While I was doing my research on COVID-19 vs. Spanish Flu, it struck me that one of the hypotheses behind the high number of deaths among young people during the 1918-1919 influenza pandemic was overcrowding in the military settings and secondary bacterial infection. Increased risk in the military population could be due to increased influenza transmission, increased risk of bacterial coinfection in crowded conditions, or both factors.

This would be a simplification to use as an answer to all questions. However, while being active at war, in a ditch, trying to get out alive, washing your hands or not-touching your face is probably not a priority. Whether it’s genes or other correlation behind these findings it doesn’t take an expert that subsequent infections make a deadly illness far deadlier. This subsequent, aggressive bacterial pneumonia ‘superinfection’ was behind 85% of deaths from ‘Spanish Flu’.

100 years later, while we all have equal access to the same healthcare there is a group that seems to be picked by the disease unequally to the rest of the population. The poor. We heard more and more about higher death rates from COVID-19 amongst people from BAME background but we don’t know why. Some trying to blame genes while others point out to statistics.

Not being racially biased, the facts show that out of all the infected with coronavirus, 35% of patients falling critically ill are non-white. In March 64% of all deaths from COVID-19 at Birmingham City Hospital were from Black African and Asian communities. This figure dropped to 50% in April. The last census from 2011 accounted for 53% of Birmingham population as White British. The second-largest ethnic group were Pakistani with 13.5%. All other groups were below 6% of the total city population. This shows that people from BAME background are disproportionally more likely to die from COVID-19 than white people. But why?

For those not familiar with Birmingham, to the right are less affluent wards.

Social-economic factors are evident. People from BAME backgrounds are more likely to live in worse areas, overcrowded households and in much worse conditions. This has negative effect on their mental and physical health.

households in the Black African (20%) and Arab (17%) ethnic groups had the lowest rates of home ownership

https://www.ethnicity-facts-figures.service.gov.uk/housing/owning-and-renting/home-ownership/latest

Not being able to afford to buy, housing is the only option. Most Landlords don’t use a letting agent. There is a large number of rogue landlords and a lot of substandard properties that are continuously let due to the housing crisis. The councils are underfunded and don’t have enough officers to be able to check all properties making sure they meet requirements of the housing legislation. Affordability is a huge problem and many tenants, even those in full-time employment, cannot afford to find something better. They don’t complaint out of fear of being evicted.

in 2017, the Black, Mixed and Other ethnic groups had a higher than average percentage of their workforce in ‘elementary’ occupations, the lowest skilled type of occupation

https://www.ethnicity-facts-figures.service.gov.uk/work-pay-and-benefits/employment/employment-by-occupation/latest

Saying that pandemics make societies more equal is not accurate. This pandemic so far has shown that those who already suffer will suffer more. Ironically, this is the social group that has been labelled as ‘key workers’. Over 63% of health workers that died from COVID-19 were from BAME background. When cholera visited London for the first time in 1831 it took 34 years for the authorities to do something about it. The drainage wasn’t installed to prevent the poor from dying and most likely nothing would be done if the affluent weren’t affected too. Back then it was fear of dying, now we fear we will run out of ‘key workers’ without which this country will be on lockdown for a long time.

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