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Shielding List Updated - What Does This Mean?

Nicki-Lou123
Nicki-Lou123

So I have just heard that the shielding list has been updated and new people being added... does anyone know what this mean? Does anyone know what the new thresholds are and who is being added to this list? And is this some glimmer of hope that moderate asthmatics are being reviewed too and may eventually be bumped back up the priority list for vaccines, or is this another kick in the teeth for us from the government and we will be pushed even further than we already are?!

52 Replies

It's linked to Oxford's big risk calculator thing based on covid cases in the first wave. So however they do it, some risks carry a much higher weight than others, eg age, BMI, ethnicity. I think something like asthma on its own might not out someone into CEV (unless they're already almost there maybe) but maybe combined with other conditions it might. I would have thought most of these people would already by group 6 (all conditions/issues not asthma itself) so I don't think it's pushing anyone further down as they're starting group 6 anyway. Age, high BMI, many health conditions like kidney issues or diabetes for example are already group 6 (for those not CEV for those reasons).

All anyone can do is call their GP and ask really what it means for them. People on here will have all sorts or views as to what will and will not happen or be right or wrong....but as it's so individual, the only answer that matters to individuals is the one their GP gives them personally.

Thank you for that... I was supposed to be in group 6 but looks unlikely as I miss out on the steroid criteria by one month (3 courses in 4 months and I believe the criteria was 3 in 3 months) I do have a BMI of 34.5 according to my GP records, and I also have another condition I have to take hormone replacement therapy for, so I was wondering what this new risk assessment adding it all together may end up meaning for me, but I can’t find anything that actually says what this new risk assessment is looking for... I am 29 so if this doesn’t up my risk factor then I would end up being bottom of the pile for a vaccine... obviously I would never want to queue jump or anything like that over others deemed at higher risk but I have been shielding myself apart from work as I work in a nursery so I don’t have any options to reduce my risk from work, so anything that would help me feel a bit more safer and protected and less anxious would be very great fully received right now! Thanks for your informative reply x

I honestly don't think it will be as simple as someone takes a particular medication (for asthma). I know you're not saying that but think it will be a group of things linked together. Again, for asthma. Because any asthma they use will have to be pretty severe, or mixed with other factors, to suddenly be CEV, or they'd have been there before. So if people have asthma that doesn't tick group 6, they might have other factors (eg age or a high BMI (over 40 I saw somewhere but might not have been for this) or additional underlying conditions which on their own wouldn't be CEV but now, altogether, they might be).

Thank you for that, I read that my BMI classes me as low risk obese, but underlying conditions add to that so I don’t actually know if that’ll count or if that is what this new assessment will go by... who knows, I guess it will just be a waiting game to see who gets contacted! Hopefully this will help some of us asthmatics that have been let down and forgotten, and if I’ve understood correctly and GPs are having an input then that may help to keep us safer than the Government seem to be! Thanks x

I'm pretty sure it will be other conditions that pull people into CEV. If asthma was a concern in that respect they'd have been there already. So anyone who fits other boxes of vulnerability then they might get pulled in. But I don't think asthma will be the main thing. Using the "whatever it's called they use" anyway!

Yeah, that seems like the most likely! I guess until new people get added and we find out the reasons why, we won’t know x

Good luck and I hope you get the vaccination ASAP 👍

This is the gov.uk shielding page with various links, including a link to the extremely vulnerable criteria, updated Feb 2021. (See links on left hand side).digital.nhs.uk/coronavirus/...

This website mentions asthma treatments such as anti-leukotrine (i.e monteleukast) and LABA treatments under Asthma. Also BMI but also postcodes taken into account re areas of deprivation etc. No one will know until they get the letter or not.

It's not pushing us further down it could be adding some of us to the Shielding list that wasn't already on it which would mean prioritising the vaccine as if you are now on the Shielding list and you weren't before.

Thank you! Do you know what inhalers are LABAs? Are they add on’s? I’m on Fostair which is a combined one but don’t know if it is a LABA? I was prescribed Montelukast a couple of years ago but it didn’t agree with me... Thanks for replying x

Leukotriene-receptor antagonists, such as montelukast and zafirlukast, prevent leukotrienes from binding to their receptors

Leukotriene synthesis inhibitors, such as zileuton, block the enzyme, 5-lipoxygenase, which is necessary for the formation of leukotrienes.

Montelukast, zafirlukast, and zileuton may be considered for the treatment of asthma.

LABA's to use wiki

en.wikipedia.org/wiki/Long-...

serevent

formoterol

etc

The info on those meds though refer to the section of the list that is medical reasons for being CEV - ie people who were already in Group 4. It says it's likely those with severe asthma will be on those meds AND have the steroid element that was part of CEV before.

The new part to the shielded patient list is the "other factors" document. So I suspect (although I didn't write it so can't be sure!) that someone's other factors added to their non-CEV asthma might bump them up. But not certain asthma meds because otherwise they'd be CEV already. Being on a LABA and montelukast for example doesn't actually put someone in group 6 even. Does that make sense? Apologies if not!

Thank you! To me that makes perfect sense, the meds alone wouldn’t impact on this because they’d already have been in the appropriate category, it will be the other factors that might change how much at risk someone is deemed at.. to me, and I don’t really know much about this, it does feel like a more appropriate way of assessing someone’s risk factor, especially if they allow GPs to have their say and add people x

So glad it made sense 😂And yes I agree - GPs can add people they feel need it.

Yes I agree it will probably push some group 6 up into group 4. I reckon it will be more complicated than someone takes a particular medication for asthma so there you go - more looked at in combination with other potential factors. I know they've always said age, obesity and ethnicity are huge factors with covid so expect they'll be the major elements.

I am definitely in group 6 because I am an unpaid carer but depends on this new calculator could be moved into shielding list:- Asthma (on DuoResp Spiramax/Ventolin/Monteleukast/Cetirizine)

- PCOS (complications high blood pressure medication)

- Sleep Apnoea & hypoventilation syndrome (Use CPAP machine)

- Iron deficiency anaemia (undergoing investigations)

- High BMI

etc

This link comes from the Government update on Shielding List

qcovid.org/

click on calculation

Accept terms and conditions

Put in Age, Gender, Ethnicity, Height, Weight, Postcode, Housing category,

Asks about:

- diabetes

- CKD

- Sickle cell or Severe combined immunodeficiency syndrome

- Cancer treatments or immunosuppressants

- Other conditions?

Select all options that are relevant.

Have severe mental illness

/Have cirrhosis of the liver/Have rheumatoid arthritis or SLE/Had a prior fracture of hip, wrist, spine or humerus

Severe respiratory or lung problems?

Select all options that are relevant.

- Have asthma (YES)

- Currently taking anti-leukotrienes or a long-acting beta2-agonist (LABA) (YES)

- Have cystic fibrosis or bronchiectasis or alveolitis

- Have pulmonary hypertension or pulmonary fibrosis

- Have chronic obstructive pulmonary disease (COPD)

- Neurological problems

- Have circulatory problems

It asks if I was on shielded list last year and said NO

It came up with the calculated BMI fell above the allowed range (15-47), the closest value (47) within this range has actually be used and the results shown are therefore an estimate.

Have just done the calculator and my result is as follows COVID associated death

The absolute risk of a COVID-19 associated death is 1 in 11364.

This is in rank 63 out of 100, where 100 is most at risk.

Thank you for this x

Nicki-Lou123
Nicki-Lou123 in reply to Poobah

Thank you for that link, I think I looked at it before and it didn’t really make things clearer but I’ll take a look at this and see x

Poobah
Poobah in reply to Nicki-Lou123

Everything seems to be hidden and requires some digging! With updated algorithms I hope that more people will be brought into the priority groups.

Nicki-Lou123
Nicki-Lou123 in reply to Poobah

It really does! If it can be of any help to us asthmatics who have been forgotten about and severely let down then that it can only be a good thing! Hopefully if GPs get to have their say and input too then that can only be a good thing too x

I found the list on my local paper or tv page for Norfolk and it’s shocking the seriousness of neglect for some of the worst illnesses, but i don’t know if it specifies a level for asthma or if it’s just general I’m afraid. I’m just staying hopeful, take care , good luck hope to find out more 👍🏻

Nicki-Lou123
Nicki-Lou123 in reply to Dizzart

Thank you! I am still looking for this list! Yeah, asthma alone wouldn’t account to being pushed higher up from this study, but it’s what other factors they’ve considered I am curious to know to see if added together it could push someone like me as higher risk x

The list is on edp.24 our local eastern daily press . It is not a paper which publishes junk news as some tabloids do .

Nicki-Lou123
Nicki-Lou123 in reply to Dizzart

Thank you so much, I’ll check it out!

With LABAs and anti leukotrines being included as identifiers for those possibly CEV, how can they now tell those of us who take them that we are at no risk as a result of our asthma? It must mean that there is an increased risk to that group. I don’t buy the ‘no risk with asthma’ narrative.

I totally agree with the whole ‘no risk with asthma’ narrative, it doesn’t make sense! So according to the Government I’m in the same risk category as my younger brother who has absolutely no conditions at all, never needs to see a doctor, and yet I have asthma as well as another underlying condition (I have just seen as well that this other underlying condition I have, the USA have now started vaccinating everyone with that condition and included them in their higher risk category with severe asthma!) it’s not even like I can speak to my GP either, because they point blank refuse to deal with anything to do with COVID or vaccinations unless you’ve been called up for one, even to the point where my Mum was hospitalised with COVID last month and on that morning they still refused to let her speak to someone and insisted she called 119!!! So wrong! Stay safe everyone x

My body mass is high, I am on fostair, salbutamol and have 3 other health conditions bad eczema, acid reflux and sinusitis. For eczema on steroid cream

I am on Fostair too! I also have another underlying condition I need HRT for, as well as hay fever and meds for that too! Hopefully we will get our vaccines soon, I really hope Asthma UK can continue to fight for us, as it seems our only hope right now!

Hoping too. My gp said category, 9. Not for my age for other health conditions

Ahh, I see, I can’t even ask my GP what category I fall in now because they point blank refuse to deal with anything Covid related, the only thing they do is vaccinate those who the Government say are eligible! So I assume it will be age related now, and as I’m 29 it will be a while yet! Although my GPs do seem to be getting through the categories really quickly, sounds like they’ve made good progress with those in category 6 so hopefully it will be my turn soon, especially as I work in a nursery with no PPE or no distancing!

I done through e consult. On same age category as you. My area category 4 now

Ahh fair enough! I might try to see if I can do that, although when I tried last year they wouldn’t even pass the e consult to the GP and just told me to follow the Government guidelines! Fingers crossed it will be sorted soon for us x

My gp wife contacted me through that.

EmmaF91
EmmaF91Community Ambassador

“Definition of clinically extremely vulnerable groups

People who are defined as clinically extremely vulnerable are thought to be at very high risk of serious illness from coronavirus. There are 3 ways you may be identified as clinically extremely vulnerable:

•You have one or more of the conditions listed below. (This is original list)

•Your clinician or GP has 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.

•You have been identified through the COVID-19 Population Risk Assessment as potentially being at high risk of serious illness if you catch the virus.”

( gov.uk/government/publicati... )

Basically the change is if the QCovid ( qcovid.org ) says you’re vulnerable you’re added. This looks at all the most ‘at risk’ characteristics (weight, ethnicity etc), weighted so that the ‘most risky’ gives more points than the ‘less risky’ factors.

twinkly29
twinkly29 in reply to EmmaF91

Thank you for this! So a medical condition itself isn't a factor (if it was, someone would already have been CEV because of it).

A new entrant to the CEV category would get there based on the bigger picture and points scored according to at-risk factors - so an existing medical condition might count towards it but depends how heavily weighted each person's factors are.

Looks like it! Although it looks like there isn’t much change then other than BMI and ethnicity? The one question that got me - previous fractured wrist/hip/spine? How does that have an affect? I ticked no at first, I have had 2 broken bones in my wrist but that was years ago, I then went back and did it again saying yes I had and it didn’t seem to affect my score too much x

BMI (think above 40 but could be wrong) and ethnicity will have a huge weighting I think. And age. As they are some of the biggest risk factors for covid. Plus deprivation.

The asthma on the list will probably be asthma that is (officially) Group 6 which, on its own isn't considered to be a high risk or it would be group 4, but if combined with age and BMI (for example) might swing it into group 4. Someone just on Fostair or similar would probably need a multitude of other factors.

I think it's a better way to look at it though because focusing on certain meds is largely unhelpful. Someone can be on certain meds and well controlled. But others not. So it's not as simple as a med type. There will be people highly at risk with no medical factors but maybe BMI, ethnicity, age, deprivation and so on.

The bones thing is possibly related to osteoporosis or something. Or frailty generally?

That makes sense actually, and I totally agree that they shouldn’t be just looking at one particular med type, people have different factors, risks and control it does seem that something to incorporate everything is needed to protect people... yeah I guess so about osteoporosis, but all it asked was if you’ve ever had a previous fracture in those areas, it didn’t ask how many, so I don’t know how that works unless it’s just a guidance for GPs to look in to maybe? Who knows! It also didn’t ask about what meds anyone takes, apart from the add on’s for asthma... who knows!

Nicki-Lou123
Nicki-Lou123 in reply to EmmaF91

Thank you for this Emma! Hopefully it will be able to help a few that have been forgotten about! X

EmmaF91
EmmaF91Community Ambassador in reply to Nicki-Lou123

digital.nhs.uk/coronavirus/...

Here you can see the weighted order of risk factors qcovid checks for, which is evidence based from last years data.

Nicki-Lou123
Nicki-Lou123 in reply to EmmaF91

Thank you! That really helps to understand what they’re basing it on!

From digital.nhs.uk/coronavirus/...

"How we've identified people as being potentially at high risk (clinically extremely vulnerable)...

We have used data about the following conditions and treatments to generate population risk assessments...

Asthma

Taking anti-leukotriene or long acting beta2-agonists (LABA)"

So I can't see how they're saying that asthma isn't a risk factor if you take either of these. I'm not saying it's the only risk factor or the highest risk factor but it indicates that it IS a risk factor that they've identified. Therefore I can't believe the claim of all non-severe asthma being no extra risk at all to anyone. And where does this requirement for hospital admission or three courses of steroids in 3 months come from? There's no data supporting that.

Yep, I totally agree, it makes absolutely no sense to say it isn’t a risk factor, it has clearly been done to reduce the numbers of people in the CV category getting vaccines so that the Government can turn round and say they’ve vaccinated all in group 6 quicker to make themselves look good! The thing is any asthma is so different and varied anyway, and Covid seems to be so random and unpredictable, that I don’t believe any of these claims!

EmmaF91
EmmaF91Community Ambassador in reply to Artichokes

It’s a relative risk factor thing. By itself the risk is small (as shown on here by the number of young asthmatics who managed well at home), but add on other criteria (age, ethnicity, weight) and then it may become more problematic. Which again reflects what I’ve personally observed - older, BAME or other conditions landed in hosp.

On that list being white is a risk factor, but that doesn’t mean all white people should have it in group 6. They are trying to order it in the ‘most at risk’ order, otherwise places would get over run. I think I read that AUK are trying to get all asthmatics vaccinated by group 9 (or at least first in line as group 10 - I can’t remember where I read it 😅), which would cover the risk for the younger asthmatics who would be after that.

And I think the LRTA/LABA was just their way of differentiating mild from moderate asthma. The hosp admission/3 in 3 is probably something that was provided to cover for any uncontrolled/missed asthmatic, who may be more at risk than those who have always been controlled 🤷‍♀️ (otherwise group 6 literally was the description for group 4 🙄🤦‍♀️). They (the Gov) are trying to provide clear/obvious definitions in a condition where there isn’t one, which will mean there are always people who ‘just’ miss the criteria, but from the sounds of it AUK pushed them to be ‘generous’ with their requirements, so it’s ‘ever in your lifetime have you been uncontrolled defined by this criteria’, otherwise it would have remained how it was...

I get that people are unhappy, and I do think the government need to come out and clearly explain the science behind why the thinking has changed, but I also know that on all the risk checkers being my age and black is more risking than being my age, white and with asthma...

Nicki-Lou123
Nicki-Lou123 in reply to EmmaF91

Thank you! That helps explain the rationale behind the Oxford calculations... I also totally understand that there does need to be some kind of differentiation between controlled and uncontrolled asthmatics, but I think what a lot of us are struggling to understand and accept is how we can suddenly end up being in the same risk category as someone the same age as us that has no underlying conditions at all! But if Asthma UK are still continuing to push for us then that can only be a good thing x

It could be because the conditions are not a risk factor for covid (at a particular level and when not combined with other factors). Like someone might say they have eczema but their friend doesn't - but eczema isn't relevant here because it's not a risk factor. So with controlled asthma, if it's not considered a risk with covid (without wanting to get into the ins and outs of that!) then it becomes irrelevant (or less relevant perhaps is a better term because it would be looked at in line with the QCovid risk factors).

Artichokes
Artichokes in reply to EmmaF91

I do agree this needs to be clarified or deserves a re-think. I had multiple admissions as a child and several as an adult but my surgery are saying the admissions have to be in the past 12 months and I'm not group 6. I also have steroids and antibiotics on repeat prescription but I haven't taken enough in the past year (because I've stayed home and kept my child out of school). It's a ridiculous situation. Even if it's a relative risk, it's just not true that it's no risk yet we're being peddled this line of asthma being no risk at all provided it's non-severe. (My asthma is classed as severe btw but JCVI define it differently).

The NHS still lists us as clinically vulnerable. What isn't being mentioned is that it's the risk of death they're talking about and not the risk of severe illness or long term lung damage or long covid. My asthma has already led to permanent airway remodelling and I struggle with my breathing frequently. I'm incredibly scared and worried by this whole debacle. I recognise that other conditions and age are greater risks and therefore they should be vaccinated first. No problem with that at all. But it's madness to treat us the same as others our own age who have no health problems.

You have basically summed up exactly how I feel! It isn’t just about the risk of death, it’s about the long term effects too! I am coming into the start of hay fever season which is a massive trigger for me, and the only reason I got away with no steroids or hospitalisation last year was because I was unbelievably over the top, and my work actually closed so I was able to fully shield during hay fever season last year! I work in a nursery, no PPE or distancing, no sign of a vaccine, and I’m having counselling to try and help cope with it all since I’ve had a colleague in a coma and my Mum hospitalised due to Covid... safe to say today we talked about the vaccine and it was a very emotional session! I also completely whole heartedly agree there are others who may be even higher a risk and so should most definitely be vaccinated first, but it is complete madness to treat us like others the same age with no underlying conditions at all!

I'm so sorry to hear about everything that's been going on for you. Completely understand how difficult and worrying that all must. Fingers crossed something comes of all this and we at least get a vaccine in group 9 or 10- especially given that your exposure is unavoidable. x

Thank you, that’s the best we can hope for now I guess! It just frustrates me so much but I know we just have to wait our turn for the vaccines and keep fingers crossed in the meantime! Exactly, they say teachers might be considered as an extra priority group after the main ones, but early years staff are highly unlikely to be put in with this category as early years has been severely forgotten about in all the guidance, we have basically had to make our own rules and policies and procedures as we go along x

No one knows if this vaccine is going to work do theySo i wouldnt worry too much

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