key: cord-0686167-mz3am04e
authors: Abbas, Abdallah
title: COVID-19 Risk Assessments: Shortcomings in the protection of Black, Asian and Minority Ethnic healthcare workers
date: 2020-07-15
journal: J Hosp Infect
DOI: 10.1016/j.jhin.2020.07.012
sha: 68eb1fecd1cb4714935268e4cc02ea8259d42b63
doc_id: 686167
cord_uid: mz3am04e

nan

Dear Editor,

In the past few months, various preventative measures that aim to combat spread of the SARS-CoV-2 have been implemented with good results, including the use of personal protective equipment (PPE) and reinforcing general hygiene practices [1] . However, research by Iqbal and Chaudhuri regarding management strategies for dealing with COVID-19 in the UK concluded that current efforts are 'not translating to a sense of security' amongst the National Health Service (NHS) workforce [2] . In particular, mortality statistics have highlighted a disproportionate effect on Black, Asian and Minority Ethnic (BAME) healthcare workers (HCWs); preliminary analysis of 119 HCWs that have died in the UK with COVID-19 revealed that 64% of them were from the BAME community, despite this community representing only 21% of the workforce [3] . Furthermore, a survey of frontline doctors conducted by the British Medical Association (BMA), showed that, compared to their white colleagues, almost twice as many BAME doctors felt pressured to work in high risk environments without adequate PPE [4] .

Following guidance from NHS Employers (the employers' organisation for the NHS in England) and the BMA, hospital NHS Trusts have responded to these concerns by implementing risk assessments for HCWs that take ethnicity into account. Outcomes of these assessments are then used to provide individualised and specific guidance to staff members, such as by suggesting modifications to their work practices.

However, there are important issues to consider in the design of these risk assessment tools, which can cause considerable concern for BAME HCWs. The latest data from the UK Office of National Statistics (ONS) indicates that being from a BAME background is itself a significant factor that increases COVID-19 mortality risk [5] .However, risk assessment systems that require two or more risk factors to be present (one being that the individual is of a BAME background) will not identify BAME HCWs with additional risk factors as being at significantly higher risk. In addition, the grouping of many diverse ethnicities within the umbrella term of 'BAME' severely restricts the accuracy -and by extension the validity of subsequent advice -of these risk assessments. This approach fails to appreciate that 'BAME' refers to a heterogeneous group, overlooking the large variations in mortality risk between different ethnicities [5] . The use of this broad term can also lead to instances of confusion, seen in the way some risk assessments clearly include mixed race under the BAME category whilst others do not specify. To avoid the consequences of using reductionist labels, we propose that risk assessments should reflect the six ethnic categories as found in the detailed reports published by the ONS regarding COVID-19 mortality rates: Black, Bangladeshi/Pakistani, Indian, Chinese, Mixed and Other [5] .

Moreover, the lack of standardisation between the risk assessments issued by each of over 200 NHS Trusts in the UK can result in significant variations in risk stratification between hospitals. This is not a trivial matter, as variations in risk categories will subsequently impact advice around work; an HCW at one hospital may be advised to change to a non-patient-facing role, whereas in a different hospital they may be advised to continue to work as normal. For some HCWs, these variations in management could be the difference between life and death. Whilst it may sometimes be appropriate for individual NHS Trusts to take a different approach to risk assessment, for example based on their regional circumstances, the so-far inconsistent approach has left many staff feeling worried and unsure about what they need to do to best protect themselves and their patients. These feelings have been compounded by recent reports that so far only 23% of NHS Trusts have completed the process of risk-assessing their staff [6] .

In conclusion, these issues highlight the need for standardised and widely implemented risk assessments that use the best available evidence to more accurately assess the risk to BAME HCWs. Finally, although in this letter we have focused on the impact on workers in healthcare, we stress that similar approaches must be taken for public-facing jobs across any other relevant industries. Moreover, steps to mitigate the short-term risk to BAME staff must continue in parallel with ongoing investigations into contributing socioeconomic or biological factors leading to the racial disparity in COVID-19 mortality rates.

Prevention and protection measures of healthcare workers exposed to SARS-CoV-2 in a university hospital in Bari

COVID-19: Results of a national survey of United Kingdom healthcare professionals' perceptions of current management strategy -A crosssectional questionnaire study

Exclusive: deaths of NHS staff from covid-19 analysed 2020

British Medical Association. BAME doctors hit worse by lack of PPE 2020

COVID-19) related deaths by ethnic group, England and Wales -Office for National Statistics

Coronavirus: NHS England apologises after investigation finds only 23% of health trusts have risk-assessed BAME