Risk criteria

Patients deemed to be at high risk of developing complications from COVID-19 include:

• solid organ transplant recipients
• people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD)
• 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)
• people on immunosuppression therapies sufficient to significantly increase risk of infection
• people who have problems with their spleen, for example have had a splenectomy
• adults with Down’s syndrome
• adults on dialysis with kidney impairment (Stage 5 Chronic Kidney Disease)
• women who are pregnant with significant heart disease, congenital or acquired
• 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

In February 2021, people identified as being at high risk as a result of the COVID-19 Population Risk Assessment have also been included in the Shielded Patient List. You can find further information about this assessment here.

Children and young people at “high risk” from COVID-19 will continue to be identified based on the guidance published by the Royal College of Paediatrics and Child Health (RCPCH).

Some speciality 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 high risk category will be on a case by case basis. 

Association of British Neurologists

British Society of Gastroenterology (liver and IBD)

The renal association

British Society for Rheumatology

British Association of Dermatologists

British Thoracic Society

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

1. They meet the criteria that make them eligible for the annual flu vaccination (except those aged 65 to 69 years old inclusive who have no other qualifying conditions).
2. They do not meet the CMO criteria for the high risk group for COVID-19, including those identified by the COVID-19 Population Risk Assessment.

This includes patients aged 70 or older (regardless of medical conditions), or patients under 70 years old who:

• have chronic (long-term) respiratory disease, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
• have chronic heart disease, such as heart failure
• have chronic kidney disease (Stage 1 to 4)
• have chronic liver disease, such as hepatitis
• have a chronic neurological condition, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
• have diabetes
• have a weakened immune system caused by a medical condition or medications such as steroid tablets or chemotherapy
• are seriously overweight (a BMI of 40 or above)
• are pregnant.

For adults, this is usually anyone instructed to get a flu jab as an adult each year on medical grounds.

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