Covid-19 and ethnicity: we must seek to understand the drivers of higher transmission.

In early April 2020, as the first wave of the covid-19 pandemic hit the United Kingdom, concerns were raised regarding the disproportionately high numbers of people from ethnic minority groups being hospitalised and dying from covid-19.1 It was uncertain whether this was mainly due to a greater risk of acquiring the infection, greater risk of severe illness and death following infection—or both. By November 2020, a meta-analysis of over 18 million patients found a higher likelihood of infection in ethnic minority groups compared to White groups.2 This was confirmed by analysis of UK primary care data on the OpenSAFELY platform, which also found that the risk of testing positive between ethnic groups during the first wave was similar to the risk of covid-19 related death.3 Similarly, the REACT-2 study found that no differences existed in the infection-to-mortality ratio in ethnic minority groups compared to White groups despite high levels of SARS-CoV-2 antibodies in the ethnic minority population.4 It is increasingly recognised that the majority of disproportionate clinical outcomes from covid-19 is driven …