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Information for patients about the COVID-19 Clinical Risk Assessment Tool

The COVID-19 Clinical Risk Assessment Tool helps NHS staff estimate the risk of you dying from coronavirus following a positive PCR test. 

This helps you, and the NHS staff supporting you, understand how at risk you are from coronavirus, and the steps you could take to reduce your risk.

How the tool works

The online tool works out how at risk you may be based on research by the University of Oxford. Researchers looked at information about people who had coronavirus between January 2020 and June 2021 to find out if certain things like age, ethnicity, weight and health conditions impact how coronavirus affects people.

The researchers found that some of these things make it more likely that a person may need to go to hospital or die from coronavirus – these are called ‘risk factors’.

The researchers then used this information to create a way of estimating how at risk a person might be, based on the answers to questions about them and their health.


How NHS staff can use the tool

Your clinician will enter information into the online tool about you, your health and the medicines you take. Some of this information will be taken from your health record but your clinician may also need to ask you some additional questions. They may also need to measure your height and weight to work out your body mass index (BMI).

Your clinician will enter information about your:

  • age
  • sex registered at birth
  • ethnicity
  • living arrangements (whether you live in your own home, in a care home or are homeless)
  • postcode
  • height and weight
  • medical history (for example heart or liver conditions, or whether you have had cancer treatment. View the full list of conditions)

Each piece of information is then used by the online tool to generate a risk assessment. Risk factors that have a bigger impact on how people are affected by coronavirus will contribute more to your results.

The tool does not store or share any of your personal information. You can ask your clinician for a copy of their privacy notice for more information about how your information is used.


Understanding your results

Your clinician will talk to you about your results, explain what they mean for you and may discuss with you things the online tool cannot take into account, such as your occupation, individual behaviour (such as hand washing, wearing face coverings and visiting friends or family), current infection rates in your area. Your clinician may also talk to you about:

  • possible health and lifestyle changes
  • a decision on what to do about your health or treatment
  • ways to stay safe and prevent the spread of coronavirus

The online tool will generate results for absolute risk and relative risk, estimating the likelihood of dying from coronavirus after testing positive with a PCR test.  


Absolute risk

Absolute risk is the overall risk, based on what happened to other people with the same characteristics and risk factors who caught coronavirus and died as a result.

Example: combined risk of dying from coronavirus following a PCR test 

If someone has an absolute risk of 1%, we expect there to be a 1 in 100 chance that they will die from coronavirus following a positive PCR test. 


Relative risk

Relative risk is the level of risk compared to a person who is the same age and sex registered at birth as you, with the same vaccination status but without any other risk factors.

Example: risk of dying from coronavirus following a positive PCR test 

If someone has a relative risk of 2, we expect them to be twice as likely to die from coronavirus following a PCR test than someone who does not have their risk factors.


Current limitations of the tool

Because we don’t yet have enough research about some groups of people, risk assessment results may not be accurate for people:

  • aged under 19 and over 100, because the research was done on adults aged from 19 to 100 and because very few children became seriously ill with coronavirus
  • who are trans or intersex, because the research was done using information about the sex people were registered with at birth
  • who are pregnant, because only small numbers of pregnant people were included in the research so we cannot be confident about their level of risk
  • who have conditions that meant they would have been advised to shield because, when the research was done, many of these people were shielding at home and so were less likely to catch coronavirus. This means the tool may underestimate the risk for these people
  • who have rare conditions, because there was not enough data available to accurately assess their level of risk 

This tool can not take into account booster vaccines or new variants of coronavirus. Your clinician can explain more about what these limitations may mean for you personally when they discuss your risk assessment with you.


Missing information

If NHS staff do not have a certain piece of information about you and you cannot provide them with the information, the online tool may use a default or replacement value. This might mean that your risk assessment results are higher or lower than they would have been if this information had been available.

For example, if you or your clinician cannot measure your height and weight (used to work out BMI) and this is left blank, the online tool will use a default BMI of 31. Your clinician will explain more about this and how this might change your risk assessment results.


Updates to the tool

Researchers are continuing to learn more about coronavirus as more information becomes available. Over time, the online tool may be updated to reflect this and other changes such as new strains and levels of immunity.

This tool was updated to the newest version of QCOVID® on 25 November 2021. The latest version was based on more up to date data and takes into account vaccination status. 


Health conditions and treatments

To reflect the fact that some risk factors have a bigger impact on risk, some values contribute more to the result than others (weighting). Some risk factors also interact with others, and this means that the extent to which each risk factor contributes to a person’s overall risk level (and risk assessment result) will depend on the individual.

  • The weighting impact of some risk factors is affected by the presence or absence of other factors. For example, the risk associated with Type 2 diabetes increases with age.
  • The impact of some risk factors increases with their severity, for example, a higher level of obesity means a higher risk.
  • Some risk factors affect men more than women, and vice versa

The tool uses information about the following conditions and treatments to generate risk assessments.

Cardiovascular diseases
Respiratory diseases and treatment

Asthma
Taking anti-leukotriene or long acting beta2-agonists (LABA)
Chronic Obstructive Pulmonary Disease (COPD)
Cystic fibrosis, bronchiectasis or alveolitis
Pulmonary hypertension or pulmonary fibrosis
 

Diabetes, kidney disease, cirrhosis and fractures

Type 1 diabetes
Type 2 diabetes 
Gestational diabetes
Chronic kidney disease
Cirrhosis of the liver
prior osteoporotic fracture of the hip, spine, wrist or humerus (fracture as a result of osteoporosis)
 

Autoimmune conditions and immunosuppression

Rheumatoid arthritis, SLE (systemic lupus erythematosus, more commonly known as lupus) or a seronegative arthritis

Inflammatory bowel disease

Sickle cell disease

HIV

Rare immunodeficiency, such as common variable immunodeficiency and severe combined immunodeficiency

Oral prednisolone (prescribed by a clinician 4 or more times in the last 6 months)

Immunosuppressants (prescribed by a clinician 4 or more times in the last 6 months)

Haematological conditions, cancer conditions and treatments

Thrombosis or pulmonary embolus

Lung or oral cancer (such as laryngeal (larynx),  nasopharyngeal or mouth cancer)

Cancer of the blood or bone marrow (such as leukaemia, myelodysplastic syndromes, lymphoma or myeloma)

Solid organ transplant (such as lungliverstomachpancreasspleenheart or thymus)

Stem cell or bone marrow transplant in the last 6 months

Radiotherapy in the last 6 months

Chemotherapy in the last 12 months

Last edited: 24 November 2021 2:50 pm