How is someone decided to be in the shielded group?

[LivinLaVidaLoki]

Sorry this probably makes no sense, I'm just sat musing while trying to wfh.
When the vulnerable/high risk letters went out from the nhs last week I was a bit confused.
I have a brother who is asthmatic, has type 2 diabetes and a high bmi. He also has a multitude of other health issues stemming from a life of alcohol and substance misuse.
Looking at the government guidance that was released last week, I thought being diabetic and asthmatic and having a high bmi would have put him in the shielded group?
However, he has been advised that he isnt and so has been going to work and shopping and out to work etc.
He has now developed a cough and a sore throat. He has been prescribed anti biotics
and told he has a chest infection.
I know I'm being silly but it worries me (though I do seem to constantly worry about him anyway), and I know it more than likely will be a chest infection, but I don't understand how he wouldnt have been in the shielded group.

Is it just type one Diabeties that is in the vulnerable group.

Dd is asthmatic and hasn’t got a letter but Dp (cancer, type 1 diabetic, and no spleen) has

I don’t think asthma is in the vulnerable group and it sounds like the rest of his illnesses are self inflicted.

As far as I understand it the majority of the people in the shielded group have severely reduced immune systems .

While your brother has severe health issue he can, with reasonable care, go out into the community under the governments restrictions , without being infected.

Whereas my friend, who has myeloma , had an unsuccessful bone marrow transplant, and has almost no immune system left always has to be careful about possible infections(coughs, colds, chickenpox etc) and would presently only be safe if they went outside in a full hazmat suit.

He sounds vulnerable, he doesn't sound extremely vulnerable. I have two friends in the shielding group - one received a liver transplant about 18 months ago and is immunosuppressed, one has Crohns and is on immunosuppressants and steroids.

@Oliversmumsarmy it's because your DH doesn't have a spleen that he got a letter.

Op there's clear guidance on this on the gov website, he is in the vulnerable category but not the shielding category. There are a second lot of letters going out from GP's for those with diabetes if their hba1c is very high (over 9%), or if they're asthmatic and have required admissions in the past year (I think) advising shielding but this seems to be interpreted differently by different PCT's and is causing a lot of confusion among those with underlying conditions.

Sorry Oliversmumsarmy it will also be because of the cancer, I missed that bit

Oh, and diabetics aren't shielded unless there's also other issues, asthma can be but it's dependant on hospitalisations and drug levels, I haven't heard of anyone with a high BMI recieving a letter but I suppose it's possible though might be linked to other conditions - certainly they are harder to treat if critically unwell.

Even if you are on the government list, it doesn't mean you will get a letter, if you have a GP surgery as useless as ours then they won't have given everyone's names.
My DS and DP both have a range of severe lung disease and neither has had a letter. I called the GP as per the 30th March cut off and was told tough tit basically, because they have decided they don't ask them in for flu jabs and we have to beg every year, they don't qualify.
It's a joke.

I think its certain cancer patients with blood cancer being one, chemo therapy patients because obviously thier immune aytwm has been wiped. These are just 2 shielded reasons amongst others.

I think diabetes, asthma etc come under vulnerable.

How strictly anyone chooses to self isolate is something anyone can do. He could choose to self isolate as per the shielded group if he wanted.

My mum and MIL are both shielded and it's pretty rough going and the letter has really stressed my mum out and triggered anxiety. Also we haven't found the promised help very forthcoming either but doingbit best between us. We all have to pull together and just get on the best we can.

I think the confusion is coming from the fact there are two groups, ‘vulnerable’ and ‘extremely vulnerable’. The vulnerable group is basically anyone eligible for the annual flu jab. They won’t be getting individual letters but are advised to stringently follow the social distancing rules and workplaces should be supportive of them staying at home.

‘Extremely vulnerable’ is a much smaller group - people who have had transplants, on chemotherapy or immunotherapy, on certain immunosuppressant drugs, severe lung disease (including severe asthma or severe COPD), no spleen, some rare metabolic and blood conditions. People in this group should get a letter advising shielding for 12 weeks. This is done centrally so they are working on somewhat limited data so some people may be missed. At our practice we’re running our own searches to try to avoid missing anyone.

Thanks for the clarity, I guess it's just hard not to worry but I think I understand it now. rarepackoflooroll As far as self isolating goes, he is doing that now with his chest infection. He has a mild learning disability and mental health issues and unless someone in authority ie his doctor or carer tells him to self isolate he wont.
He has been doing the social distancing and staying home unless it is for work or essentials, but he has no real concept of "risk". Does that make sense?
Anyway, I went on a bit there, but just wanted to say thank you for helping clear that up for me, as I do worry about him, whether his issues are self inflicted or not.

The shielded group is absolutely tiny and unfortunately the government's communication has been dreadful. Many people have been told to stay at home for 12 weeks.

They aren't however in the shielded group who are a much smaller number of very high risk people.

More info here: digital.nhs.uk/coronavirus/shielded-patient-list

Shielded people are the EXTREMELY vulnerable

So people having radiotherapy etc. Or have cancer. Or bone marrow transplants etc

Interesting article on diabetes and the immune system.

www.diabethics.com/science/diabetes-does-not-mean-being-immunocompromised/

Dp has type 1 diabetes (he also has cancer and he has had his spleen removed)

Before he had his spleen removed because of the cancer spreading his immunity was always quite good. However if he did catch anything or get an infection of any sort his blood sugars would go haywire and he would invariably end up eventually after a few weeks of starting to act more and more strange be persuaded to go to the hospital and spend a couple of days on a drip to get his blood sugars back into line and get rid of ketones

I do think they need to be on the shielded list more because the associated effect of getting any type of virus

That's true but unfortunately this isn't government guidelines so there's loads of us type one diabetics in the nhs still working. That said I've only once had ketones when unwell and that was when I had a sickness bug many years ago before I was on a pump which makes it much easier to control blood sugar levels even when ill. Hopefully I won't get it and if I do I'm hoping I can manage it at home. It's very scary though.

Dp goes in at least once per year with ketones.

The last time he refused to go (he doesn’t think anything is wrong with him) and was close to a diabetic coma. Think his ketone level was 6.4.

His levels are getting worse each time it happens

Oh dear sounds like he really struggles to control his levels. Must be very worrying for you

Severe asthma is on the shielded list, depending on the exact medications the person is taking and a few other criteria as well.

My mum had a letter advising to stay in for 12 weeks and offering extra help, she has bad COPD and is in her 70's

My endocrine dr says diabetics need to stay indoors. Don't go out. High risk. But not shielded.

1
Transplant
HES, MS
Patient coded with ANY ICD-10/OPCS code falling within this disease group
OR
Recorded as having been prescribed medication during the past 2 months to manage post-transplant health
2a
Cancer undergoing active chemo/radiotherapy
HES
(Patient coded with ANY ICD-10 code falling within this disease group AND coded with chemotherapy treatment within the last 12 months)
OR
(Patient coded with neoplasm of lung AND having radiotherapy within the same episode of care since 2006)
2b
Haematological Cancers
HES
Patient coded with ANY ICD-10 code falling within this disease group
3
Respiratory
HES, MS
Patient coded with ANY ICD-10 code falling within this disease group
OR
Recorded as having been prescribed medication during the past 6 months used to treat severe COPD/severe Asthma
4
Rare genetic, metabolic and autoimmune diseases
HES
Patient coded with ANY ICD-10 code falling within this disease group
5
Congenital Heart
HES, MSDS
Patient coded with ANY ICD-10 code within this disease group
AND
Having an estimated date of delivery of greater than, or equal to, the date of data extraction

This is better to read

The algorithm looks to identify:
1 People who have had an organ transplant who remain on long term immune suppression therapy
2 People with specific cancers - people:
• with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
• with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
• having immunotherapy or other continuing antibody treatments for cancer
• having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
• who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
3 People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD. Severe asthmatics are those who are frequently prescribed high dose steroid tablets.
4 People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)
5 People on immunosuppression therapies sufficient to significantly increase risk of infection
6 People who are pregnant with significant congenital heart disease

Slightly easier to read

1	Solid organ transplant recipients
2	 People with specific cancers:
a	people with cancer who are undergoing active chemotherapy
b	people with cancer who are undergoing radical radiotherapy for lung cancer
c	people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
d	people having immunotherapy or other continuing antibody treatments for cancer
e	people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
f	people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
3	People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
4	People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
5	People on immunosuppression therapies sufficient to significantly increase risk of infection.
6	Women with significant congenital heart disease who are pregnant.

Oops! Sorry. It posted twice.

My Dad has COPD and is on the shielded list. He had his letter very early on.

There are some other very serious conditions though that didn't seem to make it onto the list. I was very surprised that Motor Neurone Disease didn't seem to be considered serious enough. I have known three people who have had it. All were certainly very vulnerable, and as it progresses it definitely begins to affect the chest muscles.