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BackgroundStudies suggest that certain Black and Asian Minority Ethnic groups experience poorer outcomes from COVID-19 but these studies have not provided insight into potential reasons for this. We hypothesised that outcomes would be poorer for those of South Asian ethnicity hospitalised from a confirmed SARS-CoV-2 infection, once confounding factors, health seeking behaviours and community demographics were considered and that this might reflect a more aggressive disease course in these patients.MethodsPatients with confirmed SARS-CoV-2 infection requiring admission to University Hospitals Birmingham NHS Foundation Trust(UHB) in Birmingham UK between 10thMarch 2020-17thApril 2020 were included. Standardised Admission Ratio(SAR) and Standardised Mortality Ratio(SMR) were calculated using observed COVID-19 admissions/deaths and 2011 census data. Hazard Ratio (aHR) for mortality was estimated using Cox proportional hazard model adjusting and propensity score matching.ResultsAll patients admitted to UHB with COVID-19 during the study period were included (2217 in total). Fifty-eight percent were male, 69.5% White and the majority (80.2%) had co-morbidities. Eighteen and a half percent were of South Asian ethnicity, and these patients were more likely to be younger, have no co-morbidities but twice the prevalence of diabetes than White patients. SAR and SMR suggested more admissions and deaths in South Asian patients than would be predicted and they were more likely to present with severe disease despite no delay in presentation since symptom onset. South Asian ethnicity was associated with an increased risk of death; both by Cox regression (Hazard Ratio 1.4 (95%CI 1.2–1.8) after adjusting for age, sex, deprivation and comorbidities and by propensity score matching, matching for the same factors but categorising ethnicity into South Asian or not (Hazard ratio 1.3 (1.0-1.6)).ConclusionsThose of South Asian ethnicity appear at risk of worse COVID-19 outcomes, further studies need to establish the underlying mechanistic pathways.

Objectives To compare the antibody response to a licenced polysaccharide and glycoconjugate vaccine against encapsulated bacteria in HIV-infected and HIV-uninfected adults in the UK Design Prospective cohort study Setting UK teaching hospital Participants 211 HIV-infected adults and 73 HIV-uninfected adults. Entry criteria: over 18 years of age. Exclusion criteria: previous pneumococcal, Hib or MenC vaccination. Interventions Vaccination with a 23-valent pneumococcal polysaccharide vaccine (PPV) and Haemophilus influenzae b/meningococcal C polysaccharide-tetanus toxoid conjugate vaccine (Hib/MenC-TT). Main outcome measures Concentration of IgG antibody responses to 12 pneumococcal, Hib and MenC polysaccharides and percentages of participants protected post-vaccination in HIV-infected participants compared with HIV-uninfected participants. Results Median IgG responses to Hib/MenC-TT were not significantly different between HIV-infected (3.74 and 2.88 g/ml) and HIV-uninfected groups (4.85 and 4.56 g/ml). PPV induced median IgGs above a 1.3 g/ml threshold for 10/12 serotypes among HIV-uninfected, and 5/12 in HIV-infected participants. HIV-uninfected adults had higher median post-vaccination IgGs than HIV-infected for serotypes 1, 7F, 18C and 23F (p Conclusions In a UK adult HIV-infected population, Hib/MenC-TT induced similar IgG responses to HIV-uninfected adults, while PPV induced comparatively poor responses. Lack of association with CD4 count or viral load supports early immunization. Further studies are required to guide vaccination policy in HIV-infected patients.