There is no stopping covid-19 without stopping racismBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2244 (Published 09 June 2020) Cite this as: BMJ 2020;369:m2244
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We agree with Abraar Karan and Ingrid Katz that “there is much work to be done” to stop racism (Karan & Katz, 2020). It is not a surprise that there are protests in support of the #BlackLivesMatter movement. For communities in the UK and USA, who are also at a higher risk of COVID-19 mortality and morbidity, the death of George Floyd highlights the fatal consequences of systemic racism suffered by Black people in their ordinary lives, irrespective of the pandemic.
To address racial prejudice, we need to speak directly to racial inequalities and create a workforce that is educated and reflective about racism and its detrimental impact. We need action to effect change with expediency.
Medical schools and other educational institutions need to tackle racism head on. Evidence of institutional racism already exists (Woolf, 2020), so does the evidence on what needs to change to address this. There is no need to invite BAME medical students and qualified doctors to tell their stories again through research or other methods of capturing experiences before instigating action. The repetition of sharing these experiences not only serves to retraumatise students and professionals who share their stories but also is counterproductive because it prevents us actually attempting to find solutions. These experiences are widely shared, widely known and widely understood.
Instead let’s educate our future physicians. Let’s talk about race and racism and empower our students to tackle it when they face it, when they see it, or when they hear it. Let’s teach medical students about how racism can affect health and wellbeing, and what they can do to root out racism in any context they find themselves in.
Let’s start by taking action very swiftly. Norwich Medical School students and staff have co-created Bystander Intervention Training, to enable us all to recognise and call out intentional and unintentional racist behaviour and microaggressions within the campus, the hospital, GP practice or any other context. This not only put the onus on the victims of racial discrimination to act, but also encourages peers and colleagues to implement a united front and shared accountability to deal with racism. We have also developed an Academic Mentoring scheme for BAME medical students. This will aid in creating professional relationships to build confidence and inspire junior medical students to take control of their own personal and professional development and work.
Explicit commitment and accountability are key. Norwich Medical School created a BAME Working Group in 2019 to specifically address differential attainment, and in 2020, have signed up to the British Medical Association Charter for medical schools to prevent and address racial harassment (BMA, 2020). We call on other medical schools to do the same.
We have incorporated the inclusion of explicit learning outcomes and teaching on the differences in health needs of and barriers faced by BAME populations within the core medical curriculum. Further steps to decolonise the existing curriculum are needed too. Gaps in our dermatology teaching have been addressed to include teaching on common and important dermatoses in the skin of people of colour (Kaufman & Alexis, 2018).
We agree with Liam Schneider that “we should lead by example examining and combating racial inequality in healthcare institutions” and we hope other medical schools will follow our lead. Let’s create graduates who are prepared to practice, but also well-informed and reflective about racism and its detrimental impact on communities and our society. Let’s promote and foster allyship amongst our white colleagues. Let’s have a medical workforce that is committed to equality for all. Let’s Speak up and Speak out.
BMA. (2020). Addressing racial harassment in medical education: a charter for medical schools and guidance for medical students. Retrieved from www.bma.org.uk
Karan, A., & Katz, I. (2020). There is no stopping covid-19 without stopping racism. BMJ, 369.
Kaufman, B. P., & Alexis, A. F. (2018). Psoriasis in skin of color: insights into the epidemiology, clinical presentation, genetics, quality-of-life impact, and treatment of psoriasis in non-white racial/ethnic groups. American journal of clinical dermatology, 19(3), 405-423.
Woolf, K. (2020). Differential attainment in medical education and training. In: British Medical Journal Publishing Group.
Competing interests: No competing interests
Re: There is no stopping covid-19 without stopping racism - Protests in the UK and the COVID 19 risk these pose: We need to talk about the public health implications of protesting at this time, however difficult it is.
I commend the powerful article by Aurar Karan and Ingrid Katz and am highly supportive of the message that healthcare workers should be force for good in the campaign against racism. However we need to be realistic about the public health problem of mass protests at this time.
In many respects, it is heartening to see this level of engagement from people in an effort to address longstanding, racial injustice seen in society in both the USA and the UK.
It is true that poverty and violence that are linked to established racial inequality is undoubtedly a huge factor in a lot of preventable deaths.
However these efforts to engender long overdue societal change in the current climate clash with a social responsibility to try and limit the spread of COVID 19 – particularly to protect the most vulnerable in our society.
In normal circumstances, I would be naturally supportive of the protests in the UK backing the Black Lives Matter movement. However, it is important to talk to people, as healthcare professionals, in the face of on-going protests about the risks these gatherings pose.
I am deeply supportive of the Black Lives Matter movement and horrified by the on-going racial inequality in both the UK and USA. However, the current protests feel socially irresponsible given the current precarious stage we are at in the COVID 19 pandemic. Those organising the Black Lives Matter protests in the United Kingdom have not properly addressed the health risks to the protesters and their households.
There are a variety of factors that make these protests high-risk in terms of the containment of a dangerous infectious disease. Young protesters are much more likely to be asymptomatic and are therefore at higher risk of spreading the virus. Socially distanced protesting has been attempted in some places but is clearly not happening in a large amount of the protests that have taken place. The evidence behind facemasks is of poor quality and often contradictory [1–3]. In addition, currently in the UK the R number of 0.7-0.9 is precariously close to the point of exponential transmission.  Even if we had a properly functioning track and trace system in this country, it would be overwhelmed by these protests.
As is mentioned COVID 19 has disproportionately affect BAME patients. Healthcare workers have not been exempt from this and the amount deaths of BAME workers in the UK is a travesty.  To place more of these workers at risk through these protests is potentially a tragic unintended consequence that should not be ignored.
There are many safer ways to engage with the Black Lives Matter movement. Donating to the many excellent funds set up in the wake of George Floyd’s killing or charities focused on helping disenfranchised BAME communities, for example. Sign petitions, write to your MP or virtually protest.
We, as healthcare workers, could aim to be a voice that discourages risky group meetings and protests. But rather than scolding those involved, be a positive voice for engagement and social change in a safer way. We should lead by example examining and combating racial inequality in healthcare institutions.
I believe that it is still possible to be highly supportive of the Black Lives Matter movement and think the harsh reality of COVID – 19 is that mass protesting at this time is unwise.
It does feel apt to describe the deaths linked to racial inequalities as a pandemic. If a protest movement against these inequalities is a step on a long road to righting this wrong unfortunately it collides with the realities of another pandemic, and will possibly see a rise in deaths as a result.
I am not saying do not engage with Black Lives Matter – we must. I am not saying don’t protest ever. I am just saying don’t protest when it is this dangerous. It is dangerous not because of an oppressive government, but because of a deadly virus.
This feels like another painful consequence of the coronavirus pandemic: that an effort to stand up for the disenfranchised in society might lead to more deaths for the very section of society protestors are trying to support.
1. Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. The Lancet [Internet]. 2020 Jun 1 [cited 2020 Jun 4];0(0). Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/abstract
2. Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Eur Respir J [Internet]. 2020 Jan 1 [cited 2020 Jun 4]; Available from: https://erj.ersjournals.com/content/early/2020/04/27/13993003.01260-2020
3. A systematic review investigating the effectiveness of face mask use in limiting the spread of COVID-19 among medically not diagnosed individuals: shedding light on current recommendations provided to individuals not medically diagnosed with COVID-19. 2020 Mar 7 [cited 2020 Jun 4]; Available from: https://www.researchsquare.com/article/rs-16701/v1
4. The R number in the UK [Internet]. GOV.UK. [cited 2020 Jun 4]. Available from: https://www.gov.uk/guidance/the-r-number-in-the-uk
5. Cook T, Kursumovic E, April 2020 SL. Exclusive: deaths of NHS staff from covid-19 analysed [Internet]. Health Service Journal. [cited 2020 Jun 8]. Available from: https://www.hsj.co.uk/exclusive-deaths-of-nhs-staff-from-covid-19-analys...
Competing interests: No competing interests