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

We have been shielding my 10year old daughter. Can she now go and stay at her dads for the weekend? Many thanks

Further to my message above, how can it be safe for my shielded DC to return to school, when DH's company do not consider it safe for anyone to return to the office before Jan 2021?

Hi my Autistic son has Crohn’s disease and is the shielding category due to the medication he’s on. He already had Health anxiety before Covid and when he’s due back in college in September is extremely anxious also he can now go out and meet up to 6 people again is extremely anxious about doing this we had parents have treated ourselves like we are shielding to protect him how does that work because we could meet up with people but are worried that we don’t want to pass it to him we all live in the same house. I desperately need to get my hair done for I look any greyer my son will think I’ve turned into his nan, again I am worried about getting due at my hairdresser they say it’s not compulsory for customers to wear a mask and they are only wearing shields what is in the rules for Owners when owners when treating shielding for example.

Regards

Mandy

We have been shielding my six year old for a metabolic condition. His condition puts him at risk of hospitalisation from any illness and we have open access to the children's ward.

Do you think schools should be asked to put in extra safety measures for children that have been shielding e.g. temperature checks, attempts at social distancing, masks where possible, informing parents of any illness that might be circulating (not just covid) so that shielding children could be kept home as a precaution? Can other parents at the school be made aware that there is a shielding child in the class and asked to exercise even more caution in assessing whether or not their child might be at risk of spreading germs in the classroom?

Any such measures would need to cover siblings of shielded children as in most cases social distancing within the home with small children is impossible.

Can it also be made clear to parents of shielded children that heads have discretion in whether or not to issue fines and that the Oak National Academy will be continuing during the next year should online provision be necessary?

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?

My 13 year old daughter has bronchiectasis. How will it be decided if she needs to stay on the shielded list? If her consultant says she can come off the list, do we need to take extra precautions still or treat her the same as her siblings?

How do you view this webchat?

@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)

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.

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

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.

@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.

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?

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.

@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

@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.

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?

@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

@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

@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.

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

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.

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

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?

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.