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Case study: Investigating the risks of COVID-19 for ethnic minority healthcare workers - UK-REACH

The NIHR is funding and delivering urgent research during the emergency phase of the COVID-19 pandemic that will provide rapid benefits to patients and the public.

On the frontline of healthcare

As the COVID-19 pandemic has grown and spread, it has become clear that people from black, Asian and minority ethnic (BAME) backgrounds are more likely to catch coronavirus and to have a severe infection or even die. 

A report by Public Health England has shown that the rate of diagnosis of COVID-19 is highest in people from Black ethnic groups, with death rates between 10% and 100% higher in black and Asian ethnic groups compared with white ethnic groups. 

This risk is amplified for healthcare workers, who have higher exposure to coronavirus owing to their occupation. Analyses estimate that more than six in 10 of the healthcare professionals who have died from COVID-19 were from BAME backgrounds.

“As an infectious diseases specialist, we’ve had to look after patients with COVID-19 from the early days of the pandemic,” says Dr Manish Pareek, Associate Clinical Professor in Infectious Diseases at the University of Leicester.

“I remember clearly being on call the week when things started to worsen. Although we had seen what was happening in China and Italy, we hadn’t ever seen anything like this before.”

Understanding risk in ethnic minority healthcare workers

In an urgent response to this, the NIHR, working with UKRI’s Medical Research Council, has announced a multimillion-pound investment into five research projects to investigate COVID-19 and ethnicity.

The diverse range of projects funded by the NIHR and UKRI will help examine the association between COVID-19 and ethnicity in detail, so that new treatments and approaches to care can be developed to target the ethnicities most at risk.
Chief Medical Officer for England and Head of the NIHR Professor Chris Whitty

Dr Pareek is leading one of these urgent projects: the UK Research Study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH). This study will calculate the risk of contracting and dying from COVID-19 for healthcare workers from certain ethnic groups, using existing data held by national healthcare organisations.

The study, which has already begun, will follow a group of ethnic minority healthcare workers over 12 months to see what changes occur in their physical and mental health. Dr Pareek and his team will also interview a smaller group of ethnic minority healthcare workers to understand how risky their jobs are, and how they have changed their professional and social behaviours in response to COVID-19. 

“Using staff data and linking it to healthcare data may be sensitive,” Dr Pareek says, “and so we will explore how to do this in a way that is acceptable. We want the findings of this research to be useful for healthcare workers and so we have a stakeholder group of major national organisations to help us do the research, publicise the findings and make recommendations.”

This is a vital, wide-reaching study that aims to provide rapid evidence through five interlinked work packages. One strand, for example, will provide expedited linkage and analysis of anonymised registration datasets from the General Medical Council and Nursing and Midwifery Council and from the NHS to calculate the incidence of, and outcomes from, COVID-19 amongst healthcare workers. 

The study has also been awarded Urgent Public Health Research status by the Department of Health and Social Care, to expedite its delivery in the NHS by the NIHR Clinical Research Network.

Bringing personal experience to the fore

Dr Pareek and his team are acutely aware of the potential impact their research will have on government policy, so are working fast to answer the critical questions. But this isn’t only about analysis and figures—for Dr Pareek’s team working on the study, dealing with COVID-19 in this context has been very real.

“I was one of the first doctors to see and treat the first patient with COVID-19 in Leicester,” says Dan, a registrar on the research team. 

Of Chinese ethnicity, Dan contracted COVID-19 early on. “In some ways, as someone so involved in the local COVID-19 response, it was not a surprise when I got COVID-19 myself. I knew instantly when I started getting fevers, chills, aches and pains. I was hopeful that I would get over the illness since I am young with no comorbidities.” 

Dan was hoping to improve but after seven days of non-stop fever, breathlessness and coughing, he ended up in the infectious diseases unit he works in, requiring oxygen, and eventually needing to go to the intensive care unit.

For Dr Pareek, these have been challenging times, but the experience has united his healthcare team. “Patients were arriving very unwell and requiring a lot of care,” he says, recalling the start of the pandemic. 

“It was stressful for everyone (and I particularly include in that families of those who were unwell). But from that adversity, the hospital and staff from all specialities and levels of seniority came together in a common purpose of dealing with the pandemic.”

As the urgent study continues, Dr Pareek wants the research to answer two simple questions: if, how and why ethnicity affects COVID-19 clinical outcomes in healthcare workers; and what the impact of COVID-19 is on the physical and mental health of ethnic minority healthcare workers

“By undertaking this work,” he says, “I want us to understand what the risk is and help inform the government on how we can reduce that risk, so as to prevent healthcare workers, my colleagues, becoming unwell and dying.”