Home Coronavirus: News and Advice Shielding Q&A

Shielding Q&A

by Guy Murphy

As you know, more than one million people will be asked to shield over the coming days. This is in addition to those clinically extremely vulnerable residents who have been shielding since lockdown was announced last month.

But why are more people being asked to shield now?

A new predictive risk model (called the QCOVID model) is helping clinicians identify adults with multiple risk factors that make them more vulnerable to COVID-19. It’s in response to the Government learning more about COVID-19 and the factors that lead to poor health outcomes, including hospitalisation.

This model combines a number of characteristics to estimate the risk of catching and then being hospitalised or dying from COVID-19. These include age, sex registered at birth, ethnicity, body mass index (BMI), and specific health conditions and treatments.

The model has been applied to medical records of NHS patients in England which has identified people who may be at high risk of becoming seriously unwell from coronavirus because of a combination of their individual characteristics and their underlying health conditions.

Through this process, more people will be asked to shield and they will also be prioritised to receive the COVID-19 vaccination.

The Government has produced a question and answer document to help to address any questions you may have:

Additions to the SPL are being made as quickly as possible as we want to provide vaccination as quickly as we can, but due to the large numbers involved, they will take place in two stages.

We expect that individuals aged 19-69 to be added to the SPL on 16 February.

The remaining individuals aged 70+ who should have already been offered a vaccine are expected to be added to the SPL as soon as possible after that.

The QCovid® model combines a number of characteristics such as age, sex registered at birth, ethnicity, body mass index (BMI), height and weight (to calculate BMI) and specific health conditions and treatments to estimate the risk of catching and then being hospitalised or dying from COVID-19.

The NHS Digital website has detailed information about the QCovid® model, how this has been used to help identify those most at risk from coronavirus, and the Shielded Patients List. Please visit www.digital.nhs.uk/coronavirus/risk-assessment

Individual patients will receive a letter and email if their details are available, with background information on the model that explains why they have been added to the SPL as a precautionary measure to ensure early vaccination.

If the patient has not already been vaccinated, they will be prioritised for vaccination and receive a separate letter inviting them to vaccination in the normal way.

Because of the new research, this group can be considered alongside the clinically extremely vulnerable.

People in the highest risk category (the clinically extremely vulnerable) are currently advised by the Government to shield and stay at home as much as possible until 31 March, except to exercise or to attend health appointments (including vaccination appointments).

Shielding guidance is available on the GOV.UK website, here: https://www.gov.uk/government/publications/guidance-on-shielding-andprotecting-extremely-vulnerable-persons-from-covid-19

The advice to the clinically extremely vulnerable, and to this group of new additions to the SPL, is to shield and stay at home as much as possible until 31 March, except to exercise or to attend health appointments (including of course their vaccination appointments).

We will also write to the existing CEV cohort informing them of an extension of shielding until 31 March 2021.

The data in January showed that the virus was spreading rapidly across the country, driven by the new variant of COVID-19.

The Government introduced national lockdown restrictions which apply to everyone to help slow down the rapid spread, and as part of that we are advising clinically extremely vulnerable people to take additional measures to protect themselves.

Whilst the national lockdown has been effective and cases of COVID-19 are now falling, the levels of infection in the community remain high and the virus continues to pose a high risk to people across the country.

Therefore, the Government has decided to extend shielding measures until 31 March.

The existing list of medical conditions used to identify individuals who may be clinically extremely vulnerable to COVID-19 was agreed by the four UK Chief Medical Officers on the basis of the latest available evidence. As we had very little data about COVID-19 risk factors at the time, this list was based on our understanding of vulnerability to other respiratory viruses such as flu.

Patients being added to the SPL using the COVID-19 Population Risk Assessment are those who may be at increased risk of becoming seriously unwell from coronavirus because of a combination of their individual characteristics and their underlying health conditions based on this new research.

This includes characteristics like someone’s age, ethnicity, BMI and certain medical conditions.

NHS Digital’s website will provide a list of the risk factors that the QCovid® model uses, in an approximate order of their impact on coronavirus outcomes. This is available at www.digital.nhs.uk/coronavirus/risk-assessment/population

QCovid® is a ‘living’ model and designed by Oxford University to be updated as new evidence emerges.

The SPL has been monitored and updated regularly throughout the pandemic. Clinicians have the option to review and make amendments to the SPL. Patients will be contacted by their GP or clinician if, in their professional judgement, they are being removed from the list.

No, this model is not suitable for people under the age of 19, because the QCovid® model is not designed for use on this group.

We are aware of the pressures that GPs are currently under at the moment and the fact that they are balancing many very important priorities as they work to care for their patients.

To ensure that we act as quickly as possible to protect those newly identified as high risk, we are adding these patients to the SPL as a precaution.

The vaccine deployment programme principle is that anyone newly identified as higher risk than the current priority cohort is moved to the top of the list at that time.

Patients identified by the COVID-19 Population Risk Assessment powered by QCovid® will be invited to receive the COVID-19 vaccination as soon as possible, if they have not already been invited.

Many of the people now identified alongside the clinically extremely vulnerable would have been part of group 6. However, now they have been identified, we are able to ensure they can be vaccinated as soon as possible.

At the beginning of our response to COVID-19, the CEV group was drawn up based on a list of conditions agreed by UK Chief Medical Officers and senior clinicians. As we had very little data about COVID-19 risk factors at the time, this list was based predominantly on our understanding of vulnerability to other respiratory viruses.

 

As further evidence has emerged about the virus, we now have a better understanding of the importance of a combination of individual characteristics and underlying health conditions that determines someone’s risk of serious illness from COVID-19.

 

The identification of these adults who may be at high risk is only possible now because the QCovid® risk model and NHS Digital’s technology together enable risk stratification across the population in a way that has never been done before. This new approach has made it possible for the NHS to identify more people who may be at increased risk of becoming seriously unwell from coronavirus and prioritise them for vaccination as soon as possible.

Ethnicity is an important risk factor used in the QCovid® model to give a personalised risk score.

The current evidence shows that a range of socioeconomic and geographical variables - such as occupational exposure, population density and household composition - as well as pre-existing health conditions are likely to contribute to the higher infection and mortality rates for ethnic minority groups.

The current evidence shows that it is a range of socioeconomic and geographical variables - such as occupational exposure, population density and household composition - as well as pre-existing health conditions which contribute to the higher infection and mortality rates for ethnic minority groups.

Ethnicity may therefore be an overarching indicator for these underlying social, location and context-based risks.

Evidence suggests genetics alone does not account for the disproportionate impact.

If individuals need support to access food, or have other support needs, they should continue to request support from their local council to help them to stay at home as much as possible. If you’re a Knowsley resident and need support, please call 0151 443 2600.

Yes. If you need advice on shopping or picking up medication, contact the council’s Adult Social Care team on 0151 443 2600.

Alternatively, you can register on the National Shielding Support Service (NSSS) to indicate that it is a service you want. You can register online gov.uk/coronavirus-shielding-support

 

If individuals are already on a supermarket database or customer list (most people are) the supermarket should contact those people within a week confirming that they have priority access to book slots. Individuals will need to create an online account, if they do not have one already, in order to be able to make an order.

Please be aware that delivery slots may not be immediately available

 

People at highest risk from COVID-19 are advised by Government to stay at home as much as possible, except to exercise or to attend health appointments. They are strongly advised to work from home if they can.

If they cannot work from home, then they are advised not to go to work.

They may be eligible for the Coronavirus Job Retention Scheme (furlough) which has been extended until 30 April 2021. They are advised to speak to their employer if they think they are eligible. More information is available here.

 

If they cannot work from home, they may be eligible for Statutory Sick Pay (SSP) or Employment and Support Allowance (ESA). And Universal Credit (UC) is available both in and out of work. Eligibility criteria apply.

The letter they will receive can act as evidence for their employer or the Department of Work and Pensions that they are advised to shield and may be eligible for SSP or ESA. However, those eligible for SSP or ESA will be eligible for the full period that the shielding notification covers, no matter when the individual receives their letter. Eligibility conditions still apply.

 

Guidance on the employment rights of those who cannot attend work due to COVID-19, including those who are shielding, has been published and can be found here

For those who are self-employed, the Government has extended the Self-Employment Income Support Scheme (SEISS) until 30 April 2021. Further information is available here