They have been designated at higher risk under a new predictive risk model following an analysis of the characteristics of patients who died or suffered severe infections during the first wave of the pandemic last year.
Nearly two million people across England are to be told for the first time that they personally are at greater risk from coronavirus and will be prioritised for vaccination and should consider shielding at home.
In total 1.7 million people will be offered the chance to join the list of clinically vulnerable patients shielding at home, doubling the list from 2.3 million to 4 million.
The model has been developed by experts at Oxford University at the request of the chief medical officer Chris Whitty and adopted by the Department of Health and Social Care and NHS England. It is the first time any model has been used like this anywhere in the world.
Patients will be encouraged to start shielding at home and offered the chance to receive the extra support available to those patients including food deliveries and access to statutory sick pay.
Dr Jenny Harries, deputy chief medical officer for England said: “All of these people who are identified for the first time are those who have not had an individual clinical condition that we’ve previously been able to identify through the clinically extremely vulnerable group.
“But they are people who have multiple personal risk factors and underlying health conditions, which moved them into a higher risk group.”
She said the reason for the new model was because it was clear not all patients at risk from the virus were being identified. The new model combines factors including underlying conditions, age, sex, ethnicity, body mass index and the postcode where people live and its link with deprivation.
“It provides a weighted cumulative risk of serious outcomes from Covid-19. And therefore allows us to prioritise these individuals for vaccination and to give them appropriate advice. And the easiest way for us to do that is to include them on the shielded patient list.”
She said patients would be receiving letters giving them advice, but she added joining the shielding list would be voluntary. The patients’ records will be flagged for their local GPs meaning anyone who has not already been vaccinated may be put to the top of the list.
Many of the 1.7 million patients may already have been vaccinated due to other clinical conditions they may have.
The tool covers everyone aged between 19 and 100 and may help prioritise some patients including those with learning disabilities who are thought to be up to three times more likely to die from Covid-19. Adults with Down’s Syndrome have been added to the shielded list due to a higher risk.
Other factors included in the model are whether people live in a residential care setting, which will apply to some disabled and learning disabled people as well as underlying physical health conditions that can affect many disabled patients.
A diagnosis of learning disability on its own is too broad a definition and will not be picked up by the tool.
“It’s quite difficult to disentangle the individual risks,” Dr Harries said, adding: “We hope that we’ve captured within this all individuals who may have a learning disability and have other associated risk factors which through this assessment, this predictive risk model, cumulatively pulls them into the group.”
She said initially when the virus first arrived in the UK there was little or no information on the types of patients who would be at greater risk and clinicians drew up the list of at risk groups based on the knowledge of how respiratory viruses work.
“What we have done here is looked at the evidence which is accrued primarily through the first wave… who were at risk and what conditions they had, and then said, going forward could we identify people with similar characteristics that we think might need to be additionally protected.”
She said the model would be continually updated and revised to take account of changes in the virus and patients it was affecting.