Shielding: Who is now considered at ‘high risk’ of coronavirus?

An extra 1.7m people have been added to the shielding list in England

The number of people who are being advised to shield in England has been expanded.

Now, an extra 1.7 million people are being advised to stay at home and avoid leaving the house except in cases of emergencies.

The expansion of the group classified as in need of shielding was announced this week to account for more people who are believed to be at a higher risk of becoming severely unwell from catching Covid-19.

Before now, the shielding list purely took into account health factors, such as pre-diagnosed medical conditions, people who took certain drug treatments that can suppress the immune system, and those with severe respiratory conditions.

Now, following analysis of deaths in the first wave of the pandemic by experts at the University of Oxford at the request of the chief medical officer Chris Whitty, the shielding list has been expanded to include other factors that may make someone clinically extremely vulnerable to Covid-19.

The new modelling takes into account factors such as weight, ethnicity, economic deprivation (according to postcode), age, underlying health issues, and prescribed medications.

Those who are now being strongly advised to shield are being sent letters by the NHS informing them and will also be fast-tracked for vaccination against coronavirus.

In light of the recent changes, here’s everything you need to know.

What is shielding?

Shielding is a strategy implemented by the government to protect those who are clinically extremely vulnerable and are at a greater risk of becoming severely unwell by catching Covid-19.

Government guidelines state that those who have been advised to shield should stay home at all times except in cases where they are exercising or attending medical appointments.

Those who are shielding are also advised to maintain social distancing within their household if possible, particularly in instances where they or members of their household have displayed symptoms of coronavirus.

Currently, those who have been advised to shield have been told they should continue to do so even after they have been vaccinated.

Who is being advised to shield now?

According to the government website, there are now three reasons why someone may be advised to shield, which means they have been defined as clinically extremely vulnerable.

The first is having one or more of the conditions listed on the government’s website, which includes specific cancers, Down’s syndrome, heart disease, and issues with the spleen.

The second is that your clinician or GP might have added you to the Shielded Patient List because, based on their clinical judgement, they deem you to be at high risk of serious illness if you catch the virus.

And the final reason is that you have been identified as clinically extremely vulnerable through the Covid-19 Population Risk Assessment, which is the model developed by the University of Oxford, as potentially being at high risk of serious illness if you catch coronavirus.

What are the conditions that might mean someone is advised to shield?

Currently, as listed on the government website, people with the following conditions are automatically classified as clinically extremely vulnerable.

• solid organ transplant recipients

• people with cancer who are undergoing active chemotherapy

• people having immunotherapy or other continuing antibody treatments for cancer

• people having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

• people who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppression drugs

• people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)

• people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)

• people on immunosuppression therapies sufficient to significantly increase risk of infection

• problems with your spleen, for example splenectomy (having your spleen removed)

• adults with Down’s syndrome

• adults on dialysis or with chronic kidney disease (stage 5)

• women who are pregnant with significant heart disease, congenital or acquired

• other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decisions

What is the Covid-19 Population Risk Assessment and how has it identified people who are at risk?

The list has been created using a risk calculator, named QCovid®, which calculates an individual’s risk related to Covid-19 by combining a number of factors such as age, sex registered at birth, ethnicity, body mass index (BMI) and specific health conditions and treatments.

The government website explains: “We have used patient data held centrally to identify people who might be at high risk and generated risk assessment results for these people.

“People whose results are above the agreed threshold for high risk (clinically extremely vulnerable) of severe illness from coronavirus have been added to the Shielded Patient List (SPL) in England.”

Is shielding compulsory?

The shielding advice is only guidance and is not mandatory.