Yesterday, NHS England announced they have cleared the QCovid tool for assessing patients on a range of risk factors, including age, ethnicity, deprivation, BMI and underlying health conditions such as diabetes and heart disease. This has led to an addition of 1.7 million people to the shielding list, including 800,000 people who have not yet had a vaccination.
There is always the worry this will pile work onto GPs. NHS England is responsible for contacting these patients, but as we saw last year (and highlighted recently by the National Audit Office), this could go very wrong.
Regardless, this is a good development. We have known for a long time Covid disproportionately affects BAME people, and those in deprived areas, and hopefully this tool provides a bit more safety for those at risk.
But this, to me, highlights something that has become apparent in the pandemic: that the pre-Covid standards for evidence-based medicine are a bit of a luxury. This might seem heresy. But, in fact, public health chiefs have been practising this on the whole: for example, the original rules on self-isolation were based on common sense with guesstimates, rather than waiting for the evidence. This was undoubtedly the right thing to do.
When public health chiefs have waited on gold standard evidence, it has often led to unnecessary delays. Look at how it took until May of last year to add anosmia to the list of symptoms requiring self-isolation, despite GPs and patients realising this at the start of the pandemic. The same could be said for mandating the use of face masks in public places – something that common sense dictated far earlier.
I do think there has been a delay in terms of approving the QCovid tool, which was first developed in October. In terms of ethnicity data, I agree with Dr Partha Kar, who wrote on these pages last month: ‘The evidence has been there from all corners since the pandemic took its foothold in the UK in March 2020.’ GPs in Greater Manchester, where there is a high proportion of BAME patients, created their own risk scores in May last year. So why couldn’t the authorities get something like this out earlier, when BAME communities were crying out for it?
Of course, we can’t cut corners when it comes to vaccines, or treatments – it goes without saying they need the highest standards of evidence.
But how many lives would have been saved if we didn’t wait for the data on face masks, anosmia and observable risk factors? Sometimes, a rush to action is safer than waiting for the evidence.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at firstname.lastname@example.org