Recent notice to shield (Feb 2021) and history of gestational diabetes

[HelloViroids]

This has popped up on a few other threads and had blindsided me today so thought I’d make a thread in case others want to discuss.

I had gestational diabetes but have since been tested for type 2 diabetes and don’t have it. I know my risk of type 2 is increased though. I’ve now have notice to shield and (separately) link to book vaccine.

I have no other significant risk factors (overweight but not obese, ethnicity more risky - but NOT asthma or any other respiratory conditions or similar), so I am assuming the GD must be the reason I am now being treated as CEV. Someone pointed out on another thread that gestational diabetes is a factor in the algorithm being used to add people to the list (digital.nhs.uk/coronavirus/risk-assessment) - but I had thought that would be current GD not historic?!

Just wondered if anyone else has been surprised by this - or if anyone has had GD but NOT been told to shield? I wasn’t expecting lockdown to get worse at this point

@NeedsImprovement01

Maybe an update tomorrow?

Hopefully! Although I think people will still need to speak to their GPs to see if they have any other risk factors before being asked to be removed from the shielding list.

I personally doubt it will be a simple "its all a mistake no need to shield", I think that at the very least GPs will need to validate each record.

If the model was correct (ie not based on bad data) then it may be that, for example, a recent HbA1c is required to remove from shielding. If the model was based on bad data (eg GDM coded as type 2) this could have knock on implications for type 2 (ie they are at greater risk than modelled so more need to shield).

I guess the update i am hoping for is whether this was a model/data error or if there is a genuine statistical trend for GDM to be higher risk. If GDM are higher risk, the hypothesis for why this is the case. Then next steps.

It would be helpful to have some explanation of which additional factors in the model cause historic GDM to need to shield, (if we really do) where no other medical factors are present. I would guess postcode (deprivation), bmi, ethnicity and age with postcode very significant. I am wary though it may breach data protection to state too much, ie if there was actually usually a compounding medical factor of a history of mental health issues, many ladies may not want this publicised! If it is mainly postcode I can see this making those not asked to shield quite nervous - as clearly your post code doesn't directly impact your risk it just correlates to it.

@NeedsImprovement01 Any history of hyperglycaemia is statistically significant according to latest modelling. So it's not as simple as just the risk of undiagnosed type 2 as anyone who's had GDM has a predisposition to insulin resistance

www.diabetes.co.uk/news/2020/dec/high-blood-sugar-levels-linked-to-covid-19-deaths-in-those-without-diabetes.html?fbclid=IwAR2eSWEvTRdljaB74OQKAloIrqJGhgy4LMb9r5KJyOPNZsUvBiqd-tsNLO0

Does anyone know why postcode makes a difference?

I live in a middle class area but work (and was raised) in a deprived area.

What's the actual risk... that deprived areas have more cases (im there more than home).. that they assume cramped living conditions? Poor diet?

I believe the Covid stats are worse amongst deprived communities so whilst it is correlation not causation, it is a data point which is readily available and enables this risk assessment exercise.

We can guess as the causation factors, for example lower income and not able to afford to isolate/ distance or large household numbers BUT this is just guessing. I presume that the data bods do have an idea of the causation factors but they are probably impossible to track and turn into vaccination priorities or shielding notifications. So instead, they are having to use the data they have got (postcode, in this instance) to help get go to ultimate goal which is protect the most people as quickly as possible.

It’s not post code per se - it’s looking at the Townsend Material Deprivation Score, which has a long established correlation with health outcomes.

There is a huge BUT here. This is public health and epidemiology. These findings and risks are POPULATION based. They are based on groups as a whole. There is a danger of “ecological fallacy” - trying to apply these population based risks to individuals when it doesn’t work like this. The easiest way to visualise this for the uninitiated is often life expectancy. In a materially deprived area, the life expectancy will be lower than in areas with less deprivation. Overall, the population will die at a younger average age, but this doesn’t mean that any individual person will necessarily die younger, because the data applies to the area as a whole, not individuals.

In this case it appears that the powers that be are willing to accept an over estimation of risk for some (perhaps many) people, in order to try to protect the interests of others. A utilitarian would claim this is ethically correct. We could probably debate it week.

See screenshot. Sounds like it is a mistake, announcement coming soon.

If you got the shielding letter you can book a jab via the National online booking service. I did it yesterday and got my jab this morning.

I booked my jab on Friday and had it yesterday. After the guest on the Jeremy Vine show and the updated population risk assessment webpage digital.nhs.uk/coronavirus/risk-assessment/population suggested that the shielding notice was correct. They responded fairly quickly to say it was right so I'd be surprised if they've now done a U turn?

Hi , I had GD my little one is 2 now, my BMI is 30+ live in east london and have asthma.... so this is why I got the letter. It’s a combination of all of the above. The algorithm is not accurate they airing on the side of over cautious, GD wasn’t incorrectly used in the Qcovid Oxford university rush portal.

If you want to be removed you speak to GP. They will actually do a risk assessment abit more accurately and you then discus together you then make a more informed choice.

I am a key worker worked onsite in a hospital from beginning of covid. Currently working from home doing admin duties, I will continue to do low risk activities ie drop my son to nursery on public transport practicing government guidelines hand washing distancing and face mask.... & exercise in the park with him on days off... I have signed up to priority delivery slots and already had a delivery pass with Asda, so I’m just taking extra caution now as it has put a little worry on me....

Anyhow keep safe everyone, those whom aren’t key workers or furloughed are effectively shielding anyway as there is nought else to do part from exercise outdoors!!!

Stay safe

@Seaneen831 how do you get priority delivery slots?

I'm yet to receive a letter but think one may be in the post as I can now book my jab through the NHS site but am 34, with no other health issues other than GD in both my pregnancies & a high BMI that's just under 40.

@Desperatelywaiting2022 check your junk mail for the email, if you previously provided your email to GP Then you should have got 1. Is this the first time you got out on list?? I have put link for you.

It’s through government website they then send your information to anyone supermarket if your already registered with sat Asda or Tesco then no further action.

Or if not registered then register then once you apply through government for help you’ll see extra slots available.

Shopping

You are advised not to go to the shops. If you can, ask others to collect and deliver shopping for you (friends and family, local volunteers or NHS Volunteer Responders (www.nhsvolunteerresponders.org.uk/). If you already have priority access to a supermarket delivery slot, that will continue – you do not need to do anything further. If you would like to request priority access, because you do not have anyone who can do shopping for you, you can register at the Shielding Support Website: www.gov.uk/coronavirus-shielding-support. When registering you will be asked for your NHS number. You can find it on any letter the NHS has sent you, or on a prescription.

If you are on a supermarket database or customer list (most people are) they should contact you within a week confirming that you have priority access to book slots, if not it may take a little longer.

Please be aware that delivery slots may not be immediately available and registering on the site does not mean you’ll definitely get a delivery slot.

If you need help accessing food, including support to register for priority access to supermarket delivery slots, you should contact your local council directly. Find out how your local council can help at: www.gov.uk/coronavirus-local-help

@Desperatelywaiting2022 I am a key worker for nhs and very privileged to have got my 1st jab and 2nd due in 1st April. I also test my self twice a week...

@Seaneen831 thank you for the information, it's all good to know for if I get a letter come through.
I've not received an email/letter but a couple of weeks ago there was a mix up where it was thought that people in my profession could get the vaccine (I work in early years), at that time I looked on the NHS booking site just out of interest to see if I could book my vaccine but rightly so I couldn't. Yet I can now book my vaccine through the site & the only thing that I think has triggered this change is this current situation that's ongoing.
Glad you've got your jab, did you have any side effects from it? Just so I know for when I finally get mine so I can work out when yo book it in terms of partner being at home/looking after children etc

@Desperatelywaiting2022 I just had a bit of a heavy arm for a day or so, just like when I get normal flu jab, they put it in the left arm as I’m right handed, didn’t effect my daily chores or even lifting my 2 year old up.

There has been mention that another load of letters will be issued this week. Take care seaneen

[quote Desperatelywaiting2022]@Seaneen831 thank you for the information, it's all good to know for if I get a letter come through.
I've not received an email/letter but a couple of weeks ago there was a mix up where it was thought that people in my profession could get the vaccine (I work in early years), at that time I looked on the NHS booking site just out of interest to see if I could book my vaccine but rightly so I couldn't. Yet I can now book my vaccine through the site & the only thing that I think has triggered this change is this current situation that's ongoing.
Glad you've got your jab, did you have any side effects from it? Just so I know for when I finally get mine so I can work out when yo book it in terms of partner being at home/looking after children etc [/quote]
I just wanted to jump on and say plan for when you're off and your partner is home if you can. I'm having dreadful side effects and feel like I have been hit by a bus. It started exactly 12 hours after I had the vaccine. I'm still happy I had it, just a warning as everyone is different.

NHS digital statement released (tweeted by Dr Partha Kar)

So are we at more risk if we had GD previously? It is as clear as mud 🤷🏻‍♀️

So confusing. Presuming once had the vaccine - no need to shield?

@HelloViroids Thank you makes a lot sense. Best to chat to go if you want removed and believe your risks are low, but I believe having just history of gestational diabetes and nothing else like high BMI , asthma and of course the postcode deprivation area attached to you.. that you wouldn’t be put on the list..,

I’m choosing to not fully shield. As a key worker mainly from hone but on site sometime and a little one in private nursery - I will remain on the list as I do consider myself high risk with gavin my all the above...

Then maybe as the Qcovid system evolves and maybe takes me of the list..
I have a a shop delivered ever Monday on my day off and make a few trips to the park with little one few times a week.. also I’m in london and all my family are in Belfast- so long as I follow guidelines and wear my PPE - so far it’s worked..I am confident I will be fine..

Had 1st dose 2nd in April and lateral flow test twice a week not much else I can do!

I just hope they don’t try and cancel our 2nd doses of the vaccine now. I had the 1st dose yesterday off the back of their shielding notification to me. It’s not our fault if it is wrong.

@mumboss1984 They wouldn't do that, would they? I had mine this week after receiving the letter, and since reading this, I'm really worried the second will be cancelled. But surely that would be unethical - everyone has to be offered the second dose, don't they?

This is all really doing my anxiety no good whatsoever !

I wouldn’t have thought they could as we need to have it anyway and it isn’t our fault. Fingers crossed all will be fine 🤞🏼 I will jab myself if needs be and I am scared of needles 🤦🏻‍♀️

I had that fear too. Had my vaccine today and now seen all this about it being reviewed and that some of us without GD are likely not to actually need to shield. But presumably unless we have a discussion with doctor and ask to be taken off the list it won’t automatically remove us? That would be a considerable amount of further work surely?

I can’t imagine it will make any sense to cancel our second jabs - that would leave us half protected and mess up the schedule entirely, and as PP said it’s hardly our fault we were added and told to book a vaccine. Would also be a bit pointless since we would’ve received our first jab within a few months anyway. But I am a bit concerned! 😬

I was going to call doctor this week to discuss whether I am actually at risk, but what if they say oh no it was a mistake in your case, we’ll take you off the list ...?

I really, really doubt they will cancel already scheduled second jabs after people have had the first. Especially when all people have done is follow the advice in the shielding letter.