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We write this letter as doctors and proud members of the Black, Asian and Minority Ethnic (BAME) community from a South Asian background. Recent Office for National Statistics (ONS) data suggest that the BAME population is disproportionately affected by Covid-19.1 Observations and experiences from within our family and wider community led us to explore how cultural aspects may account for these figures. Both intrinsic and extrinsic factors are likely to contribute to this unfortunate statistic. Intrinsic factors such as pre-existing health conditions and comorbidities e.g. cardiovascular risk factors, diabetes2 and diet are likely to play a role. Extrinsic factors such as living in overcrowded conditions,3 multigenerational households and a large proportion of this population being key/essential workers,4 which are often less likely to be amenable to remote working. Faith also plays a part and the large congregational gatherings in places of worship may add to the risk in this community, as does the tactile nature of greeting in BAME communities. One factor, which is often not recognised by the Western world is a general lack of trust in the medical profession and those in positions in authority. As in other UK communities, fake news stories and conspiracy theories are rife amongst South Asian communities. Increased usage of social media by older generations helps the spread of this. The recent adoption of these technologies by the older South Asian population may leave them vulnerable to these messages, in comparison to more digitally native younger and tech-savvy populations. One recent theory, amongst many, circulating in the Pakistani community, likely perpetuated by the high number of deaths within this community in London and the Midlands, is that when patients of Pakistani heritage are admitted to hospital, they never leave. The assumed belief is that medical staff want to eliminate this community by administering lethal doses of medication to euthanise these patients.5 The videos circulating amongst the South Asian community often appear authentic, using people with a professional title like doctor or nurse to deliver the message. They appeal to the audience by purporting to be sharing a hidden message not sanctioned by the authorities. It is easy to see how someone would fall into the trap of believing these messages and passing them onto family members and friends out of fear, who would themselves propagate this message, as it has come from a trusted source; their family! These absurd and often ridiculous theories, however, are based on one underlying message; the general distrust of those in positions of authority. Just as some sections of the West African population had a lack of trust in Western medical professionals delivering aid to them during the Ebola crisis,6 we are seeing a similar phenomenon happening in the UK by our own British citizens of South Asian heritage. This could result in patients not seeking help when they desperately require it, hence causing delayed presentations when they are left with no choice but to seek it. Years of prejudice and discrimination can lead to a community behaving in this manner. We can all do a little bit to help this situation from escalating. The government Covid-19 press conferences could be more accessible to those whom English is not their first language. In hospitals we could utilise faith chaplains to help dispel some of these rumours. Community leaders could help dispel some these false narratives and those of us who are able to, can continue to act as quality control for our family social media circles.

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