Ethnic disparities in health & social care workers’ exposure, protection, and clinical management of the COVID-19 pandemic in the UK

A Kapilashrami,M Otis,D Omodara,A Nandi,A Vats,O Adeniyi,E Speed,J L Potter,B Eder,M Pareek,K Bhui

doi:10.1080/09581596.2021.1959020

Abstract

ABSTRACT This paper examines determinants of ethnic disparities in workplace risks of COVID-19 among health and social care workers (HCWs) in the UK. This was undertaken to inform public health policy in the management of COVID-19 relating to health and social care provision. A cross-sectional survey was administered in July–August 2020 (n = 456) to elicit HCWs’ experiences of COVID-19 management in the workplace and their perceptions of exposure, personal protection against infection, involvement in local clinical management, and other workplace hazards. Findings suggest minority ethnic HCWs were twice as likely as White HCWs to be in a patient-facing role (OR = 2.14, 95% CI:1.21; 3.78, P < 0.01) and twice as likely (63% vs 39%) to be caring for COVID-19 positive patients (OR = 2.68, 95% CI: 1.77; 4.06, P < 0.01). Those in nursing, were three times as likely to be redeployed to a COVID-19 care setting (OR = 3.33, 95%CI: 1.23; 9.02, P= 0.02). Minority ethnic HCWs within lower- and mid-level roles carried a higher burden of frontline clinical management of COVID-19 positive patients than their White counterparts. This study found evidence of ethnic disparities across several workplace hazards, with increased exposure to and less protection against infection, more responsibility for the clinical management of infection, and evidence of systemic racial bias in the disproportionate redeployment of minority ethnic nursing staff to COVID-19 areas. An NHS-wide review is required to assess procedural fairness, ensure safe practices now, and to avert future crises.

Highlights

The global outbreak of COVID-19 placed unprecedented strain on health-care services, with more than 3 million deaths worldwide as of 20 April 2021 (World Health Organisation [WHO], 2021)
We examined the frequency of change of protective equipment (PPE) guidance, which can adversely affect health and social care workers (HCWs) by making them feel overwhelmed and confused resulting in poor implementation of protective guidelines
They carry a disproportionate burden of care, facing risks to safety due to shortages of personal protective equipment (PPE), and are expected to manage pressures on hospital and staff capacity to manage the surge of COVID-19 patients (Nguyen et al, 2020; Vindrola-Padros et al, 2020)

Summary

Introduction

The global outbreak of COVID-19 placed unprecedented strain on health-care services, with more than 3 million deaths worldwide as of 20 April 2021 (World Health Organisation [WHO], 2021). Reports indicate a disproportionately raised risk of death in the UK among minority ethnic staff compared with those of White ethnicity, accounting for 67% of all health workers’ mortality (Office of National Statistics [ONS], 2020a; West & Bailey, 2020) despite making up only 22.3% of the total health and care workforce (National Health Service [NHS], 2020). Their overrepresentation in COVID-19 fatalities and risk of infections (Raifman & Raifman, 2020; Yancy, 2020) led to growing concerns and calls for enquiry into ethnic/racial inequal ities in the burden of COVID-19. To date few empirical studies have examined experiences of staff and workplace management of COVID-19 in the UK or the influence of ethnicity on workplace hazards of and protections against COVID-19

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Conclusion