Last updated 11 Aug 2020
Caution: This guidance was developed early on in the Covid-19 epidemic when little was understood about the virus. The guidance was not based on evidence, but on assumptions, largely that the virus behaved like flu. It did not appreciate the main factor in vulnerability, age. It has become clear, since early May onwards, that the list for Clinically Extremely Vulnerable (CEV) patients does not reflect those who are now known to be extremely vulnerable. Most of the extremely vulnerable do not have a condition on the CEV list, while most of those on the CEV list are not extremely vulnerable; many are not particularly vulnerable at all and did not need to shield. The CEV list should not therefore be used as the only tool to identify those who are extremely vulnerable; it is unsafe to do so.
GPs have been given advice by RCGP on how to interpret ‘shielding’ recommendations at https://elearning.rcgp.org.uk/course/view.php?id=377
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Individual risk categories
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Vulnerability
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References
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| Solid organ transplant recipients.
cancer undergoing active chemotherapy lung cancer undergoing radical radiotherapy cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment immunotherapy or other continuing antibody treatments for cancer people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs severe respiratory conditions including: severe asthma (4 or more courses of oral steroids in previous 12 months) severe COPD (LABA and LAMA and ICS or Roflumilast) cystic fibrosis, interstitial lung disease or sarcoidosis or non-CF bronchiectasis or pulmonary hypertension rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell). immunosuppression therapies sufficient to significantly increase risk of infection. Women who are pregnant with significant heart disease, congenital or acquired. |
Clinically Extremely Vulnerable |
https://digital.nhs.uk/coronavirus/shielded-patient-list#risk-criteria) These individuals should receive a letter from the NHS informing them that they should be shielding.
There is some uncertainty regarding these letters. Some GPs are sending letters to patients in lower risk groups. Some patients have not yet received letters. Some employees are presenting letters that do not appear to be official NHS letters.
It is important to check the medical history, particularly in those who have not received letters, and advise in this case that they are in the shielding group despite the absence of an official letter.
If they are clearly not in this shielding group but have received a letter, a discussion with the treating clinician may be the best way to determine the individual risk. It may be appropriate to advise on the actual risk and reassure accordingly. |
| aged 70 or older (regardless of medical conditions)
under 70 with an underlying health condition listed below (ie anyone instructed to get a flu jab as an adult each year on medical grounds): chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD) emphysema or bronchitis chronic heart disease, such as heart failure chronic kidney disease chronic liver disease, such as hepatitis chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy diabetes problems with your spleen – for example, sickle cell disease or if you have had your spleen removed a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy being seriously overweight (a body mass index (BMI) of 40 or above) those who are pregnant |
Clinically Vulnerable | https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults
These are very broad risk categories. It is important to take a detailed medical history in order to accurately determine risk. The specific tables on this website can then be used to provide a more useful risk stratification
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Risk of severe illness or death if contracts COVID-19. Read more
Likely to need hospitalisation if contracts COVID-19, with protracted illness and heavy NHS burden. Read more
Increased risk compared with healthy individual but should recover.
No greater risk than healthy individual.