Since March 2020, when reports that the UK’s minority ethnic groups were being disproportionately affected by Covid-19 first came to light, CRER has been keeping a close eye on data showing racial disparities in the impact of the virus. Early reports showed that the first medics who lost their lives from the virus were all from BME backgrounds, and as time went on, evidence on this was building consistently in other parts of the UK.
Meanwhile, the silence on this in Scotland was conspicuous. A Parliamentary Question was lodged on 21st April, asking the Scottish Government "What research its COVID-19 advisory group has carried out or plans (to carry out) on rates of infection and death from the virus among black and minority ethnic (BAME) people."
It was due to be answered by 5th May 2020, but by that deadline only a holding answer was given (simply stating that a reply would be provided as soon as possible). It seemed to us that the lack of response strongly indicated that, two months into the crisis, there was no formal position on ethnicity monitoring of COVID-19 indicators in Scotland.
As a result, we wrote to a number of key people and agencies, including the Chief Medical Officer, the Chief Statistician, the Minister for Older People and Equalities, National Records of Scotland and Public Health Scotland to raise this:
"I'm emailing you today to call for urgent action on ethnicity monitoring of COVID-19 across all currently reported indicators.
You will no doubt be aware of the mounting body of evidence of severe racial inequalities identified in England and Wales, particularly regarding COVID-19 death rates. This data has been routinely collected, collated and made available to researchers since the beginning of the pandemic. Today, the Office for National Statistics confirmed that the death rate for Black men and women in England and Wales is four times that of the white population. However, to date, we are not aware of any statistics disaggregated by ethnicity that have been released in Scotland.
Scotland's public bodies and Government have both ethical and legal imperatives to ensure that the approach to managing the COVID-19 pandemic does not replicate or further entrench racial inequalities. It's therefore vital that all bodies with a role in gathering or disseminating data related to COVID-19 work together to develop a coherent approach to ethnicity monitoring.
Without immediate action, it will be too late to identify and mitigate inequalities for minority ethnic people. If you / your organisation is currently undertaking any work towards this, we would be grateful if you could respond to us with this information - and if not, we would be grateful if you could assure us about any action that you will take now".
National Records of Scotland (NRS) were the first to respond. They are responsible for recording data on deaths in Scotland. Although they published a two page report entitled Deaths involving coronavirus (COVID-19) in Scotland by ethnicity recorded at death registration, they were keen to downplay its validity. Collection of ethnicity data is undertaken on a voluntary basis and "unlike the rest of the death registration process, are not statutory" and NRS did not believe that the ethnicity data that has been submitted so far is "at an acceptable level of quality to produce robust statistics for these purposes".
Bearing in mind the above caveats, the NRS data (covering the period 1st January 2020 to 26th April 2020) showed that, of the 2,272 deaths recorded:
2,046 deaths (90%) were of people whose ethnic group was registered as White
Registered deaths within Black, Asian or other minority ethnic groups accounted for only 1% of deaths
Ethnicity was unknown for 9% of registered deaths, and therefore the true number of COVID19 deaths within ethnic groups couldn't be accurately estimated from the registration data. For example, the true proportion of COVID-19 deaths among the BME groups could be anywhere between 1% and 10%
Public Health Scotland looked at an initial analysis of COVID-19 outcomes across different ethnic groups in their weekly report of 20th May 2020, covering the period up to 5th May 2020.
The data showed that among those with recorded ethnicity, non-white groups accounted for only around 2% of those hospitalised with COVID-19. When comparing the rate of COVID-19 across different ethnic groups in comparison with the rate in the white group, the odds ratios were estimated to be 1 or lower for all the ethnic minority groups except the 'Other' group. In other words, all BME groups (apart from 'Other') are less likely to be recorded as having COVID-19 compared to the white group.
Data on severe cases, where someone has been admitted to the ICU or has died, showed very small numbers of non-white COVID-19 patients experiencing more severe illness from Covid-19. There were no recorded patients with a Black/Caribbean/African ethnicity with severe disease and only 14 non-white patients in this group overall (around 1%).
However, again there were issues with the data. Confidence interval calculations demonstrated that the data was too sparse to draw firm conclusions. The overall conclusion was that "...based on the available data to date, the proportion of ethnic minority patients among those seriously ill with COVID-19 appeared no higher than the relatively low proportion in the Scottish population generally."
The Scottish Government Minister for Older People and Equalities responded to our initial email on behalf of all the recipients that are part of the Scottish Government and its agencies. Part of this response restated the poor quality of the data currently available, and stated that options for improving this were being explored.
The Scottish Government have now convened a short life working group to look at the Impact of COVID-19 on Minority Ethnic Communities in Scotland. It's remit is to "work to contribute to the Scottish Government’s emerging approach, and advise on proposed actions to mitigate the harms felt by minority ethnic communities in relation to COVID-19" and will be "focussed on specific issues arising from COVID-19 in relation to data, equality, health inequalities, and other identified inequalities".
CRER is a member of this working group. Following an initial meeting on 10th June, a further meeting is scheduled for Thursday 25th June, when it's hoped that more up to date and more reliable data will be available.
Action on this has been slow, and many questions are still unanswered - how does the ethnicity breakdown of the death rate compare to the same period in other years, and how is the data affected by variables that might obscure the extent of any inequalities? Importantly, as well as gaining an accurate picture of what's happening now, this work needs to embed changes for the future.
The divergence in data practices between Scotland and the rest of the UK isn't acceptable, and the excuse that minority ethnic communities here are small in number will no longer stand. If anything, this makes it more important to have robust and comprehensive data collection.
The situation in England and Wales shows the deadly consequences of racial inequality during the pandemic. With the possibility a second wave, we cannot afford to have the same thing happen here.
For information, some of the key documents looking at ethnicity and Covid-19 for England and Wales include:
Coronavirus Related Deaths by Ethnic Group, England and Wales
Disparities in the risk and outcomes of COVID-19
Beyond the data: Understanding the impact of COVID-19 on BAME groups