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Ethnicity and covid-19

BMJ 2020; 369 doi: (Published 11 June 2020) Cite this as: BMJ 2020;369:m2282

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Rapid Response:

Re: Ethnicity and covid-19. The case for evidence based videos on covid 19 for ethnic minorities

Dear Editor

Covid-19 has affected many populations in the UK, in particular ethnic minority communities. Bangladeshi patients are twice as likely as White British ones to die from it, with higher risks for Afro-Caribbean, Pakistani, Indian and Chinese communities, compared to White British. (1) 36% of patients admitted to critical care were from an ethnic minority, and these tended to be younger than White British ones. (2)
There is evidence of the influence of social determinants of health in contributing to these stark figures. These include some ethnic minority communities living in poor housing, having poorer incomes, and working in jobs with more exposure to people. (1) There is also structural racism in the NHS. (1) Stakeholder discussions have revealed structural racism may result in ethnic minorities presenting later with Covid 19, with added risk of mortality. (1)
One factor contributing to structural racism is language barriers to health information. The government has recommended addressing this for Covid-19. (1) There has to be linguistic and cultural competence, to convey the messages effectively. (3) The NHS already produces written resources in different languages. However, this does not take into account those who cannot read or write in their mother tongue, and not all patients are receptive to written material. Latif et al found statistically significant improvement in knowledge of coronary artery disease, after a group of Bangladeshi women viewed a video on the topic. (4) Videos would therefore be a suitable method by which to convey key points.
There is a need for evidence-based videos during Covid-19. Many patients have resorted to internet videos, to find out information about the disease. In a recent study looking at Covid-19 information on YouTube, Li et al found that 27.5% of videos contained wrong information, and advised healthcare professional engagement in videos to counter this. (5) (5) Basch et al also found key preventative behaviour advice missing in more than two thirds of Covid-19 videos they sampled. (6)
AskDoc is a Greater Manchester organisation, which aims to educate, empower and engage the local ethnic minority populations. The organisation has been largely involved in delivering health related workshops in Greater Manchester since 2011. The key drive is to impact directly within the community, in their community centres and places of worship. Its approach is collaborative, engaging with CCGs, Public Health England and charities. Defining projects have included a Hepatitis C Awareness project, with delivery of workshops around Greater Manchester, the production of a Hepatitis C awareness video, and testing patients for Hepatitis C at the Manchester Mega Mela and local mosques.
When Covid-19 arrived, the opportunity for regular workshops was lost. The organisation therefore had to evolve and be recipient to the needs of the local community. The result of this has been the production of regular bespoke videos relating to Covid-19. These have been in a variety of languages, delivered by doctors and medical students, utilising up to date public health messages. Topics covered have included Covid-19 specific advice on pregnancy, Ramadan and Eid. Manchester Health and Care Commission (MHCC) have recently commissioned a video in five languages, to cover key information on the Greater Manchester lockdown. There are currently fifty-five videos created on YouTube since March 2020. The YouTube channel has 47 subscribers, with the most popular video having 376 views. The majority of messages are in English, Sylheti, Urdu, Gujarati and Arabic. However, there also videos in 13 other languages, highlighting key guidance on Covid-19. The videos are popular, particularly as the speakers in the video have used simple, easily understandable language to deliver the messages.
This video project has identified a key way to disseminate important information on Covid-19. The main concern has been to ensure a sustainable approach to design and delivery of the resource. Volunteers have given their precious time to write scripts and deliver video messages, with little use of additional technology. There needs to be financial and time investment, to improve the quality of videos and the variety of languages on offer. I recommend investment in this area, to enable further bespoke videos for local communities. I hope this will help create a rich media to counter the misinformation on the internet, and improve Covid-19 health outcomes in ethnic minority communities.


Competing interests: Chair of AskDoc

29 August 2020
Enam Haque
GP Clinical Senior Lecturer