During the first 6 months of the pandemic, people from ethnic minority groups were more likely to have COVID-19 disease and also more likely to experience severe outcomes from infection, including death. Lockdown measures have also disproportionately affected some communities more than others. What is driving this increased prevalence and death rates in ethnic minority groups? To what extent is it due to biology or pre-existing health? Or does it represent a continuation and exacerbation of social inequalities?