Odd that shielding criteria wasn’t changed to include diabetics

[Onandoff]

The vast majority of patients where I work admitted severely unwell had diabetes or hypertension. Yet neither were shielding criteria while quite a few of the current criteria resulted in very few admissions. Some of it is quite nuanced, for example some blood cancer patients were probably at low risk, but all lumped together. It made sense as a ‘guess’ at the start but odd that it wasn’t adapted as evidence emerged.

Back in Feb 20 the information coming out of China was all about increased risks for those with diabetes or hypertension. Now hypertension alone doesn't qualify an individual for a group 6 vaccine.

I guess there are a lot of people with these conditions though especially in the age groups vulnerable to Covid where some of the shielding criteria related to conditions that are far rarer.

Some type 1s were told to shield from the beginning, others were added in the latest round if the various forums are to be believed, I suspect it depended on what your GP and/or team decided was risky. Many type 1s have additional issues as well, particularly as they get older. Haven’t seen any recent research but a number crunch was done at the end of May last year which showed type ones to be around 3 times more likely to die and type 2s around twice as likely to die. The average age of type1s who died was early 70s and type 2s late 70s which, given that a diabetes diagnosis does lower life expectancy, would seen ‘reasonable’. Given the number of children who are type 1, I guess a decision to shield would have made things tough from a schooling point of view: it worries me a lot. My son has worn a mask throughout and is permitted to leave early to avoid any kind of corridor crush.

quite a few of the current criteria resulted in very few admissions
Perhaps because they were shielding?

2.2m CEV were asked to shield.
4.8m in the UK have diabetes, 11.8m adults in the UK have hypertension. So you were always going to see some and it would have been impractical to say they should all shield because you'd be adding another 30-40% of UK households. Diabetics were listed as a higher risk group for HSE throughout: www.hse.gov.uk/coronavirus/working-safely/protect-people.htm; that's the same as pregnant women who were asked to take extra precautions but not to shield. Then there's 28% of adults who are obese, what about their increased risks? It would have been nice to be able to shield everyone with any risks, but I don't think it could have worked in practice due to numbers.

My T1 family member was told to shield this time around but not first time. So sad our T1 friend.

I have T2. Was not told to shield in the beginning, but added to the list in Feb this year (by which point I had already had Covid and then my first jab).

The letter talks about a more detailed analysis of risk factors based on data from the first wave - I would imagine my weight and age combine with my diabetes to push me above the risk threshold. Whereas a younger and/or slimmer me would not have been advised to shield.

It’s not quite individualised medicine, but it is more nuanced than a blanket “if you have x condition, you shield.”

@MRex

quite a few of the current criteria resulted in very few admissions Perhaps because they were shielding?

2.2m CEV were asked to shield.
4.8m in the UK have diabetes, 11.8m adults in the UK have hypertension. So you were always going to see some and it would have been impractical to say they should all shield because you'd be adding another 30-40% of UK households. Diabetics were listed as a higher risk group for HSE throughout: www.hse.gov.uk/coronavirus/working-safely/protect-people.htm; that's the same as pregnant women who were asked to take extra precautions but not to shield. Then there's 28% of adults who are obese, what about their increased risks? It would have been nice to be able to shield everyone with any risks, but I don't think it could have worked in practice due to numbers.

Perhaps. But in reality we’ve seen a lot of patients who were thought vulnerable who’ve been fine with infection, even whole groups of diseases. But the criteria hasn’t changed as significantly as I would have expected. Obese diabetics are at massive risk, especially in older age.

@PuzzledObserver

I have T2. Was not told to shield in the beginning, but added to the list in Feb this year (by which point I had already had Covid and then my first jab).

The letter talks about a more detailed analysis of risk factors based on data from the first wave - I would imagine my weight and age combine with my diabetes to push me above the risk threshold. Whereas a younger and/or slimmer me would not have been advised to shield.

It’s not quite individualised medicine, but it is more nuanced than a blanket “if you have x condition, you shield.”

It’s good that your medical team / GP reviewed your case. It’s just a shame as I think we could have lost a lot fewer people in the winter wave of infection if diabetes and obesity had been considered earlier.

while quite a few of the current criteria resulted in very few admissions

Surely you can see the correlation between people shielding, ie staying home for a year so they're unlikely to catch Covid and a lack of that particular criteria being admitted?

Of blood cancer patients, if they get covid badly enough to require hospital admission (and do remember that they're admitted far more readily than most others because of various other possible complications), around one third die.

They are the second largest group admitted to ICU (largest is wider immunosuppressed group)

Please don't write off other co-morbidities

Those living with blood cancer have the lowest vaccine response rates of any group (lower even than those on active chemo for other cancers)

And shielding is an utterly shite thing to go through. Even now when it's stopped again, the advice is not to go anywhere indoors unless necessary, and to limit the number of people you see even outside. Essentially going from modified isolation to lockdown rules, just as everyone else is emerging from lockdown. But that still feels like an amazing increase in liberty !

@nether

Of blood cancer patients, if they get covid badly enough to require hospital admission (and do remember that they're admitted far more readily than most others because of various other possible complications), around one third die.

They are the second largest group admitted to ICU (largest is wider immunosuppressed group)

Please don't write off other co-morbidities

Those living with blood cancer have the lowest vaccine response rates of any group (lower even than those on active chemo for other cancers)

And shielding is an utterly shite thing to go through. Even now when it's stopped again, the advice is not to go anywhere indoors unless necessary, and to limit the number of people you see even outside. Essentially going from modified isolation to lockdown rules, just as everyone else is emerging from lockdown. But that still feels like an amazing increase in liberty !

Blood cancers are not a homogenous group. Some do very badly, some have similar risk to the general population. We’ve seen this in practice, before shielding and in between shielding dates, and papers have been published. It’s a shame, as some are shielding who probably don’t need to. Obese diabetics not shielding and some probably should have.

My DS is 21 he was told to shield in the second round of shielding.

He had returned to uni sept 2020 and had covid in the October. He wasn't anymore unwell than the rest of his housemates.

However, he is struggling with his his health now and is extremely tired/lethargic which is out of character. Had more blood tests this week, to see if they can get to the bottom of it.

Sorry didn't say he or type one diabetic, slim and otherwise healthy and very active.

Of course I know that blood cancers are not a homogeneous group

And that the initial assessment that for example well-controlled CML was low risk has been proved wrong as time went by as the data showed younger people (especially women) with CML are the most over-represented group in ICU

Also, the prognisus was thought to be similar to those on treatment for other cancers, but it is now known to be poorer

The assessment of risk to those with blood cancers (and and all) has stayed the same or worsened over the course of the pandemic.

I don’t think the review in February was carried out by GP’s, it was done centrally and GP’s were informed after the fact.

Statistically speaking, they tell em I was/am at high risk of having severe disease, in practice, I didn’t. I had 2 weeks of very annoying cough and fatigue - but sitting round not doing a whole lot fatigue, rather than prostrate in bed fatigue - followed by another 2 weeks of steady improvement.

I do understand to some extent how risk works - I was more likely than average to have a bad outcome, but it was not inevitable and turned out not to be the case. What this means is that I was quite anxious all of last year, and very cautious. But after I had Covid, I lost my fear of it. So when I was advised to shield, I didn’t bother.

I still follow all the rules, but am no longer afraid for myself. Because if I do catch it again it is very unlikely to be worse than the first time.

Diabetics were put on the shielding list in the second wave of shielding if they had one other high risk factor. This could include postcode.