The Government’s long-awaited Covid-19 risk algorithm has identified a black, Asian and minority ethnic (BAME) background as one of the top risk factors, alongside being male and aged over 70.
In June, a new risk prediction model was commissioned by the chief medical officer so GPs could assess risk of serious illness or death from Covid-19 based on factors such as age, sex, ethnicity, deprivation, smoking status, body mass index, pre-existing medical conditions and current medications.
Today, a paper published in the BMJ said the risk algorithm ‘performed well’ in development. However, it remains unclear when a risk calculator will be embedded in GP systems as promised and what action GPs will have to take as a result.
The Department of Health and Social Care (DHSC) previously said the tool would inform GPs’ work to update the shielding list, with a view for it to be finalised by September.
However, despite the publication of the paper, a DHSC spokesperson told Pulse that the algorithm is not yet a risk tool but is just research at this stage.
The study findings are based on data from more than 8 million patients aged between 19 and 100 years at 1,205 GP practices in England, linked to Covid-19 test results and hospital and death registry data.
Those in the top 5% for ‘predicted risk of death’ accounted for 76% of Covid deaths within the 97-day study period, while those in the top 20% for predicted risk of death accounted for 94% of Covid deaths, the paper said.
The algorithm also backed up previous research that those who are male, from a BAME background, over 70 and with certain health conditions such as diabetes were most at risk of death from coronavirus.
The paper said: ‘Of those who died, 2517 (57.4%) were male, 732 (16.7%) were BAME, 3616 (82.5%) were aged 70 and over, 1417 (32.3%) had type 2 diabetes, 1311 (29.9%) had dementia, and 1033 (23.6%) were identified as living in a care home.’
The algorithm is designed for use by clinicians with patients across the UK’s adult population to inform ‘shared decision-making’, the paper said, adding that it ‘may have relevance for shielding or other policies that seek to mitigate risk of viral exposure’.
Other applications could include ‘supporting targeted recruitment for clinical trials, prioritisation for vaccination and discussions between patients and clinicians on workplace or health risk mitigation’, it added.
The researchers said the ‘absolute risks’ should be ‘interpreted with caution’ as they will change over time and the impact of shielding measures taken during the study period could lead to the ‘underestimation’ of some risk factors.
However, they added that the model has the potential to be ‘dynamically updated as the pandemic evolves’.
They concluded: ‘This study presents robust risk prediction models that could be used to stratify risk in populations for public health purposes in the event of a “second wave” of the pandemic and support shared management of risk.’
Commenting on the algorithm, deputy chief medical officer for England Dr Jenny Harries said the Government is ‘working at pace’ and will engage with the NHS, patients and the voluntary sector on ‘how we use this knowledge to ensure we continue protecting and supporting the most clinically vulnerable’.
She added: ‘Continuing to improve our understanding of the virus and how it affects different members of the population is vital as prevalence continues to rise.
‘This is why we commissioned and funded this research, and I’m pleased it is providing useful evidence to help us move towards a more nuanced understanding of Covid-19 risk.’
Earlier this week, experts criticised the delay to the risk algorithm amid ‘unclear’ guidance from the Government.
The Government last week issued updated guidance for clinically extremely vulnerable patients advising them to take precautions depending on what ‘tier’ their local area is in. But to date no local area has advised patients to resume shielding, including in the ‘very high risk’ tier 3 lockdown areas.
Experts previously warned that patients with diabetes, hypertension and cardiovascular disease should be added to the list of patients who may be asked to shield during a second Covid-19 spike.
The current list of clinically extremely vulnerable patients is the same as during lockdown and includes patients with severe respiratory disease and those receiving treatment for cancer.