Somali families living in east London have been experiencing “acutely high” rates of infection and death during the Covid pandemic, a new study has found.
The researchers found that a late lockdown and a “community insensitive” public health approach contributed to a higher community death rate during the first wave of the pandemic in March 2020.
High rates of illness have been prolonged throughout the pandemic due to the “legacy of historical poverty, housing density and institutional racism,” the report said.
Ethnic minorities in London have suffered a disproportionate number of deaths during the pandemic and campaigners have called for race to be at the heart of the official Covid inquiry.
The report, published in the Journal of the British Academy, was prepared by Dr. Farah Bede, a Somali GP working in the East End, and Prof Joanna Lewis, Professor of History at the London School of Economics (LSE).
Data was collected from anonymised primary care patient records, in-depth interviews with residents, testimonies from GPs and feedback on preliminary outcomes from a panel of 100 community health workers in the region.
The authors note that Somali men were the first to be affected by the disease, with occupations such as Uber drivers, hospital porters and street cleaners being particularly hard hit.
Mohammed, in his 50s, worked as a taxi driver and contracted the virus in early April.
“I couldn’t get a test because there were no community tests. I wish I had known earlier and not passed it on to my family,” he said.
Muna, a community leader, said that at one point there were “five deaths a day from people we know of…. We know families that have been wiped out.”
The initially high rate of men being hospitalized meant the wider local community was less likely to report symptoms or delay serious breathing problems. The reason for this is “a massive fear of going to the hospital and dying alone,” says the report. Many of those surveyed in the report “remembered people who became ill or died in April.”
According to the report, “limited English” was a factor in persistently high mortality rates, as vulnerable patients were unable to seek treatment without the help of children, friends or neighbors. More than half of those surveyed reported problems dealing with receptionists at GP surgeries, with complaints that the health service had “less Somali-focused community health initiatives.”
Osob, an elderly Somali woman, recalled how one of her neighbors had deteriorated during the first lockdown, which banned all socializing.
“She became very lonely, stopped walking and quickly deteriorated. She was hospitalized and died soon after.”
Many in the community on “fragile incomes” have been forced to continue working on the front lines throughout the lockdown despite the risk of falling ill. These roles became a “transmission vector”.
Zamzam, an interviewee, said she has stayed overnight as a caregiver with recently discharged elderly Covid-19 patients, although no test was carried out on their return to the community to confirm they were negative.
The report also mentioned the problem of “poor housing and overcrowding” in east London, leading to increased transmission of the virus.
“From reviewed primary care medical records, it was found that the majority of patients lived in one- to two-bed apartments with the living room converted into an additional bedroom,” the authors wrote.
“On average, 4.7 people lived in each apartment.”
They added: “The disproportionate number of deaths from COVID-19 in BAME communities can be partially explained by people’s living conditions. More research is needed to look at the intersection of multigenerational living and overcrowded housing in driving health inequalities.”
The report also criticized “inconsistencies” in the government’s public health communications and in communicating with patients, leading to a “lack of trust”.
It added that vulnerability to Covid-19, mental health and economic inequality are “linked”, with the virus affecting people’s ability to find employment and their well-being.
Concluding their report, the authors said the impact of Covid-19 on the Somali community was a “perfect storm” that “severely tested and sometimes destroyed their coping mechanisms and stopped masking their underlying precarious health.”
They added that high infection and death rates have persisted longer because of the “intersection of historic socioeconomic and health inequalities, including racism.”
The researchers called for more trained Somali health professionals, sensitive community data and more local networks to reduce inequalities. A “culturally sensitive” approach is also needed to build “future resilience” for the Somali community, the authors said.