‘Shielding’ vs ‘Vulnerable’?

[aWeaponCalledtheWord]

more confused than ever now.

i though the isolation for 12 weeks group would broadly include everyone eligible for NHS flu jab (as in those people advised to have it).

the new ‘shielding’ group doesn’t make any mention of this at all.

i have 2 autoimmune conditions, i take methotrexate, my thyroid needs removing (failed op in January) and frankly, i’m fat.

will i be getting the Golden Ticket letter from the NHS? what about people who don’t get this advice, but are immune suppressed and have the NHS flu/pneumonia jab recommended to them?

so confused. and scared. can anyone cleverer than me help me make sense of this?

There is an NHS Guide, go here

www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

i guess i just wait and see if my methotrexate qualifies me...even if not, i think i’ll be staying in for the foreseeable.

If you are very overweight a personalised decision should be made as to whether isolation would be a good idea. You will probably get a letter due to your meds but might be an idea to call your GP to discuss it further.

For example dad has mild heart failure and has been told by his cardiologist that regardless of what letter he receives he needs to go for a brisk walk everyday for exercise.

I was a bit confused by this too. I guess the 'Vulnerable' category are the very most at risk but a lot of the deaths have included people with heart disease and diabetes, which I don't think are included.

I have graves disease I dont know what I suppose to be doing for the first time today my son asks me how serious it is for me I tried to explain I have had a temporary condition for over 20 years I just dont get better from it they were going to treat it this year after my latest rise...I'm guessing that's out

There are two categories - vulnerable/high risk (of which you are one, includes pregnant women, over 70s etc) and those who need to be shielded because they are super high risk and a much smaller group. I'm on similar drugs and I don't expect to be included in the latter based on what I've read (and the fact they are only predicting there to be 1.5m of them suggests we won't be). The first group should be very careful over the next 12 weeks. The second group should totally isolate.

I found this very useful. It was posted on a FB group I'm on for type 1 diabetes as people asked the same question as you.

I'd say that MTX qualifies you, as it's immunosuppressant medication that puts you at higher risk of infection.

The definition they've used is that used in the definition of what Humira is, almost word for word.

I'd have rather had Charlie Bucket's Golden Ticket, I can tell you. Even though I hate bloody chocolate.

I think there are 3 groups. The extremely vulnerable, the vulnerable, and everyone else. The extremely vulnerable are shielded, the vulnerable should isolate, and everyone else social distance.

I think it makes you high risk @MitziK, I don't think it means you need to be shielded with the army delivering you supplies etc. The gov.uk website only makes reference to the immunosuppressant medication in relation to those who have had organ transplants when talking about the group that need to be shielded.

NRAS have released an updated statement which included this link that I found quite useful in helping me work out my risk level, includes your risk level based on medication given as well as auto immune disease.

www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/clinical-guide-rheumatology-patients-v1-19-march-2020.pdf

And this is the link to the NRAS website and their faqs on it all

www.nras.org.uk/frequently-asked-questions

I'm wondering the same as you OP, guess will need to see. DH on methotrexate and humira.

I see it it says section 5. on immunosuppressants sufficient to suppress the immune system to an extent to make mire vulnerable I guess that depends therefore on the dose and condition / combination of underlying conditions.

I have a primary immunodeficiency (CVID) which requires immunoglobulin infusions to shore up my IGG. Is it likely I will meet the criteria and receive a letter? I have been social distancing for a couple of weeks - but have still gone to shop for supplies and quiet walks with immediate family. How is everyone affected feeling about this?

I too have Graves’ disease @slipperywhensparticus . I’m not sure if it falls in the government’s at risk category but I’m taking precautions. Also my 2 year old has had x8 hospital admissions for viral wheeze , he takes preventer inhaler and montelukast, he’s not going over the door .
Batten down the hatches

Thanks for the support - I'm taking point 5 of their list -

People on immunosuppression therapies sufficient to significantly increase risk of infection.

And then the use of biologics is automatically high to very high - add in connective tissue disease (EDS) to the active PsA, Humira and steroids and I think I've probably got all the bells ringing.

Already ill, anyhow. So guess I'll find out soon enough. I'm not coughing or have a fever, but I'm wheezing just like if you have a URTI, so I got automatically kicked out of the NHS 111 online site, especially as there is no way of saying you're one of the lucky few. It's still not bad enough to panic about it, but hopefully they'll be able to take the additional risk into account by the morning.

Just checked Chrons and Colitis Uk and it says yes, vulnerable if on immunosuppressants.

Yes there was something about higher risk of more than one. DH won't be happy he's still planning on going into work. 12 weeks is a long time if self employed :-(

Thank you for explaining on this thread 💐 I was specifically looking out for this information and would like to think I'm not the dimmest bulb in a box, but this press conference has managed to confuse me as to the two categories!

I can't understand it either. I thought that all types of diabetes were supposed to be on the list (I have type 2) from what I had seen before, but it seems maybe not?

I also have Graves Disease. It was controlled some years ago by zapping my thyroid with radioactive iodine and then using replacement thyroxine. It has caused my weight to yo-yo over the years, and now I am settled in an overweight category, which I try hard to do something about.

I am acting as if I am vulnerable and self-isolating as much as possible bar going to buy food or get my medication and will continue to do so, but I am really not sure where I come in this. Has the comprehensive list been published yet?

I have a parent with COPD (I know in the extremely vulnerable category) and another with severe osteoporosis (so very immobile, not sure which category). Both probably very high risk as they are in their eighties.

It is confusing.

I

Ah bugger, @MitziK, I was looking at the guidance on gov.uk which said different as the NHS website which just said to call your treatment team if you feel unwell. I don't have EDS but have another underlying risk factor plus the PsA and Humira combo. I have a feeling that I won't get an NHS letter as the vast majority of my treatment is private. I might drop my rheumatologist an email and see what he says - I can share any response if it's helpful? Hope you feel better in the morning

Sorry, for the sake of clarity, I was looking at the original guidance on gov.uk on social distancing (that came out last Monday); not the most recent update on the extremely vulnerable.

thanks for all the responses. i guess the only way forward is to wait to see who gets a letter. my other worry is that i take a large dose of Etodolac every day, which is an NSAID and there’s conflicting advice over those.

even if i don’t get the letter i think i’ll carry on as i am, which is isolating and asking friends/neighbours to top up my electricity key and collect my medication every 2 weeks.

i also have a gigantic substernal thyroid goitre which has squished my trachea to one side. i guess this is all on my record, if that’s how they’re doing it.

i assumed they’d just do lookups for certain conditions and medications and use that info. but my medical record shows that my situation is more complex than that.

i had a failed thyroidectomy in January, as the anaesthetist couldn’t keep me oxygenated enough to be safe, and there was no ICU bed available. this will also be on my record but how much time do the NHS have to do the digging?