Nearly all the doctors who have died of covid-19 in the United Kingdom have been ethnic minorities, most born overseas, like el-Tayar, according to the British Medical Association.
That grim toll has confounded health experts, alarmed minority physicians, and startled a nation that relies on immigrants to swell the ranks of its public health-care system — yet voted for Brexit with a promise to “take back control” of its borders and limit immigration.
An estimated 44 percent of doctors in Britain are from ethnic minority backgrounds, significantly higher than the 13 percent in the population at large. Last year, more than half the new doctors who registered in Britain were born overseas.
But experts say it’s still baffling that 93 percent of the doctors who have died of covid-19 were ethnic minorities.
“I can’t get my head around that,” said Michael Marmot, director of the Institute of Health Equity at University College London. “Maybe we will understand more about this terrible disease if we can explain that,” he told a parliamentary committee.
Doctors’ associations in Britain have called for a government investigation, while National Health Service leaders have advised hospitals to “risk-assess” staff and “make appropriate arrangements accordingly.” Hospitals are debating whether they should shift ethnic minority staffers away from the front lines.
If necessary, some staff should be redeployed, said Neil Mortensen, president of the Royal College of Surgeons. He told Sky News: “It’s important they are removed from — if you like — from danger.”
According to a Guardian newspaper analysis, more than 180 health workers have died of covid-19, the majority of them ethnic minorities. Another analysis of 106 National Health Service deaths found that two-thirds were among ethnic minorities.
The disparity is even greater for doctors.
Chaand Nagpaul, the chair of the British Medical Association, began calling for answers after the first 10 doctors who died of covid-19 were all from ethnic minority groups. Now, the count is 27 out of 29.
“These figures are so stark and extreme. That’s why we need an investigation,” he said.
Nagpaul said there could be a number of contributing factors, including those that affect minority groups more generally.
As in the United States, the coronavirus has hit ethnic minorities disproportionately hard here. Britain’s Office of National Statistics found that black people were more than four times as likely to die of covid-19 as white people in England and Wales, while people of Bangladeshi and Pakistani origin were more than three times as vulnerable as their white counterparts.
Nagpaul noted that among ethnic minorities in Britain, there is a greater prevalence of diabetes, cardiovascular disease and hypertension — health conditions thought to increase the severity of covid-19 — compared with the British white population.
Some physicians have also questioned whether vitamin D deficiency might play a role. People with dark skin tend to need longer in the sun than those with lighter skin to produce the same amounts of vitamin D.
But Nagpaul said there could be cultural and occupational factors at work, as well: Migrant doctors may be doing more of the front-line work, at the hardest-hit hospitals, in the most stressed settings.
A survey this month by the Royal College of Physicians found that 48 percent of all doctors reported being concerned or very concerned for their health, but that the number rose to 76 percent among ethnic minority doctors.
A separate British Medical Association poll last month of doctors involved in fighting covid-19 found that only 40 percent of ethnic minority doctors said they had sufficient access to personal protective equipment, compared with 70 percent of white doctors who said the same. And minority doctors were twice as likely to say they felt pressured to work in risky environments without appropriate protective equipment.
That’s in line with previous studies showing that ethnic minority doctors feel less confident than their white counterparts in raising safety concerns and report higher levels of bullying and harassment.
The result, Nagpaul said, could be that some feel they “have not been able to speak out about concerns of working in environments without full protection.”
One doctor who did publicly push for more protective equipment was Abdul Mabud Chowdhury, 53, a urologist originally from Bangladesh. Within days of contracting the virus, he wrote an appeal to the British government, asserting that health-care workers had “the human right like others to live in this world disease-free with our family and children.”
He was the “bravest person I knew,” said his son, Intisar, 18.
Chowdhury and his wife, Rehana, met at Chittagong Medical College in Bangladesh. They moved to England in 2001, got jobs with the National Heath Service and had two children: Intisar, who is finishing high school, and Wareesha, 11, whom her father called “my lovely-jubbly daughter.”
Chowdhury’s mentor and friend, Jhumur Pati, also from Bangladesh, described him as “extremely respectful, extremely dedicated.” They shared an office at Homerton University Hospital in east London. When no one else was around, they would speak in their native Bengali.
One of Chowdhury’s proudest professional achievements, Pati said, was setting up the BKN Memorial Hospital and Research Center, a facility in Bangladesh named after his wife’s father, mother and sister, who died in a car accident.
“He had a big heart and wanted to share his expertise,” she said.
Even after Chowdbury began to feel sick, he put off going into the hospital, because “he didn’t want to overburden the system,” Pati said.
She worried that her friend may have been a “very borderline diabetic” and was probably slightly overweight for his height. But she said she thinks that if more was known about the disease, his death could have been avoided.
The doctors who died of covid-19 in Britain came from Bangladesh, India, Iraq, Malawi, Nigeria, Egypt, Pakistan, Sri Lanka and Sudan — former colonial outposts and mandates. In obituaries, Facebook posts and interviews, family and friends repeat the same words to describe them: generous, hard-working, selfless, kind. They came here to practice medicine, while building new lives for their families and establishing themselves in their communities.
“Our father was the glue that kept us together,” Osman el-Tayar said. “I can’t really put it into words. It was the worst thing that could happen to us.”
Adil el-Tayar was born in Atbara, Sudan, a railway town built by the British, and studied medicine at the University of Khartoum. A British doctor he met encouraged him to move to the United Kingdom. He arrived in 1996, and although he returned to Sudan at one point to establish an organ-transplant unit there, he spent most of his adult life in Britain.
“He never forgot his roots, but he certainly identified as British,” said Osman el-Tayar, 30, speaking from the family home in west London.
Like his father and eldest sister, Osman el-Tayar is a doctor. He said the number of ethnic minorities dying was “quite frightening. The question that jumps into everyone’s mind is: Why? I don’t have an answer, but it’s probably multifactorial.”
He said his father had been diabetic and had high blood pressure.
Asked if his father had the protective equipment he needed, Osman el-Tayar said, “Given that he picked it up, he clearly didn’t.”
Adil el-Tayar had long told his family that he wanted to be buried in Sudan next to his father. Given the lockdown, that seemed impossible. But his wide network of friends and family mobilized and they were able to send his coffin on a cargo plane.
The funeral was broadcast on national television in Sudan. El-Tayar’s wife and four children watched from Britain on their devices.
“It was very humbling,” Osman el-Tayar said. “There was a very large crowd there that attended the burial. We obviously couldn’t make it because of what’s going on, but we got someone to FaceTime it for us.”
William Booth contributed to this report.