The spread of coronavirus has been comparatively slow in Pakistan as well as the rest of South Asia (according to official figures). The numbers of both confirmed infections and documented deaths have been lower than the rest of the world and much less than was initially feared.

The low numbers are even more remarkable given the large concentrated populations and crumbling health care systems. The same appears to hold for Africa.

In comparison, the Black, Asian and Minority Ethnic (referred to as BAME) communities in the UK, which include Pakistanis, are disproportionately affected by coronavirus. According to a study carried out by the UK intensive care national audit and research, 34 percent of all coronavirus-related critically ill patients are from BAME communities, while they make up only about 13 percent of the population. A further breakdown of the ethnic backgrounds of the critically ill patients reveals that 14.4 percent of them were ethnically Asian who only make up 7.5 percent of the population. This is a very significant departure from averages and could reflect either a higher incidence or a bigger health impact of the virus, or both.

Currently hospitals in the UK are not required to record the ethnicity of patients admitted with suspected Covid-19 infections but according to the National Health Services (NHS), 16.2 percent of all patients dying of Covid-19 until April 17 were from BAME communities. This shows that there is a good chance that the virus is affecting minorities in a higher proportion.

There could be various reasons for this. One possibility is poorer compliance with NHS guidelines on social distancing or the message being lost in translation with first generation BAME migrants, including Pakistanis, struggling with English language instructions. Furthermore, there is a greater likelihood of multigenerational cohabitation in Pakistani households in the UK which could impact the numbers given the increased risk for older people. Also, people from BAME communities, especially Pakistanis, usually work in sectors that are at a greater risk of exposure, such as taxi drivers, delivery people or salespeople in the retail sector which includes grocery stores and corner shops.

Members of the BAME communities also make up a disproportionately larger fraction of the NHS workforce. But even so, the proportion of NHS staff affected by the virus is disproportionately higher still. Around 44 percent of the NHS staff is from BAME communities. But out of the 54 medical and care staff that died due to coronavirus, 70 percent were BAME. The first 10 doctors to die of the virus in the UK were all from BAME communities. Similarly, all three GPs to have died of coronavirus in the UK are BAME and the first one, Dr Habib Zaidi, was from Pakistan.

A breakdown of the ethnic backgrounds of the critically ill patients reveals that 14.4 percent of them were ethnically Asian while they only make up 7.5 percent of the population.

These numbers are clearly skewed towards BAME medics, and thousands of Pakistani medics and caregivers currently working in the NHS are understandably concerned. At the back of calls from the British Medical Association and the opposition parties in the parliament, the UK government has now launched an inquiry into the reasons of higher rates of coronavirus in BAME communities.

“We have seen, both across the population as a whole and in those who work in the NHS, a much higher proportion who have died from minority backgrounds and that really worries me… It’s a really important thing that we must try to fully understand,” Matt Hancock, UK’s health secretary, said last week.

Dr Meysoon Qurashi is a young doctor from London working on the frontline and dealing directly with corona patients. “We are seeing a lot of patients from ethnic minorities, including those from Pakistani backgrounds, and it is a genuine cause of concern. It’s good for the government to start a review. This will help us advise these communities better on how to minimise the risk.”

“We already know that existing conditions and co-morbidities such as heart conditions, diabetes and obesity all contribute towards an increased risk of Covid-19 and unfortunately, these conditions are more prevalent amongst the Pakistani community here in the UK. But a more detailed understanding of the reasons will help determine why the numbers are high here in the UK, while they stay low in Pakistan despite being from the same ethnic backgrounds,” she says.

Are the higher temperatures saving those in Pakistan or do we have better immunities in Pakistan or are we simply not testing enough? The first issue to be addressed is the accuracy of the low numbers in Pakistan. The number of identified cases simply depends on the number of tests. With considerably lower testing frequency in Pakistan, the actual rate of infection is difficult to determine. The number of deaths should thus be a better indication but with a lower rate of testing, corona-related deaths are bound to be underreported as well.

If we assume, however, that the official figures in Pakistan are not too far off, there would have to be other explanations for the disparity in the infection rates between Pakistan and the UK. “Before we try to address any of these questions it is important to note that no scientific study or research has yet been completed and nothing can be said with certainty. Scientists and doctors are only trying to extrapolate theories out of statistics, which will in future be proven right or wrong,” says Dr Qurashi.

Various hypotheses have been advanced to explain the disparity in infection rates, such as the continued BCG vaccination programmes in Pakistan to fight tuberculosis, better overall immunity boosted by the prevalence of other diseases such as malaria, higher temperatures and sunnier climates possibly leading to better Vitamin D reserves.

“You can make arguments for all of these theories but also give counter arguments. For example, BCG vaccinations were widespread even in the UK until 2005, so older people who are most vulnerable here have already been vaccinated. Similarly, the temperatures haven’t risen high enough in Pakistan yet for this factor to be properly tested. Likewise, despite a sunnier climate in Pakistan, most people in Pakistan are Vitamin D deficient due to darker skin tones which reduces Vitamin D absorption and also because of social factors such as poor diet and less exposure to the sun for women,” says Dr Quraishi.

For now we know that the rates of infection and death are lower in Pakistan compared to the rates for Pakistanis in the UK. Whatever the reasons, it is clear that we need to continue to tread carefully and with extreme caution.