Self-reported Occupational Risk for COVID-19 in
Hospital Doctors from Black Asian & Minority
Ethnic Communities in UK
Indranil Chakravorty PhD FRCP*, Sunil Daga PhD MRCP*, JS Bamrah FRCPsych CBE, Geeta
Menon MD FRCOpth, Subodh Dave FRCPsych MMed, Subarna Chakravorty PhD MRCPCH
FRCPath, Neeraj Bhala DPhil FRCPE FRCP and Ramesh Mehta MD FRCPCH OBE
*combined first authors
BAPIO Institute for Health Research, Bedford, UK
Correspondence to -
Emerging data from COVID-19 pandemic shows a trend for increased risk for healthcare workers in the
UK, compared to other countries. In addition, there is a disproportionately high risk observed in
healthcare workers from Black, Asian & Minority Ethnic backgrounds. This high risk is independent of
biological or demographic variables. This paper presents sub-analysis of a larger survey of healthcare
workers, particularly describing possible occupational risk of COVID-19 in a subset of doctors in UK
hospitals from a BAME background. The results show higher rates of inability to access personal
protection or comply with social distancing. The inability to self-isolate was associated with a 1.7x higher
risk of COVID-19. The results of this survey suggest further research is needed to explore and understand
institutional factors that may explain excess risks to BAME hospital doctors.
Key words:
COVID-19, BAME, Healthcare workers, Personal Protective Equipment, Social distancing
Cite as: Chakravorty, I., Daga, S., Bhamra, J.S., Menon, G., Dave, D., Chakravorty, S., Bhala, N., Mehta, R.
(2020) Self-reported Occupational Risk for COVID-19 in Hospital Doctors from Black Asian & Minority
Ethnic Communities in UK. The Physician 6(1); v1 pre-print DOI: 10.38192/
By the nature of their work in caring for patients, healthcare workers (HCWs) remain at the forefront of
the risks of acquiring COVID-19. Compared to published data from China, there is a high prevalence of
HCWs being infected in France, Italy, Spain and USA during the current pandemic (1-3) Analysis of hospital
admission data in the UK, clearly demonstrates a higher risk of COVID-19 severe disease and death in
Black, Asian and minority ethnic (BAME) background being affected in the UK and USA (4). To date the
mortality among UK HCWs has surpassed that of UK soldiers in the Iraq war (5). Further breakdown of
data reveals a higher risk of severe COVID-19 disease and death among BAME HCWs than their Caucasian
Chakravorty_bame_doctors v1
peers (6). UK National Health Service employers are employing potential strategies to identify and shield
staff at risk.
The potential causes of this excess risk of death or disease among UK HCWs remains poorly understood.
Population level data analysis suggests that certain inherent or biological variables such as age, sex, body
mass index, concurrent cardiovascular, diabetes or kidney disease and previous levels of activity may
determine outcomes. However, when such potential biological contributory factors are accounted for in
multivariate analysis, BAME background appears to remain an independent risk (7). Exploring non-
biological factors, it is clear that BAME HCWs are a widely diverse group in religious, socio-cultural aspects
as well as perceptions and beliefs (8-9). Yet the observed data demonstrates a unique commonality in the
severity of outcomes within this pandemic, which cannot be explained away easily. A deeper exploration
of differential experience of BAME HCWs in the UK NHS may be necessary within the context of their
shared occupational experience and perceptions.
The British Association of Physicians of Indian Origin, in its 25 years of experience in working with diverse
groups of HCWs, predominantly doctors from the Indian subcontinent through engagement with its
national membership and their widening social networks provided the perfect vehicle for exploring the
risks and perceptions of BAME HCWs. In a national online survey of a wide range of HCWs across different
clinical settings, there were clear themes demonstrating perceptions of enhanced risks and behaviours
pertaining to profession, clinical exposure, personal protection and even organisational issues (7).
Published mortality figures among HCWs showed that as a group, 95% of doctors who had lost their lives
in the current pandemic, were from a BAME background (6). In addition, within the heterogeneity of the
survey respondents, hospital doctors from a BAME background provided a subset with the most common
shared experience and a group that was most likely to provide an insight in understanding the excess
mortality. Hence, this group was chosen for a subset analysis.
The components of this survey were conceived through engagement with an active focus group (BAPIO
Think Tank) composed of 67 members of BAPIO. The investigators from the BAPIO Institute of Health
Research then designed the survey questions by expert consensus. The anonymised, cross-sectional,
online survey was then distributed by email links to all members of BAPIO and through social networks
for a period of 2 weeks in April 2020. Results were collected online, using Google forms. Details of the
survey components, questions and results are published (7). A subset of BAME hospital doctors were
selected from the survey respondents during this analysis. Non-parametric tests including Chi square tests
and multivariate logistic regression analysis was applied to adjust for potential contributory variables in
generating odds ratios, using SPSS statistical software (SPSS v26, IBM Inc., USA).
Primary outcome - Self-reported, point prevalence of (i) access to personal protective equipment (PPE),
(ii) ability to comply with social distancing guidance during work/ commuting, (iii) ability to self-isolate if
at enhanced risk and predicted risk of COVID-19 (defined as positive viral PCR swab test result or self-
isolating due to classical symptoms based on published Public Health England and NHS guidance.
There were 1243 BAME hospital doctors in the cohort with a distributed age range (Figure 1). Majority of
respondents were middle-aged
(40-60 years of age) and
33% had one or more comorbidities
Chakravorty_bame_doctors v1
(cardiovascular, hypertension, cerebrovascular, kidney, diabetes, chronic lung disease and mental health
issues (Figure 2).
Figure 1: Histogram showing the age ranges for BAME doctors.
Figure 2: Histogram showing the proportion of BAME doctors with comorbidities.
Occupational measures to reduce risk:
Only 22% have reported access to or compliance with recommended / appropriate PPE (Figure 3).
Similarly, only 22% of respondents were able to fully comply with social distancing (SD) guidance at work.
Chakravorty_bame_doctors v1
Around 35% of hospital doctors reported that it was not practical, given the nature of the clinical setting,
to comply with SD at work and 36% reported not being able to fully comply with SD guidance (Figure 4).
There were 23% of respondents who reported inability to self-isolate when they perceived there was a
personal / family risk of COVID-19 infection (Figure 5).
Figure 3: Pie charting showing Personal protective equipment (PPE) at work place
Figure 4: Pie chart showing ability to comply with Social Distancing (SD)
Figure 5: Reported self-isolation and risks to self/family
Chakravorty_bame_doctors v1
Self-reported COVID19 illness and risk analysis:
Around 5% of the hospital doctors were in shielding or proactively avoiding exposure to COVID-19 and
18% reported a confirmed positive viral PCR confirming COVID-19 or were self-isolating at home due to
symptoms of COVID19 (Figure 6). The odds ratio for BAME hospital doctors having COVID-19 diagnosis or
symptoms associated with COVID-19 (where testing was not available), when not being able to self-isolate
due to personal risk was 1.73 (confidence interval 1.19-2.52, p=0.004) after adjusting for age and
Figure 6: Pie chart showing COVID19 related illness in BAME hospital doctors
Chakravorty_bame_doctors v1
What does the data mean?
The results of this subset analysis of hospital doctors from a BAME background was conducted to explore
the likely causes of disproportionate representation of this group in adverse outcomes in almost all recent
published data in the UK. The BAPIO online survey of healthcare workers captured an overwhelming
majority of hospital doctors from BAME backgrounds, so offered us a unique opportunity to explore the
risks and potential vulnerability in this group (7). Our data showed that nearly 1 out of 5 (18.26%) had
COVID-19 or had symptoms requiring quarantine. This figure is higher than that reported for prevalence
of infection in HCWs from similar surveys (1, 10-11).
We then explored the potential confounding factors that might explain this risk. Looking at personal
protective equipment, we found almost half of BAME hospital doctors did not report that they had access
to PPE as per PHE guidance. An overwhelming 3 out 4 reported not being able to comply with social
distancing guidance when at work or commuting for work. These proportions appear to be higher than
reported in other surveys (10, 11). What appeared to be most concerning was our analysis suggesting
that hospital doctors from a BAME background, who were unable to comply with self-isolation guidance
(based on a personal risk characteristic for COVID-19), were 1.7x more likely to have COVID-19; even when
adjusted for age and comorbidities.
There are potential limitations to the extent of extrapolation of the conclusions drawn from this survey
when compared to the population of BAME doctors in the UK health service. As explored in our original
paper (7), these include a self-selection bias, the dependence on the accuracy of the respondents’ self-
declaration of their profession and circumstances, the perception bias for reporting issues with PPE, social
distancing and the diagnosis of COVID-19. These limitations are mitigated to an extent by the nature of
the distribution of the questionnaire through membership databases and bona-fide professional social
networks. Clearly, the results of a survey such as this and its subset analysis must be interpreted with
caution, is unlikely to be generalisable beyond the defined group and merely suggests that urgent further
well-designed, controlled studies are necessary.
What should be done?
Firstly more studies are needed urgently to confirm the ‘vulnerability or health risk’ for B ME doctors in
the COVID-19 pandemic by comparing a case-control study with non-BAME doctors and perhaps
extended to all health care workers who are at the forefront of the COVID-19 response. The scientific
exploration of risks must not shy away from examining uncomfortable topics that might constitute
independent variables including individual and organisational factors. Discrimination has been linked to
poorer health outcomes (12) and this will be a valid variable to examine amongst others.
Secondly, until further robust research results are available, BAME doctors with vulnerability should be
offered/ encouraged to comply with strategies for avoidance of exposure. These may be in the form of
redeployment away from high risk areas, with limitation to direct patient contact or access to enhanced
PPE as available in aerosol generating clinical settings.
And, finally these results pooled with emerging clinical data should be computed to create a risk
stratification tool so HCWs with known vulnerability (i.e. ethnicity) can be offered appropriate safety and
deployment. It is encouraging to note recent guidance on risk assessments of BAME healthcare workers
Chakravorty_bame_doctors v1
at workplace in NHS (13), though a validated culturally appropriate risk assessment tool is urgently
needed accounting for socio-cultural factors specific for BAME communities.
uthor’s contribution and conflict of interest statements
The authors have no declared conflict of interest pertaining to this study. Indranil Chakravorty (IC), Sunil
Daga (SKD), Geeta Menon (GM), Subodh Dave (SD), Subarna Chakravorty (SC), Neeraj Bhala (NB), Ramesh
Mehta (RM) & JS Bamrah (JSB) are honorary members of BAPIO Institute for Health Research, Bedford,
UK. BAPIO is a national professional body of multi-professional health care workers in the UK since 1996
( Individual contributions are study design (IC, SKD, JSB & SC); analysis (IC &
SKD); interpreting the results and writing the manuscript (all).
The authors wish to thank the staff at BAPIO Head Office, particularly Sneha Deshpande and to all
members of BAPIO Think Tank who had helped to distribute the survey.
1. COVID-19: protecting health-care workers. Lancet 2020, Volume 395, ISSUE 10228, P922, March
5. Exclusive: deaths of NHS staff from covid-19 analysed; HSJ April 2020
6. ICNARC Case Mix Programme Database COVID19 Report; April 2020
7. Chakravorty, I., Daga, S., Dave, S., Chakravorty, S., Menon, G., Bhala, N., Mehta, R., & Bamrah, J.
(2020). An Online Survey of Healthcare Professionals in the COVID-19 Pandemic in the UK: :
Perceptions of Risk Factors. SUSHRUTA Journal of Health Policy & Opinions, 13(2).
8. The COVID-19 Pandemic: a Call to Action to Identify and Address Racial and Ethnic Disparities; J
Racial Ethn Health Disparities. 2020 Apr 18
9. Ethnicity and COVID-19: an urgent public health research priority; The Lancet April 2020.
12. Racism and Health: Evidence and Needed Research; Annual Review of Public Health 2019
Chakravorty_bame_doctors v1