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GPs will be asked to rewrite Covid-19 shielding list using new risk score

GPs and specialists will be asked to rewrite the Covid-19 shielding patient list based on a new risk prediction tool being developed by the University of Oxford and NHS Digital.

The news comes as the Government has announced that people in England can quit shielding from 1 August as virus transmission in the community has decliend to safe enough levels, however the shielding list will be retained and updated for the event of a new virus spike, in which case the shielding programme will be reactivated.

Researchers said their new model, which has been commissioned by the chief medical officer for England, would support GPs and specialists in their consultations with patients to provide more targeted advice based on individual levels of risk.

They are in the process of analysing the anonymised health records of 8m UK adults through the University of Oxford’s QResearch database to identify factors that can be used to predict who will have the highest risk of serious illness or death from Covid-19, including age, sex, ethnicity, deprivation, smoking status, body mass index, pre-existing medical conditions and current medications.

The algorithms from this data analysis will then be developed with data experts at NHS Digital to create a clinical risk prediction model that can be applied by doctors including GPs, the researchers said, in conjunction with ‘discussions on how to reduce risk’.

It will also allow for mathematical modelling to inform national public health policies in shielding and infection prevention, as well as helping to determine who should be first in line for a potential Covid-19 vaccine.

Principal investigator Professor Julia Hippisley-Cox, professor of epidemiology and general practice at Oxford University’s Nuffield Department of Primary Care Health Sciences said: ‘Driven by real patient data, this risk assessment tool could enable a more sophisticated approach to identifying and managing those most at risk of infection and more serious Covid-19 disease.

‘Importantly, it will provide better information for GPs to identify and verify individuals in the community who, in consultation with their doctor, may take steps to reduce their risk, or may be advised to shield.’ 

Chief medical officer for England Professor Chris Whitty, said: ‘The level of threat posed by Covid-19 varies across the population, and as more is learned about the disease and the risk factors involved, we can start to make risk assessment more nuanced.

‘When developed, this risk prediction tool will improve our ability to target shielding, if it is needed, to those most at risk.’ 

Speaking in this evenings coronavirus briefing, deputy chief medical officer for England Dr Jenny Harries said the changes to the shielding list comes as ‘new evidence is telling us that the risks for individuals are often more clearly due to a combination of factors in that individual, such as age, ethnicity, obesity levels for example, as well as the medical conditions that they have’.

She said: ‘The chief medical officer has commissioned work to ensure that should we need to step up the shielding programme again, we would have available a much more individualised way for you and your doctor to be able to understand your risk, and to receive more tailored advice.’

She also reiterated that the overhaul of the shielding list was likely to see the removal of the vast majority of children, including any child whose health condition is currently managed in primary care.

She said: ‘As evidence has evolved we’ve seen that admission to hospital for all children under 18 years old with COVID-19 is very low indeed. Only 36 children in the UK have been admitted to intensive care.’

Dr Harries added that ‘there is a group of children that exists who due to their underlying conditions may need to continue to shield’ but said that ‘over the summer parents can look forward to discussions through routine paediatric appointments’.

In the interim, she said ‘we will be talking with your doctors and all royal colleges to ensure everyone has the right information’.

‘So for now, there is no need for parents to speak to their doctor immediately. And we will sort that information out in due course for anybody with underlying clinical conditions whether adult or child.’

It comes as the Government said earlier this month that it was working on a ‘better’ risk algorithm for patients shielding from coronavirus, which may see 90,000 children removed.