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The US Supreme Court overturned the 1973 Roe vs Wade ruling in July 2022. A highly controversial decision with wide ranging impact on the rights and health of women both in the USA and across the world. There is no doubt that this judicial ruling will disproportionately affect those who are poor, with little access to healthcare; disabled, minors and those with physical or mental disabilities.[1] Rural women of colour from the Southern States are likely to be the worst affected.[2] This has far wider implications than only affecting the poor and marginalised. Removing legal protection for abortions cannot be considered an isolated event. It sits squarely within the realm of human rights of the woman, her right to bodily autonomy, right to dignity and economic prosperity. In countries where women are safeguarded in their reproductive rights, civil society should be vigilant about ensuring these rights are equitable. The access to safe and affordable abortion is every human’s right. It is up to us to safeguard it with everything we have.

Prior studies have described high venous signal qualitatively using arterial spin labelling (ASL) in patients with sickle cell anemia (SCA), consistent with arteriovenous shunting. We aimed to quantify the effect and explored cross-sectional associations with arterial oxygen content (CaO 2), disease-modifying treatments, silent cerebral infarction (SCI), and cognitive performance. 94 patients with SCA and 42 controls underwent cognitive assessment and MRI with single- and multi- inflow time (TI) ASL sequences. Cerebral blood flow (CBF) and bolus arrival time (BAT) were examined across gray and white matter and high-signal regions of the sagittal sinus. Across gray and white matter, increases in CBF and reductions in BAT were observed in association with reduced CaO 2 in patients, irrespective of sequence. Across high-signal sagittal sinus regions, CBF was also increased in association with reduced CaO 2 using both sequences. However, BAT was increased rather than reduced in patients across these regions, with no association with CaO 2. Using the multiTI sequence in patients, increases in CBF across white matter and high-signal sagittal sinus regions were associated with poorer cognitive performance. These novel findings highlight the utility of multiTI ASL in illuminating, and identifying objectively quantifiable and functionally significant markers of, regional hemodynamic stress in patients with SCA.

Oral and Poster Presentations at the BAPIO Silver Jubilee Annual Conference 2021 Birmingham, UK 22-24 Oct 21

Children with sickle cell disease (SCD) frequently present to hospital acutely unwell and are often exposed to diagnostic chest X-rays (CXRs). Little evidence exists to determine when CXRs are clinically useful. Using electronic hospital records, we audited CXR use in children aged 0-18 who presented to hospital over the past 10 years in both an inpatient and emergency department setting. From a total of 915 first CXRs, only 28·2% of CXRs (n = 258) had clinically significant findings that altered management or final diagnosis. Of these abnormalities, consolidation represented 52·3%, effusion 8·9%, cardiomegaly 8·4% and sickle cell-related bone changes 6·3%. Indications for CXR of respiratory distress (OR = 3·74, 95% CI 2·28-6·13), hypoxia (OR = 1·86, 95% CI 1·50-2·31) and cough (OR = 1·64, 95% CI 1·33-2·02), were more likely to have significant CXR findings. Patients who had higher peak fever (38·4°C vs. 37·4°C, P = 0·001), higher peak CRP (156·4 vs. 46·1, P 0·001) and higher WCC (20·2 vs. 13·6, P 0·001) were more likely to have clinically significant abnormalities on CXR. We found a decision tool using either hypoxia, cough, respiratory distress, T 38°C, CRP 50 or WCC 15 × 10

Bridging the Gap- Workshop series 2020-21 This is the full report and discussions in the consensus building workshops and highlights of the thematic synthesis.

Differential Attainment Healthcare professionals are among the most respected, valued members in any society- and also the most regulated. It attracts some of the most talented, innovative and resilient individuals who are keen to do good. Respect, job satisfaction and autonomy are fundamental to the experience of any professional, and often valued above financial or material reward. Doctors are no different. Education and training of the healthcare workforce is a lengthy and resource intense process. No nation-state can be truly self-sufficient. Hence workforce migration is a reality where various pull and push factors lead to professionals moving across countries and continents, in the service of populations. Society is divided along many lines and steeped with structural inequalities. Many of these are the result of thousands of years of history, legacy and societal wrongs. Healthcare services and professionals reflect similar patterns of the 'big society'. The phenomenon of differential attainment (DA), which is the subject of this report is simply a manifestation of such structural inequalities. DA or differential outcomes for doctors due to their age, race, gender, sexual orientation, ethnicity, disability, socio-economic deprivation or influenced by migrant status - rather than motivation, ability, effort or enterprise. DA is fundamentally unfair. Those affected by DA are either unaware or unable to counteract the influence on their careers. DA leads to demoralisation, disengagement and poor outcomes for professionals and their patients. It takes its toll not only on careers but on lives and livelihoods. DA leads to a huge under-utlisation of human resources- a true waste of talent and enterprise. This report- BTG21 focuses on DA in the medical profession exploring the career cycle through the themes of recruitment, assessments, career progression, research & academia, leadership roles, awards and professionalism. BTG21 is people-centred and in tackling inequalities offers solutions on career fulfillment and wellbeing- by an ideological shift of hearts and minds. Thematic Synthesis BTG21 summary report is the culmination of a thematic synthesis of evidence covering the full spectrum of medical careers. It presents lived experiences (collected through mixed method approaches) capturing patterns in peoples experiences through an online survey, and in-depth qualitative interviews with a purposive sample of professionals from across the career cycle, range of ethnic heritage, medical specialism and country of origin. Followed by consensus developed through workshops by a triumvirate of experts, stakeholders and grassroots professionals. There are 5 primary causes of DA- bias, social class & deprivation, immigration status, geographical and individual factors and impacts every stage of medical professional careers. The thematic synthesis reviews are published in the Sushruta Journal of Health Policy. Recommendations The Workshop discussions, recommendations (the 10-point plan) include policy enablers, immediate actions and research questions in the following areas; Tackling bias Embracing diversity & inclusion Celebrating the contribution of migrants Leveling the playing field Inclusive leadership & accountability Removing structural barriers Review-Reform-Rethink assessments Redefining professionalism Disaggregation-intersectionality-benchmarking of data Support-flexibility & Wellbeing

India is going through its second surge of COVID-19 pandemic caught off-guard, after it declared rather publicly that India had vanquished the enemy in September 2020. In the last 2 weeks of April 2021, India has beaten several world records for new cases and deaths by official estimates. The real numbers are likely to much higher as the testing and reporting infrastructure remains in shambles. The triple whammy of mass gatherings, lack of administrative and infrastructure preparedness and low vaccination is probably to blame. The humanitarian catastrophe that is played out so visually in heart-wrenching stories across the interconnected digital world is of scrambling for oxygen, scarcity of hospital beds, lack of medication and the incessant burying or cremating of the dead. The desperation in the eyes of the people as they queue outside of locked hospital gates, the oxygen cylinders supplying minutes of life to patients in cars or auto-rickshaws as they wait is heartbreaking. For members of the Indian diaspora, these pictures hurt deep and one is bound to feel helpless. Yet through all this, there is hope. The Gurudwara’s with their oxygen langars, the elderly vacating beds for the younger and often sicker patients, the journalists who are using every social media access to request essential oxygen and drugs, the volunteers who ferry, bury and burn the abandoned dead are testimony of the good that exists in humanity. The world is rising to the call of India including efforts by the Indian diaspora. There are lessons to be learnt but first, let us help and heal.

The advent of the Omicron variant

It is 2021. The world is reeling from the ravages of a merciless pandemic that knew no borders and killed at will. When scientific collaboration, market forces and societal will resulted in the creation, testing, approval and deployment of multiple vaccines that may yet stop the virus in its tracks. Where most were forced to live apart, and yet joined up like never before. And yet, it has been a year where the privileges of a few were starkly overshadowed by the destitution of many. A year where inherent societal inequalities in many nations were held in sharp focus. Where the poor and disadvantaged were much more likely to be infected and die of the virus, and where untreated premorbid conditions hastened their demise. Many governments used the necessary restrictions of civil liberties to their advantage, and many congregated to protest. Where do women feature in this? The author explores the impact of inequalities on women and why women do need to stand up for equality and justice, now more than ever before.

Background and aims: Children with sickle cell disease (SCD) frequently present with limb pain. Differentials include vaso-occlusive episode (VOE) and osteomyelitis (OM). X-rays expose to radiation but rarely aid in diagnosis. We audited the use of x-ray in investigating children with SCD presenting with limb pain to a South London hospital and analysed whether x-rays aid in diagnosis. Methods: Patients aged 0-18 with SCD were identified using the hospital’s SCD database. Admissions from January 2010 to September 2019 in which limb pain was a documented symptom were included. Results: Of 342 patients investigated, there were 188 admissions with limb pain. Diagnoses at discharge were: 174 VOE, 4 OM, and 7 others. 44 (25%) of those with VOE had limb x-rays, compared with 3 (75%) of those with OM. Of those x-rayed, 11 with VOE and all with OM had a subsequent MRI. None of the x-rays assisted in confirming the diagnosis or change management. Of the VOE patients, more of those that were x-rayed had swelling (48% vs 8%, p=

Liver involvement in sickle cell disease (SCD) is often referred to as sickle cell hepatopathy (SCH) and is a complication of SCD which may be associated with significant mortality. This review is based on a round-table workshop between paediatric and adult hepatologists and haematologists and review of the literature. The discussion was prompted by the lack of substantial data and guidance in managing these sometimes very challenging cases. This review provides a structured approach for the diagnosis and management of SCH in children and young adults. The term SCH describes any hepatobiliary dysfunction in the context of SCD. Diagnosis and management of biliary complications, acute hepatic crisis, acute hepatic sequestration and other manifestations of SCH are discussed, as well as the role of liver transplantation and haemopoietic stem cell transplantation in the management of SCH.

Regular transfusions are effective in managing strokes in paediatric sickle cell patients. However, there are associated risks, including alloimmunisation and iron overload. This study evaluated the efficacy of top-up transfusions in primary and secondary stroke prevention in a single tertiary paediatric centre in Central London. Forty-seven children with sickle cell disease who received transfusions in the last decade were included. No patient on a primary stroke prevention transfusion programme had a cerebrovascular event during the study period but 9.5% on secondary stroke prevention programme did. Twenty-one per cent of patients in this cohort converted to exchange transfusions following transfer to adult services, of which 11% had subsequent strokes. Targeted pre-transfusion haemoglobin S % was not always met; 43% of HbS% readings in a 12- month period were above the set target of 30% and 37% were above the set target of 50%. About a third of patients had evidence of severe hepatic iron overload, but no significant cardiac iron. 25% of patients became alloimmunised, but not severe enough to warrant discontinuation of the transfusion programme. Although transfusions are effective for primary stroke prevention, iron overload remains a significant burden.

Summary With the developing COVID‐19 pandemic, patients with inherited anaemias require specific advice regarding isolation and changes to usual treatment schedules. The National Haemoglobinopathy Panel (NHP) has issued guidance on the care of patients with sickle cell disease, thalassaemia, Diamond Blackfan anaemia (DBA), congenital dyserythropoietic anaemia (CDA), sideroblastic anaemia, pyruvate kinase deficiency and other red cell enzyme and membrane disorders. Cascading of accurate information for clinicians and patients is paramount to preventing adverse outcomes, such as patients who are at increased risk of fulminant bacterial infection due to their condition or its treatment erroneously self‐isolating if their fever is mistakenly attributed to a viral cause, delaying potentially life‐saving antibiotic therapy. Outpatient visits should be minimised for most patients, however some, such as first transcranial dopplers for children with sickle cell anaemia should not be delayed as known risk of stroke will outweigh the unknown risk from COVID‐19 infection. Blood transfusion programmes should be continued, but specific changes to usual clinical pathways can be instituted to reduce risk of patient exposure to COVID‐19, as well as contingency planning for possible reductions in blood available for transfusions. Bone marrow transplants for these disorders should be postponed until further notice. With the current lack of evidence on the risk and complications of COVID‐19 infection in these patients, national data collection is ongoing to record outcomes and eventually to identify predictors of disease severity, particularly important if further waves of infection travel through the population.

In an unprecedented show of scientific solidarity and collaboration across the globe, research on the novel SARS-CoV-2 (Covid-19) virus has progressed at a pace that could almost match the virus’s relentless movement through communities. This has been a pandemic like no other. Whilst it is hard to speculate how the world will emerge at the end of this, there is little doubt that scientists are trying to rise up to its challenge in a way that has never been seen before. As of the 21st of March 2020, the National Library of Medicine research repository has a collection of nearly 1000 articles on Covid-19, a novel virus whose genome was sequenced less than 12 weeks ago12. Almost all these articles were published in February and March 2020, reflecting the explosion of global research activity on this virus.

Background Young children with sickle cell anaemia (SCA) often have slowed processing speed associated with reduced brain white matter integrity, low oxygen saturation, and sleep-disordered breathing (SDB), related in part to enlarged adenoids and tonsils. Common treatments for SDB include adenotonsillectomy and nocturnal continuous positive airway pressure (CPAP), but adenotonsillectomy is an invasive surgical procedure, and CPAP is rarely well-tolerated. Further, there is no current consensus on the ability of these treatments to improve cognitive function. Several double-blind, randomised controlled trials (RCTs) have demonstrated the efficacy of montelukast, a safe, well-tolerated anti-inflammatory agent, as a treatment for airway obstruction and reducing adenoid size for children who do not have SCA. However, we do not yet know whether montelukast reduces adenoid size and improves cognition function in young children with SCA. Methods The Study of Montelukast In Children with Sickle Cell Disease (SMILES) is a 12-week multicentre, double-blind, RCT. SMILES aims to recruit 200 paediatric patients with SCA and SDB aged 3–7.99 years to assess the extent to which montelukast can improve cognitive function (i.e. processing speed) and sleep and reduce adenoidal size and white matter damage compared to placebo. Patients will be randomised to either montelukast or placebo for 12 weeks. The primary objective of the SMILES trial is to assess the effect of montelukast on processing speed in young children with SCA. At baseline and post-treatment, we will administer a cognitive evaluation; caregivers will complete questionnaires (e.g. sleep, pain) and measures of demographics. Laboratory values will be obtained from medical records collected as part of standard care. If a family agrees, patients will undergo brain MRIs for adenoid size and other structural and haemodynamic quantitative measures at baseline and post-treatment, and we will obtain overnight oximetry. Discussion Findings from this study will increase our understanding of whether montelukast is an effective treatment for young children with SCA. Using cognitive testing and MRI, the SMILES trial hopes to gain critical knowledge to help develop targeted interventions to improve the outcomes of young children with SCA. Trial registration ClinicalTrials.govNCT04351698. Registered on April 17, 2020. European Clinical Trials Database (EudraCT No. 2017-004539-36). Registered on May 19, 2020

This article rationalises the culmination of the design, testing, regulatory approval and delivery of the SARS-CoV-2 vaccine in the UK, USA and across the world. The author champions the worldwide collaboration of scientists, industry, governments, regulatory agencies and several thousands of people who have courageously put themselves forward to make this immense feat possible. So that we, the rest of the people may reap the survival benefits. The author presents a balanced view and acknowledges the uncompromising science that has fuelled this marvel- encouraging people who fear the unknown and vaccine sceptics to come forward.

Letter to the Editor

Sickle cell disease (SCD) and thalassaemia are genetic disorders that are caused by errors in the genes for haemoglobin and are some of the most common significant genetic disorders in the world, resulting in significant morbidity and mortality. Great disparities exist in the outcome of these conditions between resource- rich and resource-poor nations. Antenatal screening for these disorders aims to provide couples with information about their reproductive risk and enable them to make informed reproductive choices; ultimately reducing the likelihood of children being born with these conditions. This review provides an overview of the current status of antenatal, pre-marital and population screening of SCD and thalassaemia in countries with both high-and low prevalence of these conditions, methods of screening in use, and discusses some of the pitfalls, ethical issues and controversies surrounding antenatal screening. It also discusses outcomes of some screening programmes and recognises the need for the establishment of antenatal screening in areas where their prevalence is highest; namely sub-Saharan Africa and India.

Background Transitions from paediatric to adult health-care services cause problems worldwide, particularly for young people with long-term conditions. Sickle cell disorder brings particular challenges needing urgent action. Objectives Understand health-care transitions of young people with sickle cell disorder and how these interact with broader transitions to adulthood to improve services and support. Methods We used a longitudinal design in two English cities. Data collection included 80 qualitative interviews with young people (aged 13–21 years) with sickle cell disorder. We conducted 27 one-off interviews and 53 repeat interviews (i.e. interviews conducted two or three times over 18 months) with 48 participants (30 females and 18 males). We additionally interviewed 10 sickle cell disease specialist health-care providers. We used an inductive approach to analysis and co-produced the study with patients and carers. Results Key challenges relate to young people’s voices being ignored. Participants reported that their knowledge of sickle cell disorder and their own needs are disregarded in hospital settings, in school and by peers. Outside specialist services, health-care staff refuse to recognise patient expertise, reducing patients’ say in decisions about their own care, particularly during unplanned care in accident and emergency departments and on general hospital wards. Participants told us that in transitioning to adult care they came to realise that sickle cell disorder is poorly understood by non-specialist health-care providers. As a result, participants said that they lack trust in staff’s ability to treat them correctly and that they try to avoid hospital. Participants reported that they try to manage painful episodes at home, knowing that this is risky. Participants described engaging in social silencing (i.e. reluctance to talk about and disclose their condition for fear that others will not listen or will not understand) outside hospital; for instance, they would avoid mentioning cell sickle disorder to explain fatigue. Their self-management tactics include internalising their illness experiences, for instance by concealing pain to protect others from worrying. Participants find that working to stay healthy is difficult to reconcile with developing identities to meet adult life goals. Participants have to engage in relentless self-disciplining when trying to achieve educational goals, yet working hard is incompatible with being a ‘good adult patient’ because it can be risky for health. Participants reported that they struggle to reconcile these conflicting demands. Limitations Our findings are derived from interviews with a group of young people in England and reflect what they told us (influenced by how they perceived us). We do not claim to represent all young people with sickle cell disorder. Conclusions Our findings reveal poor care for young people with sickle cell disorder outside specialist services. To improve this, it is vital to engage with young people as experts in their own condition, recognise the legitimacy of their voices and train non-specialist hospital staff in sickle cell disorder care. Young people must be supported both in and outside health-care settings to develop identities that can help them to achieve life goals. Future work Future work should include research into the understanding and perceptions of sickle cell disease among non-specialist health-care staff to inform future training. Whole-school interventions should be developed and evaluated to increase sickle cell disorder awareness. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 44. See the NIHR Journals Library website for further project information.

Aims Fever is an important sign in children with sickle cell disease (SCD), often being the only indicator of serious and potentially life-threatening secondary bacterial infection. Treatment of febrile children with SCD in our Paediatric Emergency Department (PED) can be variable, including escalation of care of those who are unwell and pragmatic management of those who are well. We therefore audited the management of fever with SCD presenting to PED and developed guidance to aid management, particularly looking at whether ambulatory nursing teams can be utilised to manage ‘low-risk’ patients. Methods We analysed the management of SCD children presenting to PED with fever over a one year period. Using these results, we developed guidance for febrile children with SCD, based on risk stratification. Results 28 children with SCD presented between July 2018 – July 2019, of whom 22 were admitted and 6 discharged from PED. Diagnoses among these patients are displayed in table 1. Antibiotic treatment was consistent in the management of fever due to acute chest syndrome, but was otherwise variable. One third of children discharged (2/6) received oral antibiotic treatment to complete at home. None of the discharged children were referred to the ambulatory nursing team for review. Subsequently we developed guidance to standardise clinical assessment, direct antibiotic choice, give clear risk-stratification criteria and advice on management of low-risk fevers of SCD children in the community. Conclusions Fever may indicate serious bacterial infection in children with SCD, requiring prompt and specific antibiotic treatment. Implementation of a guideline will help tailor treatment to the most likely cause of fever and risk-stratify these children accordingly. Utilisation of ambulatory nursing teams should be encouraged to promote admission avoidance and ensure low-risk children can be managed safely at home.

Tonsillectomy and adenoidectomy (T&A) is frequently performed in children with sickle cell disease (SCD). Our aim was to evaluate the impact of this surgery on overnight oxygenation and rates of complications in these patients. Children with SCD who underwent T&A between 2008 and 2014 in two tertiary hospitals were retrospectively evaluated. Overnight oximetry and admission rates due to vaso-occlusive pain episodes (VOEs) and acute chest syndrome (ACS) in the year preceding and following the surgery were compared. 19 patients (10 males, 53%) with a median age of 6 years (range 3.5–8) were included. A significant increase of mean overnight arterial oxygen saturation measured by pulse oximetry (SpO2) (from 93±3.6% to 95.3±2.8%, p=0.001), nadir SpO2 (from 83.0±7.1% to 88±4.1%, p=0.004) and a reduction of 3% oxygen desaturation index (from a median value of 5.7 to 1.8, p=0.003) were shown. The mean annual rate of ACS decreased from 0.6±1.22 to 0.1±0.2 events per patient-year (p=0.003), while the mean cumulative rate of hospitalisations for all causes and the incidence of VOEs were not affected. T&A improved nocturnal oxygenation and was also associated with a reduction in the incidence of ACS at 1-year follow-up after surgery., In children with SCD, this retrospective analysis suggests that tonsillectomy and adenoidectomy may have a beneficial effect on nocturnal oxygenation level and the rate of ACS. This finding will need further confirmation in prospective and larger studies. https://bit.ly/3gL6gaU

Differential Attainment is a phenomenon, recognised globally, where certain cohorts of people tend to have poorer career outcomes based on factors other than capability, academic effort, or motivation. Although by no means unique to or exclusive to, it is indeed well described and monitored in the health education/ training, and affects professionals throughout their entire career journey from admission to retirement. It is a marker of an unfair system and affects individuals as well as organisations adversely. It is the responsibility of all organisations, policymakers and regulators to urgently understand the causes, find solutions, and support those that are disadvantaged as a result of this inequality. The British Association of Physicians of Indian Origin addressing its declared mission of achieving excellence through promoting equality and diversity, along with its collaborative partners and a panel of international experts has created an Alliance for Equality in Health Professions. This Alliance will spearhead a thematic analysis of the entire spectrum of differential attainment in medical professions. This paper describes the protocol for the thematic synthesis of evidence, the priority setting partnerships for undertaking a critical integrative analysis, and the process for combining evidence from experts with lived experiences of grassroots professionals to produce meaningful solutions, actions, and policy enablers. The output will be published as a series of papers in Sushruta and culminate in a seminal report in 2021 when BAPIO turns 25.

Curated by Triya Anushka Chakravorty

The novel coronavirus pandemic is posing significant challenges to healthcare workers (HCWs) in adjusting to redeployed clinical settings and enhanced risk to their own health. Studies suggest a variable impact of COVID-19 based on factors such as age, gender, comorbidities and ethnicity. Workplace measures such as personal protective equipment (PPE), social distancing (SD) and avoidance of exposure for the vulnerable, mitigate this risk. This online questionnaire-based study explored the impact of gender and religion in addition to workplace measures associated with risk of COVID-19 in hospital doctors in acute and mental health institutions in the UK.The survey had 1206 responses, majority (94%) from BAME backgrounds. A quarter of the respondents had either confirmed or suspected COVID-19, a similar proportion reported inadequate PPE and 2/3 could not comply with SD. One third reported being reprimanded in relation to PPE or avoidance of risk. In univariate analysis, age over 50 years, being female, Muslim and inability to avoid exposure in the workplace was associated with risk of COVID-19. On multivariate analysis, inadequate PPE remained an independent predictor with a twofold (OR 2.29, (CI - 1.22-4.33), p=0.01) risk of COVID-19.This study demonstrates that PPE, SD and workplace measures to mitigate risk remain important for reducing risk of COVID-19 in hospital doctors. Gender and religion did not appear to be independent determinants. It is imperative that employers consolidate risk reduction measures and foster a culture of safety to encourage employees to voice any safety concerns. (240 words)

Following the first few reports of a novel coronavirus affecting a large number of Chinese residents in the city of Wuhan, it was rapidly clear that the disease did not affect everyone to the same degree. Often this is based on socio-political factors, leadership and resilience of the public health infrastructure. The predicted surge in infections due to high viral transmission rates threatened to overwhelm every healthcare system in the world. However, it has become clear that the experience of different population groups or subsets with variable characteristics was not the same. This review assesses pre-existing conditions that were identified as pathophysiological or sociodemographic risk factors of COVID-19. This will allow policymakers to decide what mitigation is needed to reduce those risks and protect the public from infections.

Emerging data from COVID-19 pandemic shows a trend for increased risk for healthcare workers in the UK, compared to other countries. In addition, there is a disproportionately high risk observed in healthcare workers from Black, Asian & Minority Ethnic backgrounds. This high risk is independent of biological or demographic variables. This paper presents sub-analysis of a larger survey of healthcare workers, particularly describing possible occupational risk of COVID-19 in a subset of doctors in UK hospitals from a BAME background. The results show higher rates of inability to access personal protection or comply with social distancing. The inability to self-isolate was associated with a 1.7x higher risk of COVID-19. The results of this survey suggest further research is needed to explore and understand institutional factors that may explain excess risks to BAME hospital doctors.

2945 Reads/ Downloads To explore the emerging concerns of COVID-19 related issues amongst health care workers, members of a range of healthcare organisations, governmental agencies, and the media, an online self-administered survey of healthcare workers was undertaken by the British Association of Physicians of Indian Origin in April 2020. Results The respondents were predominantly hospital doctors (67%), aged between 40-60 years (72%) and from Black, Asian, and Minority Ethnicity (BAME) backgrounds in the UK (86%). Thirty percent of respondents had one or more health comorbidities. Over 78% reported either lack of, or inappropriate personal protective equipment (PPE) for their role and 68% of respondents felt that they were unable to comply with or that it was impractical to adhere to social distancing at work (including commuting). At the time of the survey, 18.5% of respondents reported having a confirmed or suspected diagnosis of COVID-19. In multivariate analysis, the inability to self-isolate and having a BAME background emerged as independent risk (OR 1.45) for COVID-19 when adjusted for confounding factors. Conclusions These results add to the emerging concerns expressed internationally on the observation that BAME ethnicity appears to have a higher risk of developing COVID-19. This is the first study that adjusted work-related factors (inability to maintain social distancing and inadequate PPE) and comorbidities. Our work supports the imperative for designing and conducting urgent larger studies to understand this risk and plan appropriate mitigation of the risks to health care workers *version 1.2 includes the addition of self-isolation as a risk for COVID-19. See Table 4.