Second lockdown= clinically vulnerable need to shield?

[ginglebellsginglebells]

Anyone know whether the possible announcement of a second lockdown will mean those who previously were shielding will have to shield again?

@TheMonaOgg
Sorry, I didn't mean to give false reassurances.

I think it's still unclear. I certainly wouldn't advise taking any unnecessary risks or dropping your guard.

It might be slightly less of a risk than expected - but remember that's very different to no or even low risk.

I'd assume your son should continue to be as careful as possible.

I think there's some evidence to suggest autoimmune patients, especially Lupus and RA, who are taking immunosuppressant medication are at lower risk. They seem to be underrepresented in hospitalisations. However it's still very early days and still worth exercising caution.

To be clear. Cancer and transplant patients are still vulnerable.

In Scotland we have a process for individual risk assessments that takes medical conditions into account. All those who were shielding should have this done.

The Scottish system sounds sensible.

If ECV have to stay home from work, will they be entitled to furlough this time?

My employer refused to claim and put me on SSP last time. I'm still paying back the money I put on my credit card to survive. I can't afford to go back on SSP.

@SheepandCow

To be clear. Cancer and transplant patients are still vulnerable.

That's solid organ transplant recipients - bone marrow drop off the list after 6 months or when they discontinue immunosuppressive drugs, whichever is later

Nor all cancer patients. Those automatically included are:

• 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

Though others might be included in the general,category "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"

@TheMonaOgg

Does anyone have any hard info immunosuppression? My son is a kidney transplant recipient and I'm very worried about him but there seems to be no advice out there.

See his consultant. There are separate paediatric guidelines, and your DS should have been individually reviewed over the summer.

www.rcpch.ac.uk/sites/default/files/generated-pdf/document/COVID-19---%2527shielding%2527-guidance-for-children-and-young-people.pdf

"Not government but I haven't heard supermarkets are re starting priority slots?"

That's because they never stppped. People who were on the shielding list retained priority for supermarket slots, plus NHS volunteer and local council support. Itn was only the food parcel service that ended when shielding paused

@nether I was referring to likely actual real clinical risk. Not the government's failed shielding list.

The government based the shielding list on flu. Instead of the evidence coming out of China, Hong Kong, and Italy.

Covid seems to be a vascular and inflammatory disease.

I refused the food boxes from the beginning but have retained my priority slot for supermarket. All supermarkets continued with priority slots. I get a weekly email from Iceland even though I never shopped there.

The exceptionally vulnerable list was revised over the summer. Which bits do you think are still wrong?

@TheMonaOgg and @tobee the renal org released figures to end of July (I.e the first wave) . The highest risk is to dialysis patients. Of those transplant patients, most didn't need any additional treatment in hospital and of those admitted to hospital those under 50 had a 20% risk of death that's compared to 30% for the general public admitted to hospital.

I have a kidney transplant, I've been told I'm at no additional risk compared to the general population, mainly due to age, healthy weight, female etc. Apparently many transplant patients are in a favourable position as the mmf drug we take is an antiviral (they're in the process of testing against covid 19 as was successful against original SARS) and many on low dose aspirin which helps protect the blood from clotting (again I think a specific issue from covid 19)

As a little anecdote, my husband and children all tested positive for covid, I never caught it at the time atleast if I did I had no symptoms and no need for a test. Doesn't mean I won't ever catch it, but I didn't that time.

Thanks for that info @midgetem. Unfortunately my Dh got bk virus about a year ago and had to go back on in centre hemodialysis just at the start of lockdown! . Fortunately it's in a centre away from the hospital and they've been and they've been great so far. We have to take each day as it comes. Like all of us really.

Boris said no, but I think I would as much as possible.

My daughter has a kidney transplant and recently tested positive for Covid. Her symptoms were mild, a lot less severe than flu and she is now back to normal. I’m very thankful.

@SheepandCow

The original shielding list got it wrong. It was based on flu.

Those most at risk are people with diabetes (1 in 4 of the deaths), cardiovascular conditions, hypertension, and kidney issues.

It's looking increasingly like immunosuppression does not increase the risk (and in fact might protect).

They won't want to do shielding again. There are too many extremely clinically vulnerable including many working in healthcare and schools. Diabetes and hypertension are very common. Then there's obesity. Also common. They can't afford to lose so much of the workforce.

All that makes it ever more important to take effective containment measures.

How do you know that they're most at risk? How do you know the current list is wrong?

@SheepandCow

You’re slightly off base about immunosuppressed patients with autoimmune diseases like RA and SLE. Some drugs are not as high risk as they had initially thought (e.g anti TNFs) and, in fact, may be a protective factor. However, there are other drugs which suppress the immune system (e.g long term prednisolone) and have been found to increase risk.

@purpleme12
The medical and scientific research, i.e. indicating it's a vascular disease AND the (worldwide) evidence from deaths and hospitalisations, i.e. 1 in 4 of the deaths are in people with diabetes.

It was known very early on that diabetes and hypertension were major risk factors (the info from China, Hong Kong, and Italy) but our government ignored the data when doing the shielding list.

Here is the (updated) list from the US Center for Disease Control (CDC).

www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

Ah ok sorry @Haenow
I thought I read somewhere that prednisolone didn't, afterall, increase the risk - and that it too might help protect? The research is fast moving and perhaps it's changed again.

The government guidance says those who are CEV should WFH or if that is not possible they should not work and may be able to claim SSP. More details are to come.

@tobee

Venerable shopping slots havent stopped this whole time

This might explain my confusion. A Harvard article on trialled drugs included a bit on dexamethasone. This sentence below is what makes it look like possibly other steroids including prednisolone might help. I probably misunderstood it.

Dexamethasone and other corticosteroids (prednisone, methylprednisolone) are potent anti-inflammatory drugs. They are readily available and inexpensive.

www.health.harvard.edu/diseases-and-conditions/treatments-for-covid-19

Hi OP,

I think that on the government website it says Extremely vulnerable people should not go to work in person. They're expected to either work from home or if this isn't possible then to claim sick pay or Employment Support Allowance/Universal Credit for ill-health.

(Moderately) Clinically vulnerable people are just expected to get on with it and try to avoid other people as much as poss (which is obviously impossible if you're a teacher!).

That's interesting @HotToCold. Someone obviously gave me duff information!