Shielding list to add extra people

I have had a phone call from my doctor’s surgery today inviting me for my vaccination on Thursday. I am thrilled. I think, maybe, they have been prioritising some people, like me, after reassessing their medical history. As I said earlier, l am a lifelong asthmatic and I have been so very careful this year. I feel as if l have won a gold medal.

I was surprised to hear yesterday that women who were diagnosed with gestational diabetes are to be advised to shield. One woman was diagnosed 10 years ago when pregnant with BMI of 30. Ten years on her BMI is 23 and she’s training for a marathon. Her blood sugars are normal. One of my loved ones is in similar situation.
How can young women who have worked throughout the pandemic, suddenly be told to shield. If their sugar levels have been normal since the end of the pregnancy (years ago) how realistic is it to recommend and expect shielding. Mumsnet is WTF about this

I’ve been hearing about the Gestational Diabetes issue. I had it ten years ago and have subsequently been diagnosed with Diabetes and am not overweight - but I haven’t received the notification. I do live in an affluent area though and we have had very few cases - despite us being in Tier 4 prior to this lockdown.

There have been questions regarding the accuracy of the algorithm. I’m currently working from home but spent four months last year working in an environment where many people contracted Covid, in a town which had very high rates. To be honest, I’m not too keen on returning but I don’t really have much of a choice.

If anyone is interested, here’s the research which produced the risk prediction algorithm. Obviously there are limits to how it is individualised - it’s a public health tool. So for example, it doesn’t take into account where you work, but where you live. I think it’s a very impressive piece of work. I hadn’t heard about gestational diabetes being factored in - I’ll look at that.

www.bmj.com/content/371/bmj.m3731

So gestational diabetes is a subset of T2 diabetes. However, having any kind of diabetes does not mean a person is automatically on the new shielders list. The whole point of the model is that it combines as many known relevant facts about the person and comes up with a predicted risk. So for example, dh is white, not overweight, not living in area of high deprivation, so despite T1 diabetes, is not a new shielder. Hence not all women who’ve had GD will be on the list, it will depend on the combination of all relevant factors a particular woman has.

suziewoozie, thank you for that link.
I had been pestering my RA consultant for months during lockdown, as to how high a risk I am. He was never precise, just saying you will not survive it and won't be resucitated!

The link clarified things, so thank you. I always need an explanation and all the in and outs of my treatment and conditions.
However, as I fulfil at least five of the criteria for shielding, I'm surprised that I'm still here! ? The one thing I don't have is diabetes!

I had a Tesco delivery on Friday and the driver, with very mild asthma, had been five weeks in hospital with the virus. Initially, he thought he was having an asthma attack.
Also, he said he thought he would die. It serves to show that no-one can predict the effect on people.

I wonder if the lady with previous gestational diabetes, may need her medical record updated, if she no longer has diabetes. It may be worth contacting her GP for advice.

Marydoll, mumsnet has a lively thread on the issue. Radio 2 had a phone in, none of the women who had been asked to shield had diabetes after their pregnancy. For one, the pregnancy was 10 years ago. It may be the algorithm adds other issues, eg living in a deprived area. One of the callers lived in a wealthy area, 4 years since pregnancy. It does seem odd.

I’d thought the same Marydoll about updating of records. In the same way the various NHS records won’t show where we work, they won’t know if we’ve lost (or gained)2 stone over lockdown unless it’s been recorded in our notes. Occasionally there will be an error but if we think there is then we can contact the doctor. Like you I feel better understanding all the ins and outs of decisions. I think what needs to be better communicated in general is issues around prediction, risk and probability. Models like this can make predictions which are true across a group of people but cannot possibly be 100% true for each individual.

I've never completely understood the basis on which the original shielding list was drawn up. One friend who has had illnesses but doesn't have any chronic conditions was told to shield right at the start. My DH has a chronic heart problem but was never told to shield, though we actually decided to do it ourselves. Yet DH did get a relatively early vaccination and I was offered one too.
From a cynical point of view I have to ask if the high number of people from ethnic groups working for the NHS has caused the delay in them being asked to shield.
A friend's DIL (from an ethnic background) was very worried about going back to her work as an NHS consultant after maternity leave but also worried about her highly skilled job in a prestigious medical unit. Presumably if an employee is asked to shield their job must be protected?

Iam64

Marydoll, mumsnet has a lively thread on the issue. Radio 2 had a phone in, none of the women who had been asked to shield had diabetes after their pregnancy. For one, the pregnancy was 10 years ago. It may be the algorithm adds other issues, eg living in a deprived area. One of the callers lived in a wealthy area, 4 years since pregnancy. It does seem odd.

I had gestational diabetes and developed full-blown T2 diabetes less than a year later. It's a known risk factor, but not the only one. I wasn't overweight and was fit and ate healthily. It was a puzzle why I developed it.

It could be that if these women have no other risk factors, there's an error in the codes on their NHS records.

I used the algorithm and a tool to calculate my own risk. I ended up with a score of 88, which means only 12% of people are more likely to die if they're infected but isn't high enough to put me in the shielding group. I posted the link, but can't find it now.

I don't think the list of clinically extremely vulnerable has changed much in a year:

"People with the following conditions are automatically deemed clinically extremely vulnerable:

-solid organ transplant recipients
-people with specific cancers
-people with cancer who are undergoing active chemotherapy
-people with lung cancer who are undergoing radical radiotherapy
-people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
-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,

People with heart problems were never considered to be clinically extremely vulnerable, unless there were other issues.

At the start, it was considered to be mainly a disease of the respiratory system and the damage done to other organs was not really recognised.

Reading over on MN, a GP has said that it’s when the episode of GD hasn’t been closed down on the records following pregnancy so it looks like they still have it. But that then begs the question as to why those of us who had it and went on to develop Diabetes haven’t actually had the letter.

PaperMonster

Reading over on MN, a GP has said that it’s when the episode of GD hasn’t been closed down on the records following pregnancy so it looks like they still have it. But that then begs the question as to why those of us who had it and went on to develop Diabetes haven’t actually had the letter.

My understanding is that no one factor in the risk predictor tool would automatically trigger being advised to shield. Many other factors come into play such as post code, ethnicity, BMI ( if known).

I am 61 and have COPD. I haven't left house since last March and can't wait for my first vaccine as I struggle with breathing in everyday tasks, I dont think I would survive Covid.
I know it may be a long wait with so many in this latest tranche, all equally deserving, but I feel I now have no idea where I am in this long queue. My brother is 4yrs younger with Type1 Diabetes and had his last week so hopefully will not be too long.

misty Is your COPD classified as "severe"? If it is, you should have been in the "clinically extremely vulnerable" group. It could be that the code against your name on the GP's list is inaccurate.

I read something that a lot of the deaths of "healthy" people could have been PreDiabetes, so I think they are trying to protect more "obese" people from now on?

It's being recommended that people are tested for blood sugar levels if they are admitted to hospital for two reasons. It's estimated that there about a million people in the community with undiagnosed diabetes. Secondly, any infection can send the endocrine system off balance and increase blood sugar levels quite dramatically.

About a third of the people who have died with Covid have had high blood sugar levels, but the doctors aren't sure whether Covid caused diabetes or whether the patients already had it (and maybe undiagnosed) when they were admitted.

Diabetics aren't automatically on the shielding list, even those with confirmed diabetes and other conditions. Unless there's been an error, I'm fairly sure that there will have been other risk factors in the people who have been vaccinated "because they have diabetes".

In the shielding algorithm, diabetes and obesity are separate risk factors.

grow there’s clearly been a huge communication failure. I think because we all got used to the CEV list and the CV list which was uni dimensional, people can’t get their heads around this algorithm which is multi dimensional. I’ve tried explaining it, I gave the link but there still seems to be a belief that having a condition puts you on this extended list. If anyone thinks they should or shouldn’t be on this list and are , then they should contact their gp.

I agree with you suzie. I noticed that many people were claiming to be CEV when they weren't. Some people hadn't ever bothered to look at the lists produced by the NHS. Loads of people think they should be on the list, but actually it's only for a very small group of people.

There is a second group of people considered to be at high risk and some people have confused the two. The second group was advised to follow the guidelines very strictly, but was never advised to shield and didn't receive food parcels or eligibility for supermarket deliveries, etc. I'm one of them and it was a very grey area (it still is). I received a very strange text from the NHS, which was as clear as mud.

This latest algorithm includes the medical conditions on the original CEV list, some of those in the second group and, additionally, includes factors such as postcode and ethnicity. The full algorithm is pages long and you need to be a mathematician to understand it (I'm not), but there are summaries available in the public domain, which I've posted twice. There is also an online calculation tool. It's not rocket science, if people look.

As far as I know, the new list doesn't affect priority for vaccination, which is also confusing.

PS. It also includes gender. Males are at a higher risk of dying or being seriously ill than females.

I did notice posters on here, claiming to be CEV, but hadn't been contacted to inform them they were.
One poster, then said, she thought she was, but admitted she didn't know the criteria and realised she was mistaken.
There seems to be a lot of confusion about what actually CEV means.

I think initially part of the problem was nobody knew who was more vulnerable, so people were advised to shield or at least self isolate as much as possible, as it was an unknown quantity. We didn't receive a shielding letter but I was rang by the local authority to say we had been put on their list for services and the man I spoke to said they were suggesting people on this list shield as much as they could. I just naively assumed they were trying to keep people out of hospital. I realise this is, she said this, he said that. It is luxury to have any choice, a lot of people have had no choice as to whether they go to work or not and what risks they have had to take.

At the beginning, I really think the co-ordination and messaging was appalling. GPs weren't informed what was going on and local authorities were "tardy" (errmm - I think that's a fair word) in getting their act together.

Even now, they still don't know who is at risk if they're infected (eg people living on their own or as sole carers for others) and rely on community volunteer groups and people contacting them.

For the past year, I've lived almost as though I'm shielding because I'm not prepared to take anything more than minimum risk, but that's my choice and a rational decision. I'm just lucky that I don't have to work outside the home. The new list gives such people a little added support because they can claim sickness benefit, for what it's worth.

The Council Officer who phoned me said that they also had a duty of care to those who were vulnerable, but not CEV. That's why they were contacting other people who were not on the shielding list.