Academic seeks to reassure Asians over pandemic risk

By Amit Roy

AN ACADEMIC who has been studying the two- and three-fold incidence of heart disease and diabetes, respectively, among Asians for 35 years, has some common-sense advice on how they can protect themselves during the coronavirus pandemic.

Professor Raj Bhopal, 67, emeritus professor of public health at Edinburgh University, says: “The number one advice for people is that we should be working very hard to try and avoid getting this disease, obviously. And the way to avoid it is the way the government has said. It seems to be coming from close contact.”

He explains the chances of getting it simply by walking down the streets are pretty small.

“More likely you’re going to get it at home,” he says. “With your close family and your friends and your community. You’re going to get it from places of worship, busy shops and public transport. So take that advice seriously. Wash your hands.

“I wash my hands whenever I touch something that’s not inside our house. For example, when I come in from outside and touch the doorknob, I wash my hands before I do anything else. I wash my face and my glasses as well.”

He goes on: “The other advice to the population, whoever you are, is get fit. Make sure you get plenty of exercise. Make sure you don’t drink too much. If you smoke take this chance to give up.

“I’ve heard one of our friends has put on two stone – that is 28 lbs – just in this short lockdown period. You can’t afford to do that. Being obese is a risk factor, anyway, for Covid 19. What I’m telling you is just common sense.”

Another tip: “Vitamin D is important for south Asians. We are short of it much of the time. And we need it for our bones. Some think we need it for our immune systems, too.

“In our family, we take vitamin D supplements from October 1 to March 31 every year routinely. This year we’re taking it all year because more time is being spent indoors.

“A vitamin D supplement is going to do you no harm at all. So I recommend it.”

For 19 years from 1999 until he retired in 2018, Bhopal held the Usher chair of public health at Edinburgh University. Established in 1898, it is the oldest public health chair in the UK.

After having studied medicine at Edinburgh University, he became a lecturer in 1985 in Glasgow University and has written several books and 300 research and scholarly papers. His most recent book is called The Epidemic of Cardiovascular Disease and Diabetes in South Asians Worldwide. He was appointed a CBE in 2001.

Bhopal, who is an expert on disease patterns among Indians, Pakistanis and Bangladeshis, says: “I’ve been a scholar and researcher for most of my life.”

It’s something of an understatement when he says: “Many of us who come from abroad have interesting histories.”

Rajinder Singh Bhopal was born in Moga, a town in Punjab, in 1953, and arrived with his Sikh parents, Jhanda Singh and Bhagwanti Kaur (née Rakhra), in Glasgow on “New Year’s Eve 1955”.

The couple were preceded by Bhagwanti’s brothers, Kehar Singh Rakhra and Nahar Singh Rakhra, who arrived in 1937 and 1947, respectively.

His mother’s side of the family were in the tailoring business that supplied uniforms to the British Indian army.

Jhanda, whose father was a master tailor, started a wholesale clothing shop called Moga Trading Company in Glasgow. He expanded the business which was relocated and renamed Norfolk Fashions – “because it was in Norfolk Street”.

Initially, the family lived in the Gorbals, one of the most notorious slums in Europe – “the reality was much worse than the image”.

To this day, Bhopal, who was taught aspects of tailoring from the age of five by his father, can sew a button better than his wife, Roma. The couple have four sons, who wear kilts and one of whom, 6'3" tall, is a bagpiper.

Bhopal reckons he is both Punjabi and Scottish in a 50-50 ratio: “I like living in Scotland, I feel very proud of this country.” His parents, who married at 15, died, aged 85, within a month of each other in 2010, six months after celebrating their 70th wedding anniversary.

Bhopal didn’t become a tailor: “We’ve all become professionals. Traditional Indian approach, isn’t it? You migrate, and then you want all your children to become professionals.”

The pandemic has brought him out of retirement “because it’s all hands on deck” as he tries to “explain ethnic variations in disease patterns”.

He has this hunch – “and it is only a hunch” – about why when south Asians get coronavirus, the effect is unusually severe. He reckons this might be because they are infected not once but get multiple doses through physical contact at home or in places of worship.

He sets out his reasoning: “We would expect ethnic minority populations to have more of this disease. They live in the inner cities, in larger families, and in more overcrowded circumstances. They also have a life which involves a lot of socialising.

“If you’re infected by one person, maybe it’s not too bad, your body can cope. Maybe a bit more surprising is that once we get it, it seems to be more severe. People intermingle across the generations; people visit mosques, temples and gurdwaras.

“Let’s imagine you’ve gone to the Hindu temple or the gurdwara or mosque. Well, we know how people behave there. The men shake hands with everybody. There’s a lot of hugging. We sit together and eat in the gurdwara.

“And you might have been picking up the virus from several people on the one occasion. So that could give you a bigger dose of the infection. That might be harder to shrug off.”

He acknowledges: “We still don’t have a full explanation of what’s going on.”

He has also been considering how the virus actually infects a person by getting inside a human cell – and whether Asians have some additional susceptibilities.

“A virus is not dangerous unless it can get into a cell,” he says. “If a virus is just sitting on your hands, it can survive for a short period of time. It needs to get into a cell.

“So once it gets into the body, the body will try and kill that invader. Before it is killed off by the body’s immune system, it needs to invade a cell.

“So how do they get into it? A cell has got a membrane. It’s like getting into a room and the room has got a lock and the virus has to unlock the lock. It does it through this ‘receptor’ on the surface of the cell.

“Now whether different ethnic groups have different amounts of this receptor, whether the amount of the receptor is affected by diseases, whether the receptor is affected by drugs and medications that people are taking, and whether it is affected by genetics, are all questions that require study.”

Bhopal makes another important point about the general health of south Asians: “It’s not as if we get we’re falling apart. You can see we are vigorous. Cancer is a big killer in this country, and we’re getting much lower rates of cancer. So I wouldn’t want anyone to get the impression that ethnic minority populations are weak or falling apart. In fact, life expectancy in south Asian populations tends to be high in the UK.”