‘The virus piggybacked on racism’: why did Covid-19 hit BAME families so hard?

Sir Oyaseh Ivowi sits in front of a poster of two of his three boys. Olume, the older brother, hovers over Isi; both wear traditional Nigerian dress. Underneath are the words: “Gone too soon, but not forgotten. Olume Godfrey Ivowi, 7 November 1973 to 10 April 2020. Isi Benjamin Emitsemu Ivowi, 17 November 1985 to 19 April 2020.”

Olume, 46, and Isi, 34, died in Luton and Milton Keynes respectively. Their passing made headlines because it was so shocking: two brothers killed by Covid-19 in such a short space of time. A third brother, Osi, also caught the virus, but has recovered.

“It is not easy to lose two children in nine days,” Oyaseh says now. “As a Christian, whatever happens, we give glory to God, but it is not easy.” Oyaseh is 80, wise and accepting, but his pain is obvious, even over Zoom. He is at home in Benin City, Nigeria, and says the poster is there for the visitors who come to offer condolences – to make them feel at ease. They can sit in front of it, and don’t need to explain why they have come. When he talks about his sons, he veers between the present and past tenses. “They are lovely chaps – very close to each other. Isi is a Down’s syndrome child. He has learning difficulties. He is very close to Olume. I expect a call from them every Friday between 7pm and 12 midnight. They always phone me together. Isi is very jovial, always smiling and shaking hands. They are very active children.”

The Ivowi family moved to Britain in the 1960s. Oyaseh worked as a healthcare administrator before returning to Nigeria in the 1970s, where he ended up as a director of administration in a hospital. The boys’ mother, Agnes, who died in 2013, worked as an NHS nurse and midwife before returning to Nigeria. In recent years, the family have found themselves scattered around the world: Oyaseh in Nigeria, the boys in England, and their older sister Ida in the US. Despite this, they were close. While Isi celebrated last Christmas and New Year with Olume in Nigeria, Ida stayed in Milton Keynes with Olume’s family – his wife and their four-year-old daughter – and their brother Osi.

On a call from New York, Ida tells me how she and Olume went through an identical midlife career change. He was a business analyst, Ida worked in IT, and both decided to retrain as lawyers – Ida has just completed an MA in law. After their mother’s death, Olume effectively became Isi’s primary carer, visiting him every week in his sheltered housing.

“I miss Isi’s smile and his warm heart,” Ida says. “He was very caring, remembered people’s names. He loved music; his favourite song was Bob Marley’s Buffalo Soldier. Olume would never forget a birthday, and was the glue that kept us all together. Now we have to carry on that mantle.” Like her father, she says her Catholic faith is helping her cope.

The last time she spoke to Olume, he told her he was starting to feel better. Then, on 10 April, Good Friday, she was told he was going into hospital. There was a second call to say he had been admitted for tests. “The next call I got was that he had passed. And that was such a shock, because it was under two hours since he had left the house. It wasn’t something I could wrap my brain around. All I kept thinking was: how is his wife going to deal with this? This was somebody who was at home with her that morning.”

The following Thursday Isi tested positive for Covid-19 and was hospitalised. Three days later, he died. “Sometimes I still feel it’s not real, and then it hits me that they are gone,” Ida says. “We’re just trying to accept that this was their time to go, because you can’t deal with it any other way. We are continuing to celebrate their lives as best we can.”

It has brought the extended family closer together. “When Olume passed, we were on Zoom 24 hours a day. We stayed online with my sister-in-law, all day every day, till we buried the boys. Now that family unit, 10-15 of us, we do it every weekend.” The brothers were buried on 20 May in Milton Keynes. As neither Ida nor her father could attend the funeral, they watched it on Zoom. “Only a few people were there, physically. The boys were buried side by side. There was a requiem mass, Olume’s wife spoke, and there was a montage of pictures showing their lives. We played It Is Well With My Soul, a spiritual.” She says it was a beautiful ceremony.

Both the British and American governments have faced criticism about their initial handling of the pandemic – notably the lack of testing, personal protective equipment for frontline staff, and the delayed lockdown. In Nigeria, Oyaseh tells me, it has been a very different story. At the time of writing, there have been around 850 deaths in a country with a population three times that of Britain. Oyaseh, who was honoured with a papal knighthood in the early 1990s in recognition of his services to the Catholic church, believes the key factor is that the Nigerian government made serious preparations. “There was no question of it not being real. We had Ebola, and we had a strategy for dealing with it, which is still in place. For every pandemic, Nigeria has had a system. We were among the last countries to get it, so we had time to prepare.”

Meanwhile, Ida is cautious whenever she goes out in New York, where the number of deaths has now reached 32,000. Does she tell people off for not socially distancing? “Absolutely, you have to.” Would she mention her brothers? “No. I say, ‘This is not a joke. You have to be a bit more responsible – if not for yourself, for others around you.’ I don’t think it’s fair if I invoke my brothers, because they weren’t negligent, they were just unfortunate.”

Since their deaths, she has found a new sense of purpose. She wants to make sure her brothers are remembered, and hopes to set up a foundation for Olume’s family (a GoFundMe page has already been established). But she says her values have changed, too. “Before all this, my major ambition might have been to make a lot of money as a lawyer. Now I’m thinking more about working with people who can’t afford legal services.”

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On 27 March, Michael Gove told the daily Covid-19 press conference: “The fact that both the prime minister and the health secretary have contracted the virus is a reminder that the virus does not discriminate. We are all at risk.” While this is true, all the evidence suggests that certain groups are more at risk than others – men, the elderly, frontline workers, and ethnic minorities. A week before Isi Ivowi’s death, the Guardian reported that the first 10 doctors to die from the virus in the UK were all from ethnic minorities. Data collected by the Health Service Journal in March and April revealed that, while 21% of all NHS healthcare staff are black, Asian and minority ethnic, 63% of those who died with Covid-19 were BAME.

Meanwhile, the Office for National Statistics found that black men in England and Wales are three times more likely to die from Covid-19 than white men, and that black women were twice as likely to die from Covid-19 as white women. In June, a study of 30,693 people by the University of Edinburgh showed that south Asian people are the group most likely to die from Covid-19 after being admitted to hospital in the UK.

Around the same time, researchers at King’s College London found that BAME Covid-19 patients were on average 11 years younger than their white counterparts (63, compared with 74). New data on the disparity is being collated every week. While some findings appear to contradict others, what doesn’t change is that minorities are more vulnerable to Covid-19 than the white British community.

Why? The reasons are complex, interrelated, and much debated. Underlying health problems play a part. The King’s College researchers found that BAME patients were more likely to have high blood pressure (63.3% compared with 48% of white patients), and diabetes (48.6% compared with 24.6%). Geography is also a factor. London was hit fastest and hardest; at the last census, in 2011, 40% of Londoners identified as BAME, compared with 13% of the overall population of England and Wales. Public Health England (PHE) also produced a report claiming a lack of trust in the NHS may have left some BAME communities reluctant to seek help early enough.

Then there are socioeconomic factors. People of colour are more likely to work in high-risk frontline jobs (healthcare, public transport, essential shop work) and live in deprived, densely populated urban areas in crowded, multi-generational homes. A Runnymede Trust report published earlier this year shows that for every £1 that white households have in wealth, black Caribbean households have 20p, and black African and Bangladeshi households just 10p.

In May, the Ubele initiative, an African-diaspora-led organisation focused on building more sustainable communities across the UK, sent a letter to the prime minister signed by more than 650 people, calling for an independent public inquiry into the severe impact of Covid-19 on BAME communities. On 3 June, it sent a second letter, in response to a PHE report into disparities in the risks and outcomes of Covid-19 that produced no recommendations, contained no detailed breakdown of the impact on particular communities, and omitted third-party submissions. Two weeks later, having had no response, Ubele, represented by Leigh Day solicitors, called for the government to commit to an immediate independent inquiry into the disproportionate impact of Covid-19 on the UK’s BAME communities. The prime minister’s office has since responded in full to Leigh Day, resisting Ubele’s call for an inquiry and arguing that it has complied with the Equality Act in its handling of the pandemic.

Michael Hamilton, a director of Ubele, says he believes the government had a legal obligation to carry out equality impact assessments early on. “It became very clear, very quickly, that something different was happening in those communities that needed to be explored. And we are not satisfied the government carried out adequate assessments.”

Why does Hamilton think the virus has had such a severe impact on BAME communities? “Viruses piggyback on other viruses,” he says. What virus does he think Covid-19 has piggybacked on? “Racism,” he states baldly. “Racism creates all the conditions that a virus needs to exist: social conditions, which then drive physical conditions. So children with less money spend more time in chicken shops, and people with less money live in houses with fewer opportunities to self-isolate. Racism and poverty create the conditions in which it becomes easier for a virus like Covid to establish itself.”

Nish Chaturvedi, professor of clinical epidemiology at University College London, believes the greater impact of Covid-19 on people of colour is more about socioeconomic disadvantage than ethnicity – it’s just that a disproportionate number of people from ethnic minorities are disadvantaged. She points out that a similar pattern emerged with the H1N1 swine flu virus of 2009. “We saw a similar ethnic and socioeconomic gradient in death as we do for Covid-19. BAME groups, and the most disadvantaged, suffered an almost two-fold excess of death. But as mortality from the H1N1 virus is much lower than that for Covid-19, these inequalities attracted less public attention.”

She acknowledges that a greater burden of underlying medical conditions in some BAME groups also play a part, but believes that many of these differentials are shaped by socioeconomic disadvantage. “Health behaviours, such as diet, physical activity and smoking are driven by social and economic circumstances – these, in turn, influence risk of conditions such as diabetes, hypertension, heart and respiratory disease and obesity.”

Why have so many black and Asian doctors died, though? By and large they are not conventionally disadvantaged. Chaturvedi says doctors from BAME backgrounds remain relatively disadvantaged throughout life, reflected in risks of certain chronic medical conditions. For example, south Asian doctors have higher rates of heart disease, and of diabetes, than their white counterparts. She is also convinced that the kind of frontline work many BAME medics do also plays a part: “Doctors from ethnic minority groups are more likely to work in unpopular specialties, such as geriatrics, where exposure is greater.” The British Medical Association has also expressed concern that more BAME staff work in patient-facing roles and has asked Public Health England and the NHS to urgently investigate this.

There is so much that is still unknown about the impact of Covid-19 in the UK. Some reports conclude that Bangladeshis have suffered most, others that black African and black Caribbean groups have been worst affected. Chaturvedi says that these inconsistencies are due in part to relatively small numbers once individual ethnic subgroups are studied; whether data is stratified by other factors such as gender; whether you’re looking at risk of infection, severity of disease, or risk of death. “People assume science has definitive answers, but with something as new as this, where information is constantly updated, there remains a lot of uncertainty.”

Chaturvedi is determined to quash one misconception. “Some suggest that genes can account for the excess risk of Covid-19 in BAME groups, and I just want to say that’s not the case. Genetic heterogeneity is far greater within than between populations. This is a story about social inequality, not biology.”

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Dr Minesh Talati’s CrowdJustice fundraising page doesn’t mince its words. It is headlined: “Holding the government to account for over 50,000 Covid-19 deaths”. Minesh is taking on Boris Johnson’s administration, and his fight could not be more personal. He wants justice for victims of every ethnicity, particularly those infected before lockdown. He argues that the health secretary and PHE have failed to comply with their duties under article 2 of the Human Rights Act – protecting our right to life.

Minesh was ill for only a day and a half with Covid-19, but is convinced he passed it on to his pregnant wife, his mother and his father. His wife and mother survived, but his father, Navin, died on 18 April. Months on, he still sounds distraught. “I am totally responsible. It was my fault. I was worried about it, but I put my trust in the government.”

On 7 March, Minesh, who is a dentist, visited his parents’ house to make sure they had everything they needed. Supermarkets were already running out of stock, and he didn’t want them making unnecessary trips. An attentive son, he made sure his 80-year-old father had blood tests every two months.

Navin had arrived in the UK from Ahmedabad in India in 1969, with £3 in his pocket. He spent the next 46 years working as a pharmacist. In 1987 and 1991, he was named Essex Pharmacist of the Year. Minesh draws a marvellous pen portrait of a stylish man with a Victorian work ethic, fierce morality, and a zest that belied his years. Every summer, he and his father would attend the first day of the cricket Test at Lord’s; and every Friday they went to their favourite gastropub for lunch and a “glass”.

“He was one of the most kindly, spirited people I’ve met,” Minesh says. “He would deliver medicine on his bicycle in the 1970s to elderly people who couldn’t get out.” When Minesh was a boy he took over the delivery, and his father told him never to accept money or sweets by way of thanks – performing a public service was sufficient reward. In 2017, Minesh stood for election as the Conservative candidate in Barking, where he was beaten by the incumbent Margaret Hodge. Navin canvassed alongside him.

Navin had mild diabetes, but did not need medication. He was fit and healthy, walking 10,000 steps a day, travelling from his home in Ilford, Essex to work in London every weekday, and still putting in 12-hour shifts. But Minesh was anxious about Covid-19, and told his father he thought it was time to start isolating. Although the government had said the virus was not yet being transmitted in the community, Minesh thought it was only a matter of time. He didn’t want his parents to take any unnecessary risks; he didn’t know he had already taken the ultimate risk in visiting them.

On 10 March, Minesh developed symptoms – aching legs and a runny nose, nothing much to worry about. He didn’t have a cough, let alone difficulty breathing. “When I phoned NHS 111, they said: you’ve got a cold.” But Minesh believes that, in the incubation period, he had passed the virus on. Although by 12 March he no longer had symptoms, Minesh sent off for a private test. He has always been a bit of a hypochondriac, he laughs, whingeing about the slightest cold, so on 16 March he was surprised to discover he had tested positive for Covid-19. His father was the opposite – a true stoic. But over the next few days, Navin admitted he was getting breathless on the stairs. On 20 March, when Minesh discovered his father’s blood oxygen level was low and his heart rate high, he took him to hospital.

Navin tested positive for Covid-19, but his symptoms were mild. Father and son were convinced he would be out in a couple of days. Navin played cards with Minesh, and looked forward to next Friday’s visit to the pub. Then he deteriorated, and was sent to intensive care on 25 March. After two days, he showed signs of recovery and was moved back to the respiratory ward.

When his breathing deteriorated again, Navin was returned to the ICU and put on a ventilator, where he fought for his life for three weeks. “This makes me cry,” Minesh says. “What hurt me the most is that I never told him what I wanted to: ‘Dad, everything I have achieved is because of you.’ I couldn’t have those conversations you’d normally have.” Navin Talati died of Covid-19 viral pneumonia on 18 April.

It was after his father’s death that Minesh began to investigate the spread of Covid-19 in the UK, trying to assess what was known and when. While he felt responsible for his father’s death, he had not disobeyed any government edict. If anything, he was weeks ahead of the curve in suggesting his parents start to isolate; the prime minister did not announce lockdown until 23 March.

In May, it was revealed that the UK-based Scientific Pandemic Influenza Group on Modelling (SPI-M) had produced a paper on 10 February stating that “it is a realistic probability that there is already sustained transmission in the UK”. The paper was discussed a day later by the Sage committee. And yet, on 25 February, PHE told the care home sector that there was “currently no transmission of Covid-19 in the community”. Minesh felt both livid and vindicated. If the government had shared the SPI-M findings, he says, there is no way he would have visited his parents when he did. “My dad shouldn’t have died. Public Health England could have said: ‘We don’t know whether it’s in the community, so let’s put these measures in place now – people over 60 stay at home, don’t visit your grandkids.’”

Minesh believes the government failed to carry out its duty to inform the public about the true spread of Covid-19. He does not want compensation; he is simply demanding disclosure of what was known at the time. “We’re saying, if you’ve got nothing to hide, let’s be transparent – be accountable. The utmost thing for any government is to protect its citizens. I don’t want to go to court. Please, just have an inquiry or disclose the facts, so people like me know why you made the decisions you did.”

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Scientists at the University of Leicester are still trying to work out why their city experienced a second wave of Covid-19, leading to the first UK local lockdown in June. While Leicester is one of the most diverse cities in the UK, Merthyr Tydfil, which was also at high risk of a second lockdown in July, is one of the least diverse, with a 97.5% white population. What the two places do have in common is deprivation.

Manish Pareek, associate clinical professor in infectious diseases at the University of Leicester, agrees it is too early for definitive answers. At this point, he and his colleagues can see patterns, but often they don’t understand the cause. For example, he says, they have observed that minority Covid-19 patients have tended to be younger than white patients, but at this point they don’t know why.

Pareek co-authored one of the earliest academic papers examining the relationship between Covid-19 risk and ethnicity. More recently, he has looked into the impact of lockdown. “What our research showed was that after the national lockdown was put into place, rates of covid positivity seemed to plateau or decline slowly in the white ethnic group, whereas in the non-white ethnic group it seemed to rise for three or four weeks.” Why? “If I was speculating, I’d say it was a combination of increased risk of infection in that population, living in inner-city areas with crowded housing, high levels of deprivation, and types of employment. We do know that certain ethnic minorities work in front-facing roles and must continue to go out to work even in the lockdown, so are at higher risk.”

He believes that the mix of heightened risk and poor messaging has created a perfect storm in Leicester. “What we need is enhanced testing, a track and trace system for ethnic minorities, and very clear public health messaging. But if I think what the messaging was – stuff on social media, in English usually, bus shelters with their posters in them, and the 5pm briefings – I’m not sure that the information was accessible to all parts of the population of Leicester. These messages are made for the 80-90% of the population, but not for the 10-20%.”

Forty odd miles away in Wolverhampton, Ken Sazuze can’t sleep at night. When he is awake, he makes notes about what is going through his mind: “Random thoughts about how my world has changed. We have lost the backbone of the family. We have the house, but it is no longer a home. It’s just a house. Today is Father’s Day, but… ”

On 9 April, Ken lost his teenage sweetheart, his wife of 24 years and the mother of his two children. Elsie Sazuze, a care home nurse in Birmingham, was only 44 when she died. When we Zoom, Ken is sitting on their bed. “This is my side,” he says. He still keeps to his side: he’s not changed a thing since Elsie died.

Their children, Andrew and Anna, are 22 and 16 respectively. How are they coping? “It’s difficult for everybody. One day, one is all right, the next day one is not right – so we are just helping each other, holding each other’s hands.”

Ken and Elsie grew up in Blantyre in Malawi. He was 17 when he first saw Elsie, walking home from church. “I was like: ‘Wow, what a beautiful lady, I can’t let her pass.’” Was he in the habit of stopping beautiful girls? He laughs. “No. I’d only been out with one girl.” They eventually came to a stop at Elsie’s home. To their surprise, she lived two doors from Ken. She had been at boarding school for the previous five years; it turned out they had been in the same class in primary school. They became friends first, then a couple at 18. Andrew was born when they were 22; they married at 23; Ken came to England aged 24. A year later, Elsie followed. What was Elsie like? He smiles. “She was a wise woman. Young, but she had an old soul. She didn’t speak much, but her smile did a lot of the speaking. She loved peace, and she had the magic ability to sense trouble from afar.”

Ken joined the army as a chef, and the family moved to Portsmouth. He served in the Falklands, Afghanistan and Germany, but says his service was blighted by racism. “There were only two or three black people in my platoon and we had to eat on our own. You could try to join other people, but they started moving away. That happened all the time.”

While he served in the army, Elsie worked as a hospital receptionist. In their mid-30s, they both decided that nursing was their true vocation. They returned to England, took GCSEs in English and maths, then an access course and eventually a degree, surviving on benefits and part-time work.

The family were close. He talks of wonderful holidays in north Wales, having barbecues on the beach, and how content they were when all four were studying. “We’d go to the library and do our homework together.”

Nursing may have been their vocation, but Ken is convinced it cost Elsie her life, and might have cost him his. Both of them contracted Covid-19. He is not sure how, but he believes at least one of them caught it at work. Elsie had been working in a care home for three years, while Ken was working part-time as a healthcare assistant. They became sick on the same day – 28 March. Elsie called him from work to say she was feeling ill and coming home.

“In the evening, I made some soup. She didn’t want it. Nor did I. At night, I could feel her shivering. I called 111, and they sent us a link to self-test for Covid. It was positive. We called 111 again in the morning and said, ‘We cannot smell things, we don’t want to eat, we’re feeling weak, have a headache and our temperatures are up and down.’ They said, ‘Take paracetamol, drink fluids, and if it continues after five days, call us.’” On the fourth day Elsie deteriorated. “It was 2am. She was right here.” He points to the bed. “And she opened the window. I was holding her so she could breathe and I said, ‘How d’you feel?’ After 30 minutes she said, ‘No, I still can’t breathe, let’s call the ambulance.’”

By the next evening, her breathing had deteriorated further in hospital. “She phoned and said she needed to go on a ventilator. I was sceptical. She said, ‘Don’t worry about it, honey. I have prayed and my spirit is telling me I need to do this.’” She asked him to promise to look after the children, and asked them to look after their father.

Elsie died four days later. Ever since, Ken has been thinking of all the things that went wrong. “The death rate for patients on ventilators is too high. As a nurse, we’re taught to use statistics to back up our opinion, and I don’t think ventilators are the right thing to use for this disease.” Then there is the fact that Elsie was never given proper PPE at work. “The government were sending their soldiers into war without ammunition. Elsie’s PPE was a normal plastic apron, the type a chef uses to cook with, and gloves.”

Ken believes there was an inevitability about people from minorities being so badly affected by Covid-19. “The system always puts BAME people last, so they become the weakest link in everything: housing, economy, jobs, education. We are the most vulnerable in our society. Never mind how much you try, how educated you are, you’re still going to be disadvantaged. If you are living in a poor area, poor housing, poor finances – if diseases come, you will be the first to be knocked down. And even if you’re strong, if you’ve got work, the chances are you’ll end up in dangerous areas. Most nurses were working in the danger zone.”

Does he feel let down by the government? “Oh yes. The government’s job is to protect its people, but I’m discovering our government puts money first. When things started in China, everybody saw it. Then we saw Italy, France and Germany closing their borders and we didn’t close ours. I think the reason was money. Only three weeks later, when doctors and nurses were dying, when it was at its peak, did the government react.”

Elsie was not only the love of Ken’s life, she was the main breadwinner. Now, nobody in the family is earning a salary, and he owes £2,000 in rent on their council house. He is terrified for the family’s future. As for his own health, he is still struggling. “I’m not 100% of what I was.” Does he think he could have died? “Yes. The day Elsie left, I couldn’t breathe.” His sense of having been betrayed by those in power is growing, and he recently joined a justice group for bereaved families, calling on the government to accept that its failures may have contributed to the number of Covid-19 deaths.

In July, the government committed to an independent inquiry into the handling of the pandemic. And last week it announced six research projects are being set up to examine why ethnic minority groups have been disproportionately affected by Covid-19. One of the projects – looking into the impact of the virus on BAME health care workers – will be headed by Pareek at Leicester University. But all this has come too late for Ken. Why weren’t he and Elsie offered more support at the time, he asks. “The government could have saved so many lives if it had wanted to. It has been negligent.” As well as grief, now he is having to deal with his anger.