One of the major limitations of our study is that it is mainly descriptive, ecological and uses only county-level data, which does not allow us to account for individual characteristics that may drive COVID-19 outcomes in socially vulnerable communities. In addition, we used **data** collected from different **data** sources, each of which was gathered at slightly varying timepoints and as such may not completely represent the features of the community at the time of our analysis. We attempted to account for as many confounders as possible but recognise that we may not have been able to adjust for all confounders (including vaccinations) driving the associations seen in this analysis. In terms of controlling for countylevel comorbidity, we use the HCC risk score, which was designed to reflect healthcare access and hospital admissions in a geographical area, as a proxy which may impact the associations seen. Therefore, studies incorporating individual patient-level **data** which include more confounders are needed to further delineate the associations seen in this ecological study. Finally, we focused our analysis on county-level proportion of black and Hispanic residents within the USA and do not extend it to include Asian or Native American residents. Future studies that encompass other minority groups and examine trends presented in our study on a worldwide basis are needed. Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographical or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.