Most children could be removed from shielded patient list, deputy CMO suggests

Most children could be removed from the shielded patient list in a future wave of COVID-19, a deputy CMO for England has said, revealing the DHSC is developing a new algorithm to establish more precisely which patients are at most risk.

Deputy CMO for England Dr Jenny Harries (Photo: Pippa Fowles/Getty Images)
Deputy CMO for England Dr Jenny Harries (Photo: Pippa Fowles/Getty Images)

Speaking on NHS England's regular primary care webinar on Thursday evening, Dr Jenny Harries said the DHSC was aiming to develop a 'much more nuanced approach' to shielded patients.

She said that current recommendations around shielded patients were based on modelling right at the start of the pandemic, but that officials were now 'getting greater understanding of what the actual risks are for individuals and different groups'.

Dr Harries said it was becoming clear that age was a 'very significant' risk factor for patients in the shielded group.

'As we go forward we will understand different things,' she said. 'So for example, we're working with the Royal College of Paediatrics and Child Health and we think it's quite unlikely that there will be many children in any revised advice, perhaps for a second wave, because children do very well. We've currently got about 90,000 children on the shielding list and we think that is actually unnecessary and it's probably stopping them getting good education.'

Risk algorithm

The deputy CMO said the DHSC was working to develop a better risk algorithm based on growing evidence both internationally and in the UK 'of precisely who is at risk'.

'This will hopefully be helpful to the patients, in understanding their risk, but also it will be helpful to [GPs] in having those conversations [with patients] so you have the evidence at your fingertips going forward,' Dr Harries said.

'That is clearly a growing evidence base, so I think in two to three months we will be able to give a much clearer picture to an individual patient,' she added.

A letter sent to GPs and hospital trusts on Thursday revealed that the government plans to review current guidance for shielded patients in the week beginning 15 June.

Dr Harries said that it was likely that any relaxation in the guidance would be 'blanket advice' based on the levels of the virus in the community.

'As we advise that we think it's safer to come out, it will be more of a sort of blanket advice that says actually epidemiology says your chance of meeting anybody with this disease in the community now, and therefore being at risk of transmission, is really so low - we can never remove it completely - but it's pretty low so you can go out,' she explained.

Communicating with patients

This week the government faced a backlash from GPs following an abrupt change in guidance for shielded patients advising that they could spend some time outdoors. GP leaders were not consulted ahead of the changes and many practices were left fielding calls from shielded patients who were unclear what the advice meant for them.

Dr Harries said that the government was looking carefully at how it would communicate any change in guidance in future. However, she cautioned that it would not tell all patients explicitly that they could go back to work, as such decisions would need to be taken by individuals based on their own circumstances and work situation.

Dr Harries added that while the government was looking at 'loosening some of the advice for people in this group', there was also the possibility that if there was a second wave of infections it may need to reinstate full shielding advice.

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