CoV-Ind-UK: Prospective investigation of the determinants for COVID-19 outcomes amongst South Asians in India and the United Kingdom.

Results of studies from India and the UK show that South Asian people are at high risk for risk COVID-19, or to being infected with the SARS-CoV2 virus which causes this illness. The reasons for this increased risk in South Asians are not known. To address this important knowledge gap, we will take advantage of our established 'population cohorts' comprising South Asian men and women in India and the UK who have been under surveillance for up to 20 years. All participants were recruited before the onset of the COVID-19 pandemic, and have measures of key risk factors relevant to COVID-19, including weight, blood pressure, diabetes, heart disease and socio-economic factors. In addition, we have comprehensive assessment of metabolism, genetic variation, and of gene regulation for many of the participants, generated in previous research projects. These already available cohorts, with rich data and samples, provide a powerful and efficient opportunity to define the primary risk factors for COVID-19 in South Asians.

In this new study, we will invite 30,000 of these South Asian people (10,000 in India, 20,000 in the UK) to be tested for evidence of infection with the SARS-CoV2 virus (antibody test). We will also ask them to complete a questionnaire about COVID-19 symptoms, relevant behaviours disease, attitudes to vaccination, and impact of the COVID-19 pandemic (and control measures) on mental, physical and financial wellbeing. We will link to medical records and mortality data where possible to identify people with severe COVID-19.

We will use the data collected to determine what are the major risk factors in South Asians in India and the UK, for infection with SARS-CoV2, or experiencing severe or prolonged COVID-19. We will focus initially on recognised risk factors such as adiposity, raised blood pressure and diabetes, cardiovascular disease, health behaviours (alcohol, smoking, physical inactivity), socio-economic indicators, and measures of metabolic health. We will compare our results in South Asians with equivalent measures for Europeans, and determine whether known risk factors explain the high risk of COVID-19 in Asians. We will use the results to develop simple tools for predicting risk of COVID-19 in South Asians, that can be used to prioritise people for vaccination or behavioural interventions, and to protect them from COVID-19. We will also report on vaccine hesitancy in South Asians (delayed or low acceptance of vaccination) as well as the main reasons for this. This will help identify potential obstacles to successful immunisation programmes and the need for public health education to build understanding, trust and confidence. Finally, we will use 'all-of-the-data' including the available health and genetic data to investigate for previously unidentified risk factors or biological processes that might contribute to COVID-19 in South Asians.

The findings will provide much needed knowledge into the reasons underlying the high burden of COVID-19 in South Asians, and will inform health policy and practice for prevention and control of the disease in India, the UK and globally. We will deliver significant initial outputs within the first 3 months, thus bringing early impact from the work. The research is led by teams from India and the UK who have been at the forefront of responses to COVID-19 at national level. The team also have established expertise, and track record in research to understand the health of South Asian populations. Our research thus addresses a major public health challenge, is timely, efficient and has a high probability of delivering results that will reduce morbidity and mortality from COVID-19 amongst South Asians, who represent 25% of the world's population.

South Asian people are at high risk both for infection with SARS-CoV2 virus, and for developing severe or fatal COVID-19. Addressing this inequality is a major public health priority. In this study, we will identify incident COVID-19, amongst ~30,000 South Asian men and women who are participants of our established prospective population studies in India and the UK. Participants will undergo testing for SARS-CoV2, and complete a validated questionnaire to assess symptoms, relevant behaviours, attitudes to vaccination, and adverse outcomes. We will use our available comprehensive baseline phenotypic data, including molecular characterisation and stored biological samples, collected before the COVID-19 pandemic, to determine what are the major risk factors for infection with SARS-CoV2, severe COVID-19, or prolonged COVID-19, amongst South Asians in India and the UK. We will focus initially on recognised risk factors such as adiposity, raised blood pressure, diabetes, cardiovascular disease, health behaviours, socio-economic indicators, and biochemical measures. We will compare our results in South Asians with equivalent data for Europeans, to determine whether these known risk factors explain the high risk of COVID-19 in Asians. We will develop simple tools for predicting risk of COVID-19 in South Asians, that can prioritise people for vaccination or behavioural interventions, and thus protect them from COVID-19. We will report on vaccine hesitancy in South Asians and the main reasons for this. Finally, we will use 'all-of-the-data', including available health and genetic data, to search for novel risk factors or biological processes that might contribute to COVID-19 in South Asians. Our research will thereby determine the reasons underlying the high burden of COVID-19 in South Asians and generate knowledge that will inform health policy and practice for prevention and control of the disease amongst South Asians in India, the UK and globally.