Coronavirus (COVID-19): Shielded patients list

The shielded patients list (SPL) is made up of a clinical algorithm, a publication, and our dissemination of the data.

High risk of developing complications from coronavirus (COVID-19) infection.

The algorithm looks to identify:

1. Solid organ transplant recipients.
2. People with specific cancers:

• people with cancer who are undergoing active chemotherapy
• people with lung cancer who are undergoing radical radiotherapy
• people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
• people having immunotherapy or other continuing antibody treatments for cancer
• people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
• people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs

3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD).
4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as Severe combined immunodeficiency (SCID), homozygous sickle cell).
5. People on immunosuppression therapies sufficient to significantly increase risk of infection.
6. Women who are pregnant with significant heart disease, congenital or acquired.

Some specialty organisations have developed decision-support tools to help identify patients. Please note that this is guidance, and ultimately the decision to add a person to the highest clinical risk registry will be on a case by case basis. 

• Association of British Neurologists
• British Society of Gastroenterology
• The renal association
• British Society for Rheumatology
• British Association of Dermatologists
• British Thoracic Society

Moderate risk of developing complications from coronavirus (COVID-19) infection

Patients are at moderate risk of developing complications from coronavirus (COVID-19) where:

• they meet the criteria that make them eligible for the annual flu vaccination (except those aged 65 to 69 year old inclusive who have no other qualifying conditions)
• and they do not meet the CMO criteria for the high risk group for COVID-19

This includes the following patient groups:

• aged 70 or older (regardless of medical conditions)
• under 70 with an underlying health condition listed below (for adults this is usually anyone instructed to get a flu jab as an adult each year on medical grounds):
  • chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
  • chronic heart disease, such as heart failure
  • chronic kidney disease
  • chronic liver disease, such as hepatitis
  • chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
  • diabetes
  • those with a weakened immune system caused by a medical condition or medications such as steroid tablets or chemotherapy
  • being seriously overweight (a BMI of 40 or above)
  • those who are pregnant.

Low risk of developing complications from coronavirus (COVID-19) infection

Patients are low risk if they are not in the moderate or high risk groups. 

We have published the algorithm and detailed methodology for the shielded patients list.

We are aware of the following issues. If you wish us to investigate cases where the algorithm may have an issue please contact splquery@nhs.net.

Stable HIV

Patients with stable HIV and no other conditions have not been specifically been allocated to the shielded patient list.

We are aware that despite this they are being identified as high risk. This is likely because the code of “immunosuppressed” is used on their record and this is being used to add an entry.

Sickle cell trait

The code for sickle cell disease has been used on the patient’s record rather than sickle cell trait. This has meant patients have been over identified.

Peripheral Vascular disease (PVD)

We have received reports that PVD is being picked up. PVD is not on any of the inclusion criteria. This cannot be explained without further specific investigation.

Splenectomy

Splenectomy is included in both the CMOs clinical criteria and the national algorithm.

Antineoplastic Chemotherapy (GP Extract)

In the GP flu cluster Antineoplastic Chemotherapy is included in the immunosuppresion category which means it is not limited by time, i.e. it includes patients who have ever had Antineoplastic Chemotherapy . We intend to limit this by time (24 months in a later release)

Corneal Implant (HES)

Following specialist input, corneal implant where patients are on systemic immunosuppression drugs will remain part of the national algorithm.

Incorrect category selected by Trust

A small number of additions made by Trusts are for the category “Women who are pregnant with significant heart disease, congenital or acquired” where this is not possible (e.g. aged over 70). We have contacted the Trusts to make them aware of the issue.

An updated NHS SPL will be generated weekly by NHS Digital, incorporating additional patient data provided by acute Trusts and GP practices.  Each list will be based on the latest version of the SPL clinical algorithm at that time.

Questions about the SPL publication process should be directed to: SPLQuery@nhs.net

Full details can be found on our timings for information flows between systems page. 

The shielded patient list is only sent to recipients under data sharing terms of release, and is subject to information governance controls.

We openly publish recipients of the list on our website.