The Royal College of Physicians has published a joint statement with other health organisations expressing their extreme concern for people who are clinically extremely vulnerable (CEV), unable to work from home and are losing income protection that was put in place at the beginning of the pandemic.
The statement, co-signed by the Royal College of Emergency Medicine, Royal College of General Practitioners, Royal College of Paediatrics and Child Health, National Voices and specialist societies, highlights the challenges faced by both doctors and patients in identifying and reducing the risks associated with COVID-19 for the most clinically vulnerable people.
These patients are seeking advice from their doctor and doctors are keen to help them, but it is difficult for clinicians to identify the risk for an individual. As well as clinical factors, we now know many individual and social factors have an impact on the severity of COVID-19. Shielding itself can have negative impacts. And different advice for children and adults further complicates matters, particularly for those nearing 18 years of age.
We know the government has a difficult job to balance all these factors, and that many people who were shielding have been happy to return to work. But clinicians cannot ignore the anxiety that some of their patients are experiencing. These are people who knew they were vulnerable before the onset of the pandemic and heard very clearly the message they were given about the importance of shielding.
Those who are confident to go out to work should be encouraged and supported to do so. But those who are not confident, who have taken on board government messages and are now very concerned about their risk, should also be supported.
The leading health organisations are therefore recommending that government, chief medical officers and central NHS bodies together:
- Put in place arrangements so that people who are deemed by clinicians to be at very high risk do not have to return to work if they cannot work from home.
- In addition to workplace assessments, support employers to conduct risk assessments for people who are CEV before they return to work.
- Support people who are CEV if they are unable to return to work safely.
- Put in place a transitional arrangement for younger people no longer advised to shield.
- Equip clinicians with the latest intelligence and public health advice to support informed discussions with patients.
- Continue to work closely with medical specialist societies and medical royal colleges to support a standardised approach to assessing levels of risk.
- Make sure that primary care, secondary care and community services work together locally to reduce the risk for people who are CEV.
- Make sure services do not delay or defer urgent and non-urgent treatment.
- Make sure researchers encourage and enable people who are CEV to take part in research, including those who choose to continue shielding.
- Strongly advise people who are CEV, their carers, family and those living with them to have a flu vaccination.
Professor Donal O’Donoghue, Royal College of Physicians registrar said:
“Official shielding advice may have ended, but we cannot assume that patients who were previously shielding now no longer need protection from COVID-19.
“It is incredibly important that clinically vulnerable people continue to receive appropriate advice and care for the underlying conditions that have rendered them vulnerable in the first place, including having access to the flu vaccination.
“The government must ensure that clinicians have the latest health advice so that they can effectively support their patients in making decisions about how to best protect themselves from the virus going forward.”
To discuss anything in this statement, or for more information, please contact us via policy@rcplondon.ac.uk.
The Royal College of Paediatrics and Child Health’s 'shielding' guidance for children and young people can be found here: https://www.rcpch.ac.uk/resources/covid-19-shielding-guidance-children-young-people.