
An Indonesian study described 780 confirmed cases of Covid-19, of whom 380 died and 400 survived. Of those who died, 46.7 per cent had vitamin D deficiency, 49.1 per cent had vitamin D insufficiency, and the remaining 4.2 per cent had normal vitamin D levels.
There is a possibility that many young people from the Bangladeshi ethnicity have vitamin D deficiency. Although there is no concrete evidence for that, a recent paper described a study conducted in a large hospital in Bangladesh where a total of 793 patients’ blood vitamin D level reports were analysed. The majority (62 per cent) were between 21 and 60 years of age. Eighty-six per cent had low levels of vitamin D, 61.4 per cent had deficiency, and 24.1 per cent had insufficiency. Numerous studies suggest that Bangladeshi young adults may suffer from chronic vitamin D deficiency.
More than ten thousand Bangladeshi people are living in Ireland and I am one of them. Are we also more susceptible to develop Covid-19 here? Do we live in multi-generational, over-crowded households? How many of us are in the frontline occupations like in the UK? Can we design a study to check levels of vitamin D in any targeted population?
As of today, the number of confirmed cases of Covid-19 infection in Ireland is 25,638 with 1,746 deaths. We do not know how many of these are from an ethnic minority group.
I think it is high time we looked into this, not only for Bangladeshi people but for all ethnic minority groups living in Ireland. We need to learn from our neighbours and take proper actions.
Arman Rahman is a cancer researcher at the Conway Institute, University College Dublin