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Known considerations

We are aware of the following considerations relating to the code list used for COVID-19 Population Risk Assessment and the COVID-19 Clinical Risk Assessment Tool.

QCovid® is a ‘living’ risk prediction model which means it will be updated by the University of Oxford using the latest data and as we learn more about coronavirus. NHS Digital will continue work alongside colleagues at the Department of Health and Social Care, University of Oxford and stakeholder organisations to share learning and support the development of any future updates to the model.

Relating to  Description Category
Learning disabilities 

The learning disability code set contains codes for several congenital conditions that can be sometimes be associated with learning disabilities.

Learning disability is a broad group and is not always well coded in clinical notes. In line with our precautionary approach to make sure we capture people with learning disabilities as comprehensively as possible, the code list for this category was expanded. As a result, some codes are included that are not necessarily reflective of a diagnosis of learning disabilities. 

COVID-19 Population Risk Assessment

(using original version of QCovid®)

Severe mental illness

The definition of severe mental illness includes schizophrenia, bipolar disorder and depression where it has been severe enough to result in a diagnosis by a GP or hospital clinician.

In line with our precautionary approach to make sure we capture people with severe mental illness and depression as comprehensively as possible, the code list for this category was expanded to include codes for some less severe conditions.

Since the population risk assessment takes account of a very wide range of risk factors, it is very unlikely that people with one of these codes would meet the threshold for addition to the SPL based on this condition alone and no other risk factors.

COVID-19 Population Risk Assessment

(using original version of QCovid®)

Rheumatoid arthritis, SLE and seronegative arthritis

The rheumatoid arthritis and systemic lupus erythematosus (SLE) code set contains codes for other similar rheumatological conditions.

In line with our precautionary approach to make sure we capture people with rarer conditions that may have a similar risk to rheumatoid arthritis/SLE as comprehensively as possible, the code list for this category was expanded to include codes for some less common conditions. These conditions may have a similar risk to rheumatoid arthritis/SLE but, because they are less common, definitive scientific evidence is lacking. We have therefore included them to avoid overlooking anybody who may be at high risk from coronavirus. 

Since the population risk assessment takes account of a very wide range of factors, it is very unlikely that people with one of these codes would meet the threshold for addition to the SPL based on this condition alone and no other risk factors

COVID-19 Population Risk Assessment

(using original version of QCovid®)

HIV

The sickle cell and immunodeficiency code set contains the code for Human immunodeficiency virus (HIV).

Because the data used to develop QCovid® had few instances of people living with HIV who had severe outcomes during the first wave, it was included in a broader group that includes other disorders associated with immunosuppression to offer an overall, representative risk.

This is in line with our precautionary approach to make sure we do not underestimate risk and is in keeping with emerging evidence that suggests people living with HIV may be at increased risk from coronavirus.

If a person living with HIV has received a letter advising them to shield, this is not based solely on their HIV status, but on a wide range of factors

Patients can contact their GP or another clinician for further advice. 

Clinicians can use the COVID-19 Clinical Risk Assessment Tool better understand the factors that have contributed to a person’s results.

In the latest version of QCovid®, and in version 2 of the COVID-19 Clinical Risk Assessment Tool, the approach immunosuppression has been refined and no longer groups conditions together in this way. 

COVID-19 Population Risk Assessment

(using original version of QCovid®)

Gestational diabetes

The diabetes code set contains the code for gestational diabetes.

Some people with previous gestational diabetes were identified by the QCovid® model as being at high risk. This will be appropriate for many and is in line with our precautionary approach to make sure we do not underestimate people’s risk.

Following consultation with senior clinicians and diabetes specialists, updated guidance has been published, advising clinicians when people with a history of gestational diabetes can be removed from the Shielded Patient List.

Additional clarification is now provided to clinicians completing the COVID-19 Clinical Risk Assessment Tool as to how gestational diabetes should be reflected.

COVID-19 Population Risk Assessment

(using original version of QCovid®)

Cerebral palsy

Because we have relied on hospital coding systems, rather than GP records, to identify people with cerebral palsy, we anticipate that individuals with more severe disease, and therefore higher risk, are more likely to have been identified by the COVID-19 Population Risk Assessment.

 

Work is now underway to include the most up to date GP records, so that more people with cerebral palsy will be included in any future similar assessment, and if the Shielded Patient List needs to be updated to allow people who are Clinically Extremely Vulnerable (CEV) to benefit from specific advice or interventions in the future.

COVID-19 Population Risk Assessment

(using original version of QCovid®)

Data availability 

Data for some clinical conditions is not available in the national primary care data sets used for the COVID-19 Population Risk Assessment (GPES (General Practice Extraction Service) v3: COVID-19 at risk patients data collection version 3 and GPES data for pandemic planning and research (COVID19)) 

To improve the coverage of the data, additional national datasets including Hospital Episode Statistics (HES) were used. HES data allowed us to identify people who had received hospital treatment for these conditions at any point over the past 20 years. Although we know this does not guarantee we will capture everyone, we believe this allows us to identify patients who have had more severe illness relating to these conditions

Some of these conditions were already included in the criteria for addition to the Shielded Patient List (SPL) and so people with these conditions had already been added to the SPL.

The conditions not included in the SPL addition criteria where data was not available in national primary care datasets and HES data was used instead are cerebral palsy and osteoporotic fractures of wrist, spine or humerus.

We are continually working to improve the quality of the data available to us, to allow for more complete identification of people with these conditions in the future. For example, the next iteration of the COVID-19 At Risk Patients GPES extract will routinely include data on cerebral palsy.

COVID-19 Population Risk Assessment

 

 

 

QCovid® is a ‘living’ risk prediction model which means it will be updated by the University of Oxford using the latest data and as we learn more about coronavirus. NHS Digital will continue work alongside colleagues at the Department of Health and Social Care, University of Oxford and stakeholder organisations to share learning and support the development of any future updates to the model.

Last edited: 24 November 2021 3:07 pm