A further 1.7million people in England are being told to shield themselves from coronavirus and everyone on the vulnerable list is being urged to stay at home until at least March 31.
Officials said the list — first drafted almost a year ago — was being almost doubled after No10’s scientific advisers identified additional adults at serious risk of Covid-19.
The Department of Health did not say who would be added, but the update will look at risk factors including age, weight, ethnicity and deprivation – rather than just underlying conditions.
It comes after the National Audit Office revealed last week hundreds of thousands of vulnerable patients were not told to shield due to out-of-date records.
Today’s announcement pours cold water on hopes lockdown could start to be eased next month, suggesting medics do not think it will be safe.
This is despite the Government smashing its target of vaccinating 15million of the most vulnerable by February 15.
There had been hopes that once those most at risk were jabbed and developed immunity several weeks later, that the most draconian curbs could be lifted.
Of the 1.7million new shielders, 900,000 have already had their first dose because their age or medical history made them eligible during the first phase of the roll-out.
But health chiefs are now racing to immunize the 800,000 who were missed during the first wave of vaccinations. Health chiefs said they will be prioritized.
People who are shielding are advised not to leave their homes – except for brief exercise or medical appointments – because they’re at a much higher risk of being hospitalized or dying if they catch the coronavirus.
Even shielders who have had their first dose of vaccine are being told to continue shielding until they have had their second shot and developed immunity from it, which happens after about three weeks after the injection.
But children who live with people who are vulnerable should still go to school when they reopen, providing they are not at risk themselves.
Freda Maddison, 92, was able to see her son for the first time in months. Freda, a resident at Eothen Homes in Miller Way, Wallsend, North Tyneside, had not been able to see her son Stephen Maddison since the spike in coronavirus cases. They met again on Friday
Prime Minister Boris Johnson during a media briefing in Downing Street, London, on Monday
WHY HAS THE SHIELDING LIST BEEN EXPANDED?
The Department of Health said it was expanding the shielding list after the Government’s scientific advisers identified additional adults at serious risk of Covid-19 using a new algorithm.
Oxford University scientists developed the model, known as QCOVID, which analyses a combination of risk factors based on patients’ medical records.
It looks at their age, weight, ethnicity, and level of deprivation, as well as whether they take certain medications.
Of the 1.7million new shielders, 900,000 have already been vaccinated because their age or underlying health conditions has already made them eligible.
But health chiefs are now racing to vaccinate the 800,000 who were missed during the first wave of vaccinations. They will be targeted before the end of April.
WHAT DOES THE TOOL TAKE INTO CONSIDERATION?
The following are some variables that were examined to make the tool:
- Smoking status
- Drug use
- Respiratory disease, such as asthma
- Kidney disease, such as renal failure
- Liver disease, such as alcohol-related
- Heart disease
- Neurological conditions such as Epilepsy and cerebral palsy
- Rare diseases
- Medications that compromise the immune system, such as chemotherapy
- Mental illness, such as psychosis
- Fragility fracture
- Learning disability
- Conditions or treatments that predispose to infection, such as Lupus
In other coronavirus developments today:
- Nicola Sturgeon confirmed that Scottish schoolchildren will return to class from next Monday, a full fortnight before their English counterparts;
- Another Covid variant that could dodge vaccine-triggered immunity has been identified 33 times in the UK;
- One of Public Health England’s top advisers accused the Government of doing ‘science by press release’ by announcing things without telling its scientists;
- Four passengers arriving in the UK have been fined £10,000 each for failing to tell authorities that they came from a ‘red-list’ country;
- Nearly one in five adults in England – 8.3million people – had Covid antibodies at the beginning of February, a major surveillance study revealed;
- Vaccines Minister Nadhim Zahawi said it isup to businesses’ to decide if they want to require proof of vaccination before serving customers.
The additional 1.7million shielders will bring the number of people on the list to almost four million — all of whom are being advised to shield until March 31.
Dr. Jenny Harries, deputy chief medical officer for England, said the new shielders will receive the additional support already available to those on the list, including medicine deliveries, priority slots for supermarkets and statutory sick pay.
Dr. Harries told a briefing today: ‘We have a new, evidence-based, data-driven, predictive risk model which allows us to identify adults with multiple risk factors that make them more vulnerable to Covid.
‘We can now identify additional people and help protect them now and in the future.
‘All of these people who are identified for the first time are those who have not had an individual clinical condition that we’ve previously been able to identify through the clinically extremely vulnerable group, but they are people who have multiple personal risk factors and underlying health conditions which move them into a higher risk group.’
Originally 2.2million people in England were on the list, many of whom were identified for a single reason.
These included obvious vulnerabilities, including having life-threatening conditions such as cancer, taking immunosuppression drugs or suffering from genetic disorders.
But as the pandemic has progressed scientists have found a slew of other factors that, when combined, can put people at risk of dying from Covid – including being overweight, living in deprived areas, or taking certain medications.
Oxford University researchers used a new algorithm to analyze a combination of risk factors based on patients’ medical records.
They highlighted a further 1.7million people who were at risk, which will bring the number on the shielding list to almost four million.
The move is not thought to affect the devolved nations, which set their own shielding lists.
People on the shielding list were among the first in line for Covid vaccines in the UK. (Pictured: Glasgow resident John Loch, 69, receives his jab at the NHS Louisa Jordan Hospital on February 10)
This was the original top nine priority groups for the Covid vaccines, set out by the Joint Committee on Vaccination and Immunisation (JCVI)
Officials have vaccinated the vast majority of the top four priority groups — everyone over the age of 70, NHS staff, care home residents and workers, and extremely ill adults
WHO WAS ON THE ORIGINAL SHIELDING LIST?
People who are considered ‘clinically extremely vulnerable’ should all have received an official letter warning them that they are on the shielding list and should stay at home unless necessary.
People on the shielding list include:
- Organ transplant recipients;
- People having chemotherapy for cancer;
- Lung cancer patients receiving radical radiotherapy;
- People with blood or bone marrow cancer such as leukemia;
- Cancer patients receiving immunotherapy or other therapies that affect the immune system;
- Bone marrow or stem cell transplant recipients who had the procedure during the last six months or are still taking immunosuppressant drugs;
- People with debilitating lung conditions including cystic fibrosis, bad asthma or severe COPD;
- Those with a rare condition that increases the risk of infection, such as homozygous sickle cell disease;
- Patients having immunosuppressant therapies that raise infection risk;
- Pregnant women with significant heart disease;
- Others who have been individually judged extremely vulnerable by doctors;
- Adults with Down’s syndrome;
- People with stage 5 kidney disease.
Ministers are planning to begin easing lockdown restrictions as soon as March 8, with the strict ‘stay at home’ message to be ditched by Boris Johnson.
Whitehall sources say Britons could be allowed to socialize outside for the first time since Christmas on that date.
Outdoor leisure activities, including golf and tennis, could be permitted before Easter.
The Prime Minister will publish his roadmap for easing lockdown next Monday, which will include target dates for the earliest each of the restrictions will be lifted.
But it is still not clear when lockdown curbs will be eased significantly and shops, gyms, and restaurants will be allowed to open, with the PM opting for a ‘cautious’ approach to ensure this is the last time the country has to shut down completely.
Dr Harries said: ‘As we learn more about Covid-19, we’re continuously reviewing the evidence… it was very clear that not all of those individuals who were at risk were identified by the binary approach.
‘The model that is used combines a number of underlying risk factors. And those factors include specific health conditions and some treatments which, for example, put your immune system at risk.
‘Age, which is the highest risk factor, sex, ethnicity, body mass index, and your postcode, which will also link to a deprivation score.
‘It provides a weighted cumulative risk of serious outcomes from Covid-19 and therefore allows us to prioritize these individuals for vaccination and to give them appropriate advice.
‘And the easiest way for us to do that is to include them on the shielded patient list.’ Dr. Harries said the approach was ‘risk averse’ to ‘protect as many people as possible.
‘The letter will note that this is more likely to be an overestimate of risk in a way which hopefully handles any of their anxiety,’ she said.
Oxford University has developed an algorithm known as QCOVID which takes into consideration age, ethnicity, health conditions, weight, and postcode to give an estimated odds of severe Covid-19 outcomes. It has been used in NHS hospitals to highlight frontline workers who are at risk (pictured)
Shielding alert forgot 375,000 vulnerable patients who were not warned to shield from Covid-19 because records were out of date, report claims
Hundreds of thousands of vulnerable patients were not told to shield due to out-of-date records, says a report.
The National Audit Office says the lack of a contingency plan left officials creating a system from scratch to identify people who might need support during the lockdown.
But hospital records they relied on were weeks out of date or had missing or wrong phone numbers – so some people had to wait weeks before they could get deliveries of food or medicines.
A center set up to contact people who did not register online or via an automated phone line could not reach 375,000 out of 1.8million names and advise them to shield for 12 weeks during the first lockdown last year.
And 126,000 people were contacted in error and wrongly advised to shield.
Audit Office head Gareth Davies said: ‘Challenges pulling together data meant it took time to quickly identify those needing to shield.’
Meg Hillier, chairman of the Commons public accounts committee, said far too many people ‘were not eligible for support for weeks while the Government scrambled to gather basic information.
Just before the first lockdown, the Government said an estimated 1.5million of those considered ‘clinically extremely vulnerable’ (CEV) should stay home for the next 12 weeks.
But a 2016 exercise to test for preparedness for a flu pandemic, codenamed Exercise Cygnus, had not covered the need for vulnerable people to shield.
It meant there was no system in place to allow a fast ‘sweep’ across all patient data to identify those who should be on the list and who may need support.
Initially, NHS Digital was forced to rely on the hospital, maternity, and prescribed medicines data – even though the hospital records were seven weeks out of date.
The first list identified some 870,000 people who were identified as CEV and were sent letters advising them to shield.
By April 12, NHS Digital had managed to identify a further 420,000 through the use of GP data while a further 900,000 were added to the list between April 18 and May 7, taking the total to a 2.2million.
In an attempt to ensure all those who were eligible for support registered with the scheme – whether they needed help or not – the Government commissioned a contact center to reach those who had not signed up.
However, of the 1.8million names they were given, 375,000 could not be reached because of missing or inaccurate phone numbers in NHS patient records, while a further 440,000 declined to register – in some cases hanging up because they thought it was a nuisance call.
In all, more than 510,000 people were supported through the scheme to the start of August at a cost to the taxpayer of £308million – of which £200million was spent on food boxes.
‘And it makes it absolutely clear that it is a choice for them if they choose to follow shielding advice or not – that has always been the case.
‘What it does also do – which I hope will benefit them, which is why people will hopefully be grateful to receive this – is it will prioritize them for vaccination.
‘In addition to that it means they have advice and support and that is important not just now, but should there be any changes in the pandemic in forthcoming months – for example, perhaps in vaccinations perhaps in the autumn as we go forward, then clearly they will be identified within that group as well so there are current and longer-term benefits.’
However, charities warned the sudden change in guidance 11 months into the pandemic would ‘come as a huge shock’ to patients.
A spokesman for the MS Society told Sky News: ‘Being added to the list will have greater implications for someone’s life far beyond their place in the vaccine priority list – from going to work to be able to access food and medication.
‘The government must prioritize communicating these latest developments clearly and ensure comprehensive support is in place for all those who suddenly find they must make potentially drastic changes to their life.’
It came as the Government’s leading vaccine experts met to thrash out which groups will be prioritized when the top nine groups have been inoculated by April.
The Joint Committee on Vaccination and Immunisation (JCVI) is expected to urge ministers to vaccinate people by age and ethnicity rather than their job.
Members are said to be particularly concerned about mortality rates among South Asians, who studies have shown are twice as likely to succumb to the virus as their white peers.
Both Boris Johnson and Matt Hancock have previously said teachers, police officers, shop owners, and other key workers could be bumped up the priority list once the top groups have been jabbed.
But JCVI sources said last night prioritizing people based on their occupation would ‘create too much complication’ and ‘risk slowing the roll-out down’.
Officials have until now been focusing on vaccinating the top four vulnerable groups — everyone over the age of 70, NHS staff, care home residents and workers, and extremely ill adults.
Yesterday NHS England officially moved on to the second stage of the vaccine drive, inviting over-65s and ‘clinically vulnerable’ younger people.
The program will aim to give everyone over the age of 50 their first dose by the end of April.
NHS England boss Sir Simon Stevens yesterday vowed to double the number of jabs being given in order for the Government to hit that target. It could see up to 1million doses dished out each day.
The Labour party and workers’ unions have been campaigning for weeks for the Government to prioritize people based on their jobs once the top groups have been jabbed.
London mayor Sadiq Khan told the Radio 4 Today Programme this morning: ‘The next phase should include those occupations where… you’re more likely to catch the virus with adverse consequences’.
Ministers have not yet laid out how the jabs will be prioritized once the top nine groups have been jabbed, which includes roughly 32 million people.
They are expected to receive recommendations from the JCVI by the end of this week.
A source on the committee told The Telegraph: ‘One of the main factors behind the success of the rollout so far has been the simplicity of the prioritization rules because it has been based largely on age.
‘Once you make things more complicated, you run the risk of slowing things down. You create more telephone calls for surgeries to make, while people are bashing on the door demanding a vaccine because they think it’s their turn.’
On whether ethnic minorities should be considered, they added: ‘The mortality figures for people from South Asian backgrounds are particularly worrying.
‘Once we get down to those in their 50s, we want to be reaching out especially to these ethnic minority groups.’