On 16 March, ITV reported the Chief Medical Officer for England saying that advice would shortly be sent out to ‘vulnerable’ people who should be taking extra steps to protect themselves against COVID-19, namely by shielding themselves for twelve weeks. He specifically stated that this would broadly speaking be those advised to have the annual flu vaccine:
The Times the next day published this handy chart on what you should do if you were in a specific group:
The Times table, obviously based on Government briefing, introduced the concept of ‘serious underlying health conditions’ which was clearly intended to be different from ‘underlying health condition’.
Those adults advised to have the flu vaccine include:
Ok, now bear with me. I’ve been looking for up-to-date figures on the numbers getting the flu vaccination annually. Public Health England said 25 million were eligible for free flu vaccinations in 2019. In the previous year about 70% of over 65s took up the vaccination; and 48% of those in an at-risk group and 45% of pregnant women in England. This meant about 7.5 million over-65s had the vaccination; 6.8 million of those in at risk groups. In Wales, a total estimated 868,668 people were vaccinated.
So if the 16 March definition given by Professor Whitty had been used, then many millions of people would have been asked to shield themselves. Shielding, remember means this ‘You are strongly advised to stay at home at all times and avoid any face-to-face contact‘. Any face-to-face contact. In more detail:
The extract above is from the Guidance issued by the UK Government on 21 March on shielding people defined as ‘extremely vulnerable’.
Those defined as ‘extremely vulnerable’ are clearly a much smaller group than the vulnerable groups mentioned by Professor Whitty on 16 March. They are defined as:
As an asthmatic, I looked for definitions of ‘severe asthma’. Last Monday, 23 March, I found guidance issued by Asthma UK following advice from the Department of Health and Social Care in the UK. This suggested severe asthma consisted in the following:
The original guidance posted by Asthma UK suggested ‘a high daily steroid dose’ meant – for example – two puffs a day of the Seretide inhaler, which is my own prescription. (for those definitions, see for example this). I would not have defined my asthma as ‘severe’ before reading that – I cycle regularly and feel my asthma is under good control.
The NHS Digital Clinical algorithm used to identify ‘Shielded patients’ however defines severe asthma as follows: ‘Severe asthmatics are those who are frequently prescribed high dose steroid tablets.’ (in the small print, this includes for example prednisolone.I haven’t been prescribed that for over 40 years, after I had been hospitalised for my asthma). This is of course different from the Asthma UK guidance on what is meant by severe asthma, a term which Asthma UK accepts is open to interpretation.
In the detailed explanation of the NHS Clinical Algorithm, you will find the following:
So 19 Million people would have been captured by Professor Whitty’s original suggestion of the vulnerable who should be shielded: these are now classified as ‘at risk’. Now there is a group of ‘at high risk’ people amounting to 1.5 million. These ‘at risk’ and ‘at high risk’ groups roughly correspond to the ‘vulnerable’ and ‘extremely vulnerable’ categories. It is the ‘at high risk’ or ‘extremely vulnerable’ group that have been getting letters and in some cases texts from the NHS as announced last Monday. Letters should have been received by today if you are ‘extremely vulnerable’.
If you think you should be in the ‘extremely vulnerable’ or ‘at high risk’ group but have not been categorised as such, then if you live in England you can log in here to say so. The option to challenge your categorisation may exist in Wales but if it does I can’t find it in this.
19 million at risk or vulnerable. 1.5 million ‘at high risk’ or ‘extremely vulnerable’. To my mind, this just reinforces the lack of clarity in government messaging over the last fortnight.