Ethnic disparities in health & social care workers’ exposure, protection, and clinical management of the COVID-19 pandemic in the UK

ABSTRACT

This paper examines determinants of ethnic disparities in workplace risks of COVID-19 among health and social care workers (HCWs) in the UK. This was undertaken to inform public health policy in the management of COVID-19 relating to health and social care provision. A cross-sectional survey was administered in July–August 2020 (n = 456) to elicit HCWs’ experiences of COVID-19 management in the workplace and their perceptions of exposure, personal protection against infection, involvement in local clinical management, and other workplace hazards. Findings suggest minority ethnic HCWs were twice as likely as White HCWs to be in a patient-facing role (OR = 2.14, 95% CI:1.21; 3.78, P < 0.01) and twice as likely (63% vs 39%) to be caring for COVID-19 positive patients (OR = 2.68, 95% CI: 1.77; 4.06, P < 0.01). Those in nursing, were three times as likely to be redeployed to a COVID-19 care setting (OR = 3.33, 95%CI: 1.23; 9.02, P= 0.02). Minority ethnic HCWs within lower- and mid-level roles carried a higher burden of frontline clinical management of COVID-19 positive patients than their White counterparts. This study found evidence of ethnic disparities across several workplace hazards, with increased exposure to and less protection against infection, more responsibility for the clinical management of infection, and evidence of systemic racial bias in the disproportionate redeployment of minority ethnic nursing staff to COVID-19 areas. An NHS-wide review is required to assess procedural fairness, ensure safe practices now, and to avert future crises.

KEYWORDS:

• Intersectionality
• healthcare workers
• COVID-19
• ethnic inequalities
• health & social care

Acknowledgements

We express our sincere gratitude to the health and social care workers who despite their workloads participated in the study and shared their experiences.

Author contributions

AK, AV, and KB conceptualised the study and designed the survey with inputs from DO and other members of the I-COPE consortium. DO and AK administered the survey. AK, MO, OA, AN, KB analysed data. All members commented on the draft and approved the final submission.

Disclosure statement

M Otis is funded by NIHR Applied Research Collaboration Northwest London. M Pareek is funded by National Institute for Health Research (NIHR) Development and Skills Enhancement Award and from MRC-UK Research and Innovation (MR/V027549/1) and the Department of Health and Social Care through the NIHR. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Supplementary material

Supplemental data for this article can be accessed here.

Notes

1. A research consortium was established in May 2020 to examine HSC workers’ experience of COVID-19 management and protections at workplace, and investigate the role of ethnicity, gender, role, and other factors in determining these. Led by Kapilashrami, the Intersectional view on Covid-19 Protections & Experiences (I-COPE) consortium comprises researchers from the Universities of Essex, Queen Mary and Leicester as well as practitioners and activists from the NHS and People’s Health Movement (UK).