South Asians in England worst-hit by Covid second wave, study finds

South Asian communities in England experienced greater levels of Covid-19 infection, severe disease and death during the second wave when compared to other minority ethnic groups, according to scientists.

Researchers said that while disparities for hospital admissions and death improved for most minority ethnic groups between the first (February to September 2020) and second (September to December 2020) wave of the pandemic, it widened for those from South Asian backgrounds.

The findings, published in The Lancet journal, are based on 17 million adults in England and is thought to be the largest study to date.

Dr Rohini Mathur, of the London School of Hygiene and Tropical Medicine, UK, said: "Despite the improvements seen in most minority ethnic groups in the second wave compared to the first, it's concerning to see that the disparity widened among South Asian groups.

"This highlights an urgent need to find effective prevention measures that fit with the needs of the UK's ethnically-diverse population."

The scientists said health factors - such as body weight, blood pressure and underlying health conditions - as well as household size could be some of the key factors for disparity in Covid-19 mortality for South Asian groups.

Based on their findings, the researchers are calling for more intensive strategies tailored to improve outcomes in South Asian communities in addition to reducing structural disadvantage and inequality and improving quality of and access to healthcare across all minority ethnic groups.

Dr Mathur said: "While multigenerational living may increase risk of exposure and transmission (from children or working age adults to older or vulnerable family members), such households and extended communities also offer valuable informal care networks and facilitate engagement with health and community services.

"In light of emerging evidence that minority ethnic groups are less likely to take up the Covid-19 vaccine, co-designing culturally competent and non-stigmatising engagement strategies with these communities is increasingly important."

The Covid-19 pandemic is thought to have had a disproportionate impact on minority ethnic communities in the UK when compared with white groups – with living in deprived areas, working in front-line jobs, and having poorer access to healthcare putting them at higher risk of severe disease and mortality.

For their study, the researchers analysed partially anonymised electronic health data from 17,288,532 adults in the OpenSAFELY database.

Ethnicity was self-reported by participants and grouped into five main categories - white, South Asian, black, other, and mixed.

Data showed during the first wave, nearly all minority ethnic groups had higher relative risk for testing positive, being admitted to hospital and intensive care units (ICU), and death, compared to white groups.

ICU admissions were more than doubled for all minority ethnic groups compared with white groups, the researchers said, with black people more than three times more likely to be admitted to ICU after accounting for other factors.

The researchers found these risks lessened during the second wave for all minority ethnic communities, with the exception of South Asian groups.

Dr Daniel Morales, of the University of Dundee, and Dr Sarah Ali, of the Royal Free London NHS Foundation Trust, said the main challenge now is ensuring Covid-19 vaccination programmes are rolled out effectively amongst all minority ethnic groups.

They wrote in a joint comment: "There are reports of increased (vaccine) hesitancy in minority ethnic groups, including those working in front-line health and social care roles, who knowingly face an increased risk of contracting Covid-19.

"Unless vaccine hesitancy is tackled head on, differential vaccine uptake may further exacerbate health inequalities faced by minority ethnic groups."

Additional reporting by PA