NHS Risk categories

[ML10]

The NHS website has changed the risk groups again. They changed it on the 1st or 2nd May I think , 2 groups Very High Risk ( which included severe asthma) and High Risk ( which included mild, moderate asthma). I looked on again yesterday and it‘a been changed again the Very High Risk group appears the same the the second group including non severe asthma is now called Moderate Risk ( and clinically vulnerable). The Very High risk group ( very clinically vulnerable). I wonder if anything had change or Calling a group including so many people High Risk could of caused a lot of worry.

[Swimmingaddict]

I wonder if this is a pre-cursor to lifting the lockdown. Those not in either group will be unlocked first, and those falling in the groups can be asked/strongly advised to remain in lockdown for their own safety. Presumably the economic cost is less to support the vulnerable groups and allow the others to acquire herd immunity now there is critical care capacity. That way it saves any discrimination on the basis of age.

Maybe I am just being cynical?

[twinkly29]

Is it this you're talking about?

nhs.uk/conditions/coronavir...

And this bit is the "very high risk" element: nhs.uk/conditions/coronavir...

It doesn't look much different to me to a week ago when all asthma was included as being at risk to some degree, but most people just need to be vigilant with social distancing and minimise (not necessarily stop) contact outside the home. As you say though, they've tweaked the names for the categories. Swimmingaddict might well be right and that it's in preparation for forthcoming phases as terminology people can use and remember is helpful.

However, I did notice something interesting. In the very high risk bit, those who would have shielding letters, one bullet point says

"have been told by a doctor they you have a severe lung condition (such as cystic fibrosis, severe asthma or severe COPD)"

and another says

"are taking medicine that makes them much more likely to get infections (such as high doses of steroids)"

I have always felt that receiving a shielding letter does NOT mean someone has severe asthma - early on it was used by the government as an example of a condition which would mean someone was at high risk and seems to have been jumped on as what "everyone with asthma with a shielding letter" has. Severe asthma (as a proper diagnosed, by a specialist, condition) is very very different to someone who might be at high risk (for example someone who only has mild asthma but is rubbish at taking their brown inhaler regularly and so has to take many courses of steroids would probably be very high risk).

The second bullet point about taking lots of steroids (which could be for all sorts of reasons) would account for many people with asthma receiving shielding letters - their asthma may not be severe asthma, but the medications they are on make then high risk/extremely vulnerable.

ML10, sorry to hijack your question there!

[Definitelynotjeff]

it was silly and confusing of them to have very high risk and high risk groups. it was crazy to label people as high risk but still make them go to work

i think there's going to be more confusion as the very high risk people are now only high risk. they should have just said "group 1 people do this" "group 2 people do this" etc

then when the lockdown eases the advice is separated into what each group should do.

[Beach_48 in reply to Definitelynotjeff]

I completely agree. It is confusing. They should just say clearly what the groups should be doing.

[twinkly29]

High risk are still "clinically extremely vulnerable" so it's no different really.

The advice right now is actually quite simple.

If you have a shielding letter, that's what you should be doing. If you don't have one but do have asthma, then you should be social distancing and minimising contact with others outside the home, and discuss with GP if you need to.

[Readingwheezer in reply to twinkly29]

I think you should be doing the public health messaging. That's spot on

[ML10]

Yes it is simple now but the categories were changed twice within a week. Everyone with asthma was classed as high risk and now moderate risk.

[Karen2020]

I havent heard anything from NHS or Dr's almost died many times heart stopped twice but still nothing. Who knows spoke to receptionist she just says wait for letter! So who knows

[Yellow75]

It may be to do with easing lock down, and may be more knowledge of covid. Makes more sense than previous advice and start. I didn't receive any letter, but was told by doctor I'm at higher risk than general population. I had a bad exacerbation just before lock down and have been struggling with hayfever which brought on an exacerbation. Lucky was able to get on top of it with steriods.

I'm waiting to see what to do about work when lock down finishes. Been working from home.

[Hidden]

It seems research is showing asthma is not associated with intensive care / deaths from CV so that may also be i is ting in changes as they learn more....

[Wrighty2018 in reply to Hidden]

I hope the NHS are able to confirm what you mention kikkles as I am so confused.. I didn't go in my garden for weeks.as I had a message from .Gov to stay inside and then 2 weeks ago saying I can go in my garden??

[Readingwheezer in reply to Wrighty2018]

The initial messaging really was very poor. The govt confirmed quite early on that shielding allowed going in your garden (provided you could stay away from neighnours etc) but the letter didn't say this, and implied not because it mentioned opening windows.

[barny1 in reply to Hidden]

What research? Asthmatics are still at increased risk from complications like pneumonia above the general population. Even if you don't die of Covid, you could later die of complications, it just won't be labelled as Covid.

[Hidden in reply to barny1]

Totally agree but in states they found the % of people in hospital with severe Covid who also had asthma was quite small, I think 5%

As someone who had CV and really took a beating Im not saying be complacent, but it’s reassuring it’s not associated with high mortality rates

[barny1 in reply to Hidden]

True, I've heard of reports that unlike the flu, Covid seems to be affecting people with cardiovascular disease, diabetes, obesity more and not so much people with lung conditions. Still, Covid is affecting people's oxygen supplies, so having a lung condition doesn't help your chances if you catch it. May I ask, what was your experience of Covid?

[SusW55]

I have well-controlled asthma and as a key worker (no physical contact, its a mental health support service) I’d continued to go to my work who have been great in terms of facilitating social distancing and providing appropriate hygiene measures. Five weeks in, I receive a shielding letter. I see no point in shielding at this stage given I’ve been exposed for most of this. I live in Scotland so our government may be handling this differently but why shield from week 5?! I’m making a conscious choice to continue to work (with my GP’s knowledge) and being taking precautions but I’m entirely confused as to what my actual risk level is.

[Garden18 in reply to SusW55]

It's never too late to shield. A friend only just put on list, but had stayed home as precaution. With more going to work from now on, this is not the time to play Russian roulette. Stay home, stay safe. There will be another spike-it's a numbers game.

Going to work+asthma=unnecessary risk.

Take care of yourself

[SusW55 in reply to Garden18]

Thanks for your reply. I feel it’s a calculated risk rather than an unnecessary one, the same as thousands of key workers are having to take daily to care for others.

[barny1 in reply to SusW55]

If you've received a shielding letter, rest assured you're considered at very high risk, despite your asthma being well-controlled. I assume you have moderate or severe asthma. Your asthma may be well-controlled, but you still have higher risk associated with steroid-inhaler usage because of the immune-suppression. I have mild asthma and haven't received a shielding letter. I'm staying home all the same, granted I have no need to go into work, but I wouldn't be going to work in these conditions, unless it can be proven I wouldn't come into contact with others or I work outdoors, where risk is much lower.

Consider yourself to have been lucky to have not been affected thus far, you've probably not been as exposed as you think. It's not as prevalent as you imagine, only around 5% of the population have immunity at this stage according to latest research and right now (after 6 weeks of lockdown) only 1% or 1 in every 100 people you meet in the country currently have Covid, so chances are unless you work with many people or work in a healthcare you won't have come into contact with someone with Covid.

Now, lockdown is slowly being eased, there's a reasonable chance that that number will increase, it depend on whether the rate of infection increases above 1. It's fairly safe for now only because we've had lockdown. I'm waiting for it to ramp up again.

[SusW55 in reply to barny1]

Thank you for your reply. I do somewhat take issue with your tone here, I was interested in the rationale behind sending out shielding letters 5 weeks in and understanding the risk levels, which you’ve answered - but I’m not seeking a lecture about considering myself lucky and assumptions made about my asthma, which I consider to be mild, as does my doctor.

I did explain that 1) I have taken my consultant’s advice on the risks and 2) I live in Scotland, where we have a sensible first minister who continues to apply lockdown.

There are many, many key workers in my position, having to make tough choices about continuing to work to provide the help that others need. I’m taking calculated risks, and I completely accept you might be doing something different, which is your right. I respect your choices, please respect mine.

[barny1 in reply to SusW55]

I just thought you wanted advice, so shared my opinion, take it or leave it.

In addition, other people may have received shielding letters and not gotten ill thinking they're superman or woman for not doing. I hope the read my opinion and yours and make up their own minds.

I don't really understand the rationale about not having gotten ill yet.

Meh.

[SusW55 in reply to barny1]

33000 people are dead in the UK, I very much doubt anyone thinks they are superhuman to have avoided it, least of all me. As a point of order, I have not indicated a rationale of not getting ill yet, but I don’t have time nor inclination to debate it with you. I wish you continued health.

[barny1 in reply to SusW55]

Same to you.

Perhaps don't take offence so easily, I'm commenting on your circumstances not to you personally.

Sometimes I like to think strangers on a forum appreciate my advice, maybe not.

I imagine people are dying because they didn't take it seriously enough. My tone is not important.

[SusW55 in reply to barny1]

What a truly vile, offensive thing to say, and that IS said to you, personally. How dare you suggest people are not taking it seriously - come and join us on the front line, staring it in the face, because we want to make sure those needing help continue to get it. Your communication requires a lot of work if you’d like your opinions considered.

[barny1 in reply to SusW55]

It's vile is it? It's the truth though. Of course, some aren't taking it seriously enough, and I hope no-one else suffers through their own ignorance. I'm not talking about the people in care homes or those who have had terrible misfortune.

If you're having to take the risk for the sake of your job, that's one thing. I just thought you'd been given a letter and was ignoring it, putting your job first. For most others (non-healthcare) it may be an unnecessary risk to take, and I hope my advice (to the other readers) has been helpful in that sense. I'm sorry you are in that awful position.

[MrsG29]

Both me and my daughter have severe asthma. She got the shielding letter and a further list of instructions from her respiratory consultant team. I thought I was still okay to go out as long as maintained social distancing (not really possible in this neck of the woods) but then the GP contacted us and told me to shield too.

[Garden18 in reply to MrsG29]

Listen to GP. Don't take risks. Go for a walk but get food, prescriptions delivered. You'll get a government food box. Stay home stay safe

[MrsG29]

Thankyou Garden 18 I have been doing. None of us have left the house since March x

[barny1]

Call me cynical, but I think given the large amount of people with mild asthma needed at work, the changing of risk is possibly politically and economically motivated, rather than there being new evidence of lower risk?