Clinical research’s fight against COVID-19: will we be defeated by ignorance to diversity?
Firstly, we must start by saying that we recognise that the journey from we when first understood COVID-19 to be a global pandemic, to where we are now, has been a whirlwind. It’s not something we were prepared for (despite previous virus outbreaks – we’re only human eh?), and we’re all learning as we go. That said, we can’t look at the efforts being made through rose-tinted glasses. Yes, we need to unite, be supportive and help not hinder. But in order to uncover truths and to really do our best by all humankind, we have to highlight where we’re going wrong, too. And one of those not so great areas that we’re all too aware of at COUCH Health, is how the tracking and reporting of coronavirus victims is overlooking clear ethnic and cultural differences.
Look closer at the victims
It’s important to note that coronavirus can affect anyone. However, take a closer look at the data that are currently available, and there’s plenty of reason to believe that some communities are more affected than others. For example:
70% of reported coronavirus victims in Chicago were black, despite representing only 30% of the population.
70% of reported deaths in Louisiana are black people, who make up 32% of the population.
40% of deaths reported in Michigan are black people, yet they make only 15% of the population.
The UK is yet to provide any breakdown of victim data by ethnicity, but there’s evidence that tells a similar story from the Intensive Care National Audit and Research Centre, based on 3,300 patients from intensive care units across England, Wales and Northern Ireland. It suggests that 34% of critically ill coronavirus patients are from black or minority ethnic backgrounds, which is more than double the representation in the wider population.
Something that should have really stood out to everyone keeping up with the news in the UK, is that the first four doctors to lose their lives treating COVID-19 patients were men of African or Asian heritage. And their deaths were followed by a black healthcare assistant and a nurse of Pakistani descent.
On a first look, it tells a shocking story, right? But understanding that one in five people working for the NHS in England are from an ethnic minority background (a number that increases when you just take into consideration doctors and nurses) does give some context. Ethnic minority staff make up 40% of the NHS’s workforce, which is more than double their proportion in the UK population. The graph below outlines the ethnicity of NHS staff with percentage of workforce by know ethnicity, year ending March 2019.
Context aside, there’s no denying that ethnic minorities are being impacted in a higher proportion. In recognition of this, the #CharitySoWhite campaign has demanded action over the disproportionate impact of the virus on Britain’s minorities. Their report goes further than just looking at key workers, and reveals evidence that reduced access to health treatment compared with white people, the impact of school closures, lower income and insecure housing put ethnic minorities at greater risk. That action they’re demanding from their campaign needs to come from all key decision makers involved, including those in the clinical research world…
A time for change in clinical trials
As we said at the start, action has been taken at a faster pace than normal when making decisions around responses to the COVID-19 pandemic. But when it comes to clinical research, producing valid scientific results that are inclusive of all whom the virus can affect is vital and can’t be an afterthought.
There’s clear evidence that all ethnicities can be affected by coronavirus, and that ethnic minorities in particular are impacted most. So, clinical trials looking to develop vaccines and medicines that actually work need to be trialling them on those who are most vulnerable to contracting the virus. There’s simply no excuse to fail to fairly represent members of minority populations in clinical studies. Overlooking this will mean that there’s yet another condition where treatment is less available and less effective to these populations.
Right now, not enough is being done to track infections by ethnic groups. If we don’t truly understand who, then how can we even begin to speak to the right people needed to take part in a clinical trial? How are we supposed to create treatments, guidance, and interventions that will actually make a real difference to those who the virus impacts most?
The simple answer is that we can’t, so we won’t. And where does that leave us in our fight against this global pandemic? We’d say, defeated.
There are too many conditions and diseases that have treatments and medicines developed without true testing on the minority populations they affect most. So for too many people, they simply don’t work. If we’re going to stand by the mantra that “we’re all in this together” shouldn’t we be putting it into action in every way we can? Shouldn’t the clinical research industry be leading the way if we’re going to be leading the fight against the virus? We think so, here at COUCH Health. What do you think?