A huge shake-up means nearly two million more people must now shield after bombshell research found they face a heightened risk from Covid.
Yesterday the government announced that a further 1.7 million at-risk people have been identified – on top of the 2.3m people already shielding because of the pandemic.
Conditions such as diabetes, non-severe asthma, liver disease, epilepsy, rheumatoid arthritis, sickle cell disease and HIV were linked with ‘moderate’ and ‘elevated’ risks.
And for the first time factors such as ethnicity and deprivation levels are being taken into account, with body mass index (BMI), age and drug treatments meaning more are required to shield.
Studies of those who died in the first wave of the pandemic helped scientists develop a complex system of calculating risk – meaning a combination of factors are taken into account for each patient.
The risk-predicting technology, named QCovid, was commissioned by Prof Chris Whitty and developed by the University of Oxford.
Until now the only people advised to shield in England were those deemed “clinically extremely vulnerable” by the NHS.
Here we look at some of the factors taken into account.
Location and deprivation
Data collected throughout the pandemic has found that Covid has revealed a huge deprivation gap in the UK.
People in the country’s most deprived areas are disproportionately likely to become seriously ill or die after contracting the virus, prompting experts to make this a factor in shielding advice.
It means some areas have seen a huge jump in the number of people advised to remain at home.
Neil Nerva, public health lead at Brent Council in North London, told the BBC : “We’ve got 17,000 people who are shielding. The news today means that over the next two weeks we’re going to be shielding another 12,000 people who are over 70 and another 12,000 who are under 70.”
He added: “That, I think, shows in very graphic terms the health inequalities which exist in a borough like Brent.”
Areas are identified using the Townsend Deprivation Index, which maps out inequalities across the country.
The government has not released a definitive list of health conditions which have led to more people being shielded.
However the research which was used to create the QCovid system has been published in the British Medical Journal, and lists a number of health conditions linked to an elevated risk.
Scientists have stressed that is often a combination of factors and health conditions that put people at greater risk, so the list cannot be looked at in isolation.
Conditions moderately associated with increased risk of complications as per current NHS guidance
- Chronic, non-severe respiratory disease:
- COPD (emphysema and chronic bronchitis)
- Extrinsic allergic alveolitis
- Chronic kidney disease (CKD):
- CKD stage 3 or 4
- End stage renal failure requiring dialysis
- End stage renal failure ever undergoing a transplant
- Cardiac disease:
- Congestive cardiac failure
- Valvular heart disease
- Chronic liver disease:
- Chronic infective hepatitis (hepatitis B or C)
- Alcohol related liver disease
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Chronic neurological conditions:
- Parkinson’s disease
- Motor neurone disease
- Cerebral palsy
- Dementia (Alzheimer’s, vascular, frontotemporal)
- Down’s syndrome
- Diabetes mellitus:
- Conditions or treatments that predispose to infection (eg, steroid treatment):
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Ankylosing spondylitis or other inflammatory arthropathy (eg, psoriatic arthritis)
- Connective tissue disease (eg, Ehlers-Danlos syndrome, scleroderma, Sjögren’s syndrome)
- Polymyositis or dermatomyositis
- Vasculitis (eg, giant cell arteritis, polyarteritis nodosa, Behçet’s syndrome)
Other medical conditions that investigators hypothesised to confer elevated risk
- Cardiovascular disease:
- Atrial fibrillation
- Cardiovascular events (myocardial infarction, stroke, angina, transient ischaemic attack)
- Peripheral vascular disease
- Treated hypertension
- Chronic pancreatitis
- Cirrhosis (if not above; eg, non-alcoholic fatty liver disease)
- Coeliac disease
- Blind loop syndrome
- Peptic ulcer (gastric or duodenal)
- Learning disability
- Fragility fracture (hip, spine, shoulder, or wrist fracture)
- Severe mental illness:
- Bipolar affective disorder
- Schizophrenia or schizoaffective disorder
- Severe depression
- HIV infection
- Sickle cell disease
- Sphingolipidoses (eg, Tay-Sachs disease)
- History of venous thromboembolism
Data reveals that age is one of the biggest factors in Covid-19 mortality.
Latest ONS figures show that nearly three quarters of people who died have been aged 75 or over.
But experts recognise that younger people can face acute risks, with 820,000 people newly told to shield aged between 19 and 69.
Data throughout the pandemic has identified that people from black and Asian communities are disproportionately affected by Covid-19.
Combined with a number of other factors, this is one of the reasons why people could now be shielded who did not have to do so before.
The Department of Health and Social Care said in a statement: “The QCovid model, which has been developed using anonymised data from more than 8 million adults, provides nuanced assessment of risk by taking into account a number of different factors that are cumulatively used to estimate risk, including ethnicity.”
What conditions were already identified for shielding?
Earlier in the pandemic 2.4 million people were told they should shield.
Nothing has changed for them while the vaccine programme is underway, with those most at risk prioritised for vaccines.
Shielding applied to people who had any of these conditions:
Conditions on current shielding patient list
- Solid organ transplant recipient on long term immune suppression treatment
- Active chemotherapy
- Radical radiotherapy for lung cancer
- Blood/bone marrow cancer at any treatment stage
- Immunotherapy or continuing antibody treatment
- Targeted cancer treatments that affect immune system (PARP inhibitor or PKI)
- Bone marrow or stem cell transplant in previous 6 months or remain on immunosuppression
- Immunosuppression sufficiently increasing infection risk
- Severe respiratory disease:
- Severe asthma (≥3 prescribed courses of steroids in preceding 12 months)
- Severe COPD (≥3 prescribed courses of steroids in preceding 12 months)
- Cystic fibrosis, interstitial lung disease, sarcoidosis, non-cystic fibrosis bronchiectasis, or pulmonary hypertension
- Rare diseases or inborn errors of metabolism:
- Severe combined immunodeficiency
- Homozygous sickle cell disease
- Pregnant with significant heart disease:
What do the experts say?
Deputy Chief Medical Officer for England Dr Jenny Harries said: “For the first time, we are able to go even further in protecting the most vulnerable in our communities.
“This new model is a tribute to our health and technology researchers. The model’s data-driven approach to medical risk assessment will help the NHS identify further individuals who may be at high risk from Covid-19 due to a combination of personal and health factors.
“This action ensures those most vulnerable to Covid-19 can benefit from both the protection that vaccines provide, and from enhanced advice, including shielding and support, if they choose it.”
Sarah Wilkinson, Chief Executive of NHS Digital said: “I’m very pleased that NHS Digital has been able to deliver the platform to allow the QCovid® model to be used to identify individuals vulnerable to Covid-19 as a result of combinations of clinical risk factors and personal characteristics.
“This extends the work we did last year to develop the Shielded Patients List, which included individuals with one of a number of specific clinical conditions.”
What is shielding?
Government guidelines call on people most at risk to avoid leaving their homes, except for exercise or medical appointments.
They are also encouraged to stay two metres away from others they lived with.
Currently even those who have received both doses of the Covid vaccine are encouraged to continue shielding until more data is available.