Webchat with Dr Jenny Harries, Deputy Chief Medical Officer for England, on shielding children, Wednesday at 9.30am

[BojanaMumsnet]

Hello

We’re pleased to announce a short webchat with Dr Jenny Harries, Deputy Chief Medical Officer for England, at 9.30am tomorrow (Wednesday 8 July) and for half an hour only.

This webchat is aimed at parents of shielded children - apologies for the narrower remit of this webchat, but the aim is to answer questions around this specific policy announcement, and we only have 30 minutes of Dr Harries’ time because of her considerable commitments elsewhere.

On Monday, the government confirmed that the majority of children currently considered extremely clinical vulnerable to Covid-19 will be able to be removed from the shielded patient list.

Children will only be removed from the shielded patient list by their GP or specialist doctor following consultation with the child and their family. Specialists and GPs will be asked to contact children and their families to discuss this over the summer, so families do not need to take any immediate action.

The latest guidance for families is in line with the recommendations from the RCPCH and is as follows:

• A small group of children who receive specialist care in hospitals may need to carry on shielding following a consultation with their doctor. This includes those receiving cancer care or those at risk of severe infection due to an immunodeficiency.
• Most other children who were initially identified as being clinically extremely vulnerable will no longer be considered at highest risk. In particular, children and young people who are cared for just by their GP are very unlikely to need to continue to shield in the long-term. This includes children with conditions such as asthma, diabetes, epilepsy and kidney disease

Jenny Harries was appointed Deputy Chief Medical Officer for England in July 2019, taking on a broad portfolio including the health service and commissioning support. Jenny’s previous roles include: PHE Deputy Medical Director, PHE Executive Lead for specialised commissioning and Welsh National Health and Healthcare Director. Alongside these roles, Jenny has been a member of the Welsh Medicines Committee and the Clinical Priorities Advisory Group. Jenny has an extensive clinical and public health background (BSc (Hons) Pharmacology; MPH; FFPH) and her work has extended overseas as far afield as New Zealand, Pakistan and Kenya. She was awarded an OBE in the 2016 New Year’s Honours List for services to Public Health. She advises the government on its response to coronavirus.

As always, please remember our guidelines - one question per user, follow-ups only if there’s time and most questions have been answered, and please keep it civil. Also if one topic is dominating a thread (other than shielded children, in this case), mods might request that people don't continue to post what's effectively the same question or point. (We may suspend the accounts of anyone who continues after we've posted to ask people to stop, so please take note.) Rest assured we will ALWAYS let the guest know that it's an area of concern to multiple users and will encourage them to engage with those questions.

Many thanks,
MNHQ

[RowanMumsnet]

Thanks @iVampire

We're going to close this thread again now - thanks to all for your questions, and we hope it was useful.

[RowanMumsnet]

@nevergooogle

Hi Dr Harries,
My 15 year old son is shielding due to an acute flare up of inflammatory bowel disease and high dose steroid treatment. Tomorrow we meet with the consultants to discuss moving on to biological infusion treatment (Infliximab) which is an immunosuppressant.
This is a long term treatment option for him but I'm assuming he will be immunosuppressant and extremely vulnerable until a vaccine is created?
How will this even work? We are unable to shield him within the house (one bathroom, tiny house) is he likely to be off school until a vaccine is found? (GCSE's next year) And what about his 2 siblings? Are they to also forgo their education to protect their brothers life? Can I continue to work in my healthcare job?

What is the plan long term for those who continue to be on the extremely vulnerable list. Particularly those transitioning to adult services over the next few months?

[from Dr Harries]

Hello @nevergooogle

Sorry to hear about your son’s condition.

Although you have noted he will be on long-term treatment, the shielding advice applies when the level of virus in the community is high and there is a strong possibility of infection. That is not the case at the moment so, on average, the risk of your son or his siblings getting ill are very low and so none of them should be missing their education. Not all patient on biological treatments will need to shield but as I don’t have his full medical history, you should speak to his hospital specialist who will be best placed to advise next time you see him/her.

While evidence shows young people are at a low risk of becoming seriously ill from Covid-19, certain conditions increase that risk and your doctor may advise your son to stay on the shielding patient list

The transmission of the virus in the community continues to fall and our advice is that people no longer need to shield from 1 August but the NHS will update you again if rates rise in your local area

Of course, we should all continue to take precautions to minimise the risk of the virus by washing our hands regularly and follow social distancing guidelines and that will best protect both you in your workplace and him from infection with Covid-19 but also any other illnesses such as flu. He will probably be eligible for flu vaccination too so that is something you should make sure he has.

[RowanMumsnet]

@CGB1

What happens when a Mother is considered extremely clinical vulnerable to Covid-19 & has been shielding since March & possibly has to send 3 kids back to School in September - I am waiting for a Double Lung Transplant!!!
Nothing has been said about this! What do I do??

Hello @CGB1,

As I don’t know your exact medical history, you should always discuss any specific details with your GP or hospital specialist who are best placed to offer advice next time you see them. However, the shielding programme was designed to advise people to reduce their social interactions when the level of transmission of the disease in the community was high. The advice has changed because for most people this is no longer the case and on average, you – or your children – are unlikely to meet the virus. Should this change again in your local area and rates rise, the NHS will let you know and issue specific advice for your area.

Most children are at a low risk of significant illness from Covid-19 and general transmission in the community is very low and schools are also being very carefully monitored so if there are any issues at your children’s school they will be advised by the local Health Protection teams and any necessary action will be put in place.

But we must remain alert and regularly wash our hands and social distance where possible to minimise the risk of infection – if your kids do this at home as well as at school, they will be keeping you safe.

[RowanMumsnet]

@Oaksideboard

My DC is shielding due to a life-limiting condition. Pre-Covid 19, my DC didn't go to school if there were infectious diseases present (other than coughs/colds) in the class or surrounding classes due to being hospitalised with even minor illnesses. Winter, September to May, is normally a very difficult time for my DC, and DC's attendance is very low due to illness.

Therefore, how can I send my DC and sibling to school in September with confidence that my shielded DC won't get ill?

[from Dr Harries]

Hello @Oaksideboard

We have relaxed the shielding advice because we know the transmission of the virus in most communities is very low and the risk to children of developing serious illness is also low. This is new evidence from UK and internationally based on studies on schools and children needing to attend hospitals

You should always speak to your GP or hospital specialist if you have any particular concerns but given how important it is for children to be in school and complete their education it is a really good idea to make sure you have had a look at the science. There is a good guide explaining this which parents can access here.

[RowanMumsnet]

@nether

Are children who are deshielded permanently deshielded? Or is it more a 'pause plus'?

Also, from the other way round, is it safe for a child to be at schools (mixing freely with 240 other DC, who in turn mix with siblings etc) and then return to a house where someone else is shielding, given that isolation within household containing DC doesn't work? (By shielding, I mean exceptionally medically vulnerable, whether actively shielded, or paused)

How can you reinforce the message to the general public that they need to stay 2m away from strangers? We can live with the idea that many shops and attractions need people closer together, and so we cannot go. But finding that parks, pavements and playing fields are becoming no-go areas (when we have only been outside for a few weeks) is grim

Will schools have a duty to provide online education, including full support to all GCSE and A level (and Highers, BTEC etc) options for shielded students if onsite attendance at school becomes too risky this autumn/winter? Who will be advocating for this cohort if they lose even more time in the run up to public exams?

[from Dr Harries]

Hello @nether

We are all really aware how important it is for children to be in school and complete their education.

It is impossible to absolutely guarantee safety for any illness, including Covid - 19. The same sorts of issues often arise for families when it is flu season.

However, we have relaxed the advice for shielding people because we know that the transmission of the virus in most communities is very low. If it rises in a local area in the future - such as Leicester - then we will immediately provide special advice for those in the affected area who are on the Shielded Patient List.

Your school and the Department for Education will be best placed to advise on your question about online lessons and future exams. However all schools have been prepared to be Covid safe including early testing if necessary and access to support and advice from specialists in infectious diseases at the Public Health England Local Health Protection Teams. This means schools should be able to operate safely and children can return knowing that any infectious disease risk is being continually monitored.

[iVampire]

My thanks to Dr Harries for interesting answers

[RowanMumsnet]

@Flynnshine

Hi, I have a nine year old daughter currently on 3rd line chemotherapy for a very stubborn brain tumour. We have been shielding since mid March. Today we have received a letter to say we no longer need to shield as she is not classed as vulnerable. While I am glad I can't help but feel worried that she is still vulnerable due to her low immune system. I would desperately love for her to be able to see her grandparents but is this just too much of a risk right now? Although we don't need to shield should we still take extra precautions over the general population? Thank you in advance.

[from Dr Harries]

Hello @Flynnshine,

Sorry to hear your daughter has had a difficult start to her life.

I am guessing that the letter you have just received is the one which lets people know the shielding advice is being paused for everyone from the 1st August. This is because the programme was designed to support people to reduce their social connections when the virus was circulating strongly in local communities, but in most areas that no longer applies.

While most children are at a low risk of significant illness from Covid-19, some conditions still pose a higher risk and some people may need to continue shielding. Your doctor will be able to advise the best course of action going forward.

I don’t know the exact medical history of your daughter so my advice is that you should discuss this with the hospital specialist treating her when you see them next but most people with significant conditions will stay on the list. If cases should rise again in your local area the NHS will be back in touch with you with new advice.

My general advice for minimising the risk of infection is to keep washing your hands regularly and social distancing whenever you can.

[RowanMumsnet]

Hello

Dr Harries has been able to provide a few more answers so we're going to post them up now - thanks again to her and her team.

[Swirlingasong]

If children are being removed from the shielding list, will they still be contacted in the case of a local lockdown? In which case, in what way are they being removed from the list?

[RowanMumsnet]

Thanks so much to Dr Harries and again, sorry we didn't have more time to get through more questions. We'll see if we can get any more follow-ups from the health team.

to all of you coping with really difficult circumstances.

We're going to close this thread to new comments now but we'll re-open it if we are able to get some follow-up answers.

Thanks
MNHQ

[Angelmum32]

Hi. Our son is 16 years old. Cardiomyopathy , septal myectomy last year. Runs of AF. Pyruvate Kinase Deficiency. We cannot find any evidence to risk assess and make an informed choice for unshielding and starting college with little social distancing. Our local parks have been full of teenagers not social distancing all the way through lockdown. Going for one shielded walk is problematic as others don’t abide by 1/2 metres. Much of the research is paediatric evidence based. Concerned family as our delightful young person is Male, Teenager , Congenital Heart Disease, Pyruvate Kinase Deficiency.

[DrJennyHarries]

Really sorry not to have had time to answer all your questions. Hope the ones posted help a bit and keep safe.

[DrJennyHarries]

@Tashpot1

Hi, 2 children sheilding. One endo & complex reccurant croup (airway issues rather than typical croup) and 1 with laringomalacia who suffers repeated croup episodes both viral, allergy, tiredness all triggers. Winter is hurrendous for us and they spend oct- feb frequently poorly and sometimes hospitalized and require large volumes of steroids (5-10 doses) to keep airways open. If a regional lockdown is required i feel they would need to sheild again to keep them safe and reduce risk of increased uses of steroids. Would you agree?

Sounds like your winters aren't much fun!
If your children are looked after only by your GP each year they will probably fall outside the new shielding list, but you will be able to discuss that directly with your doctor over the summer.
In any case if there are any local lockdowns in your area we will always identify those people on the shielded patient list and give them special advice until the cases have lowered again in their area. We have done this for Leicester so we know it works.

[DrJennyHarries]

@iVampire

What is the evidence on how readily mid/older teens catch the virus?

Because the schools policy seems to assume there is little chance of them transmitting it one to another, or passing it to adults they encounter in the home (and indeed elsewhere)

How many cases (nationally or globally) have there been of people with blood cancer (any age, including children) having covid? Is this number really large enough to have confidence the risks are well understood?

And Similar question for other conditions. I asked about blood cancer, not only through personal
interest, but also because it is the commonest childhood type of cancer

Are the government engaging with the major charities to ensure messages are fully understood? (From this side of the fence, the answer is no, so the question contains an implicit - why not?)

How can shielded/paused/deshielded people stay safe in a community which barely socially distances? It does seem as if we shall have to continue in home isolation because it’s unsafe to go out when people come so close. Has this difficulty ever been discussed when setting policy?

Why was ‘announcement by leak’ esp late evening ever OK’ed for such a vulnerable group?

Realise that last question is prob off-topic for your speciality, but expect you have an insight

And the flip side, what has been the most interesting part of the role you currently occupy during a pandemic?

Good morning.
We have actually been talking to the Blood Cancer charities this week, precisely to make sure we have all the evidence available on how Covid might affect people in different groups and we do the same for all different disease. That is quite a lot of charity groups and patients so it does take a little time to work round them.
Of course the evidence base is developing as we learn more about the virus and we look at evidence from other countries as well as the UK.
Teenager and older children tend to have wider social lives so rather than any risk being associated with school it is much more to do with how they are spending their time outside the school gates - so always good to encourage them to cycle to school for example and keep their social contacts down too.
Unfortunately sometimes where we engage early to help patients understand what is being planned or announced does result in some media leakage of information so really sorry if that has happened for you. Hopefully you will have seen from the latest announcements that we are always trying to build in some time ahead of changes so that people can get used to the idea of what will be a change in their daily lives.
I've met so many different medical colleagues and patient groups through the pandemic which has probably made it the most interesting professional response I have ever had to deal with

[DrJennyHarries]

@PrayingandHoping

My 8 months old baby has been shielding. We did not receive a letter but had a phone call from her consultant advising us to do so. She has Downs Syndrome, Partial AVDS and spent 5 days intubated in intensive care when 8 weeks old at RSV. Based on that she then received the RSV jab and my consultant advised shielding since March based on her overall health rather than specific condition.

However the new guidelines for only the most serious conditions make me feel more confident as she doesn't fall in any of them.

I would like to take her away for a long weekend to see her grandparents who are also shielding and live opposite end of country so cannot day trip. We feel that as neither of us have been anywhere or seen anyone it would be like one household and the risk would be minimal

Please could u advise

It sounds like your daughter has had a pretty rough start to life but glad she is doing well now. As you have seen we have made sure that doctors who know individual patients well can make sure they are added to the shielded patient list when necessary.
The new guidance is easy to interpret for families whose children usually only see their GP. As your daughter's case is quite complex it is probably important to have a quick discussion with them next time you have an appointment - although overall the likelihood of your daughter or your parents meeting the virus now in the community is very low and if it rises locally we will be letting you know so you can take extra precautions if necessary

[andymufc2000]

My son has asthma and has been shielding. My parents are often asking about when they can hug the kids etc.. They have seen the guidance that the kids will be back at school in Seotember with 30 other kids. I'm finding it hard to justify why they can't hug the kids..

Should I allow this or continue to not allow this?

[DrJennyHarries]

@Samfaz

I have a 20yr old daughter. Extremely clinically vulnerable. She has siblings. When shielding is over and we go back to the new normal. If we get a peak near us am I within my rights to keep siblings home from school to help shield her? It’s impossible to limit a normal bug in a household let alone covid.
Thanks

Hello. One of the difficulties with giving shielding advice is that everyone's individual family circumstances and housing is very different. The important thing is to remember to do the basics as frequently as possible - so keeping your distance, washing hands frequently etc but also keeping the overall number of social interactions down. However going to school for your daughter's siblings is also really important and they have strict control measures in place to ensure any risk of infection is absolutely minimised and special access to Test and Trace.
We would not bed advising schools to open if we thought they were unsafe and if there are any specific local issues - as in Leicester currently - we will be letting everyone local on the Shielded Patient List know.

[DrJennyHarries]

@Mysillydog

I am on lifelong treatment for metastatic cancer, and am a shielding parent.

I have a daughter about to start to Y13. This is such an important year for her education, and I will send her back in September. But will it be safe for me if she brings covid home? What impact will returning to school have on the mental health of children who live with shielded people?

Good morning Mysillydog
We are all really aware how important it is for children to be in school and complete their education - it will set their own health outcomes as adults for themselves and their families so I understand why you are concerned.
It is impossible to absolutely guarantee safety for any illness, including Covid - 19. The same sorts of issues often arise for families when it is flu season.
However we have relaxed the advice for shielding people because we know that the transmission of the virus in most communities is very low. If it rises in a local area in the future - such as Leicester - then we will immediately provide special advice for those in the affected area who are on the Shielded Patient List

[r3dh3d]

My daughter has 11 different hospital consultants. 5 of the 11 are concerned with conditions relevant to Covid-19. 2 of them thought she probably wouldn't need to shield, 3 of them thought she probably would, most of them were deciding based on assumptions about her other conditions and none of them spoke to each other.

While they were all faffing, her GP put her on the list anyway.

Given the NHS' inability to work collaboratively, I can't see how any meaningful decision about taking her off the list or leaving her be is going to be taken. Is there a model for these complex kids? Because I'm a governor at a special school and I have to say I don't recognize this model of kids on the shielding list looked after in primary care at all. Every shielding kid I know is terribly complicated.

[RMB20]

Vulnerable children listed in the shielding categories 2 and 3 – the guidance advises that they will be able to return to an education setting from 1st Aug, Is there a max limit of settings these children can return to, e.g education + 1 social care setting such as after school clubs or residential placement?

[DrJennyHarries]

@BecCliff

Hi. I have an extremely vulnerable daughter in year1 who has been shielding. Am I safe to return to my job in a secondary school in September coming into contact with 150 different pupils a day with no PPE? My daughter may return to school in September, in a class bubble of 20.

Hello BecCliff
I don't know the detail of your daughter's illness and you will be able to discuss this with her doctor sometime over the summer.
We know that fortunately most children very rarely get any significant illness with covid-19 infection so most parents can be reassured about their children going back to school. Bubbles are also good because they keep the number of social interactions down - a bit like living in a school family.
When you go back to work, just like the rest of us, you should continue to keep washing your hands and social distancing when you can but the levels of virus in the community now are very low which is why we have relaxed the shielding guidance.

[andymufc2000]

Hello

Why are schools not going have any form of social distance? We are told indoors with people from multiple households is a big risk yet schools often have small cramped and not very well ventilated classrooms. How are both the children and adults in school going to be safe?..

My son in year 4 is on the shielded list and I am a secondary school teacher.

[DrJennyHarries]

Hello
Morning everyone - good to be talking with you this morning

[HD02]

My son is 16 and transferring to post 16 he’s on the shielding list and his consultants want him to remain on it due to his health issues. Is it safe for him to go to post 16 with no social distancing measures and not wearing face masks as a lot of schools are not allowing people to wear them, is it safe for my daughter to return to college in September with the risk of bringing it home to her younger brother she does work placements in early years.

[RowanMumsnet]

@kellymreed

How do you view this webchat?

Hello - just stay on this thread and keep refreshing it, and Dr Harries' answers will hopefully start to appear soon - we're just waiting for her to log on (we were told she had an incredibly busy day lined up so she may have got a little delayed somewhere along the line)