The shielding list in England is about to almost double, as 1.7 million people are added to the 2.2 million who have already been advised to stay home at all costs because of their increased risk of becoming severely ill should they catch Covid-19.

It’s not a recommendation anyone would wish for. Everyone has had enough of their own four walls. But for some it will be a relief. It means they will be supported, with statutory sick pay,with people to deliver their medicines and get their shopping for them. And in the case of around 800,000 who are under the age of 70, it means they will move into the current priority group for vaccination.

These are individuals with a multiplicity of health problems, which could include obesity, diabetes, dementia, epilepsy, severe mental illness and hip fracture. The list is long. Many of them – and their families and friends – will have worried that the outcome if they were infected might not be good. Some will already have been staying at home as much as possible, even before they were officially on the shielding list.

The reason these people are now being identified is thanks to long and painstaking work by a team based at University of Oxford to figure out how to weight each risk factor and how having a number of them affects the prognosis for someone catching Covid. It was commissioned by the chief medical officer, Prof Chris Whitty, and funded by the National Institute of Health Research. But it’s not easy. Julia Hippisley-Cox, professor of clinical epidemiology and clinical practice, who led the team, previously developed a similar risk assessment tool for cardiovascular disease. That was 10 years in the making, so QCovid, as it is called, has been produced with lightning speed.

UK cases

This is about the risk of ending up in hospital with severe Covid, not the risk of getting infected or mildly ill. We already know age is the biggest risk factor for death, hence why the over-80s were called first for vaccination. Since then, the priority has been in descending age order, but adding in NHS and care staff and people with conditions that carry an obvious risk of death – basically those that undermine your immune system like cancer chemotherapy and organ transplants.

The original shielding list said nothing about people from black, Asian and minority ethnic backgrounds. The Joint Committee on Vaccines and Immunisations which advises the government did not put them in the priority groups either. That’s because it was thought those most at risk would be caught by other criteria such as age or underlying conditions.

This time ethnicity and, significantly, postcode are being included as factors to be weighed, aiming to provide information on deprivation. This is acknowledgment that many people in socio-economically deprived areas are likelier to have underlying poorer health and face great exposure to the virus due to living arrangements and jobs.

Previously there has not been a way to differentiate those in BAME groups who are affluent and healthy from those who suffer greater health inequality and therefore at risk of severe Covid. This much-needed algorithm will hopefully achieve that.

As the discussion builds over the ending of lockdown, it is ever more important to know who is most at risk from the virus – and take stringent measures to protect them, beginning with vaccines. With the extended list of nearly 4 million people who are the most vulnerable, it should be easier to ensure they are kept safe if the pandemic should take another unwelcome turn, and we find that new vaccines against emerging variants are needed in the autumn.



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