When it comes to the risk from catching COVID-19, many consultants typically put their patients before their own personal safety. Yet there is growing evidence that some of us are taking a much bigger risk than others, as the virus seems to produce more devastating illness in older, male, and BAME (black, Asian, and ethnic minority) doctors.
Co-morbidities and obesity also translate into a potentially worse outcome. It appears that, when risking our lives in the battle against COVID, some of us are more equal than others.
What use is this information if we don’t apply it quickly to protect our colleagues? To protect those who are more likely to reach the second week of illness and then free fall through an immune cascade that leaves them admitted as patients to the same hospitals in which they have become infected?
There are several problems here, but also some solutions.
The evidence itself is inevitably being collected rapidly and so incomplete. It is not a good time to be one of the 20,000 doctors aged over 60 years, because we know that a significant proportion of COVID-19 deaths are in the 60 to 69 age range. While 48 per cent of deaths occurred in men, according to analysis by HSJ, only one third of healthcare workers are male. It seems clear that there is an increased risk to men.
The same analysis reports the eye-wateringly dreadful news that 95 per cent of doctor deaths from COVID-19 had been in the BAME demographic. This is even more poignant when we consider our BMA survey, which shows that BAME doctors working in aerosol generating procedure settings were twice as likely to report that they felt pressured to work because of inadequate PPE (personal protective equipment) compared with colleagues who identified as white. There are likely to be other factors too that could explain the disproportionality and apparent increased risk for our BAME colleagues and we’re pleased the Government has announced Public Health England will carry out a rapid review.
But we can’t just sit back and wait for a research review, no matter how rapid, to come to conclusions on the likely causes. This is why the BMA wrote to Simon Stevens, chief executive of NHS England, to ask him to develop a risk-profiling framework immediately so we can be sure that those who are likely to be at increased risk from COVID, including BAME doctors, are properly risk assessed and protected at work.
I’m pleased to say that Mr Stevens confirmed this would happen in a letter last week to all NHS providers.
He wrote: ‘Emerging UK and international data suggest that people from BAME backgrounds are also being disproportionately affected by COVID-19. Public Health England has been asked by the Department of Health to investigate this. In advance of its report and guidance, on a precautionary basis we recommend employers should risk-assess staff at potentially greater risk and make appropriate arrangements accordingly.’
NHS Employers has also updated its guidance on workers who are vulnerable to COVID-19 (it now covers BAME, age, disability, sex and religion or belief). It has said employers should ensure that line managers are supported to have thorough, sensitive and comprehensive conversations with their BAME staff and they should identify any existing underlying health conditions that may increase the risks for them in undertaking their frontline roles, in any capacity. When sending out the updated guidance there was also a reminder to employers to consult with local trade unions when implementing it, a reminder that all staff should feel safe to report concerns and events which increase risk, and the need for ensuring enough occupational health capacity to support assessment of higher risk staff.
These are welcome initial steps and it is good to see some employers have promptly begun developing or reviewing their current risk assessment frameworks but local organisations are likely to need clearer and more detailed guidance on the vulnerabilities of different healthcare workers, based on existing and emerging evidence, to ensure consistency, adequate risk assessments and well informed action to protect the health and safety of staff across the country.
Nothing is as dreadful as hearing of yet another healthcare worker dying from COVID-19. This is especially the case for vulnerable groups and I feel a sense of deep anxiety around these deaths. We need to ensure that we are doing all that we can to prevent similar tragedies.
The BMA is here to help you if you consider you may be at high risk and is concerned that you are not being adequately protected at work. Please contact FPC. And everyone, please complete the BMA surveys on COVID-19 – this data is invaluable to us in helping you achieve a safe and anxiety-free workplace.
Helen Fidler is deputy chair of BMA consultants committee.