We acknowledge there has been some confusion regarding the inclusion of splenectomy on the list of conditions which may put people at highest clinical risk to COVID-19. In England, splenectomy codes are included in the methodology for identifying people who may be at highest clinical risk. The term splenectomy can cover a breadth of clinical conditions. Splenectomy codes were included in the national search criteria on a precautionary basis, because splenectomy may be associated with or have an impact on immunological function.
GPs and specialists are able to add or remove people from the Shielded Patient List based on more detailed local records, or according to their clinical judgement, specialist advice or knowledge of people’s specific circumstances. This approach has been in place since the Shielded Patient List was first created. Our methodology, and the criteria on which it is based, have not changed.
Confusion arose because splenectomy was initially included in the Government’s guidance within the list of conditions which placed people at moderate risk from COVID-19, i.e. the ‘vulnerable’ group advised to follow stringent social distancing rather than the full shielding measures. The text from the Government guidance was copied into some early communicators from the NHS and professional bodies. As soon as the discrepancy was identified, steps were taken to amend the Government guidance and to confirm in subsequent communications from NHS England and RCGP that splenectomy had been included in the shielding criteria.
The Government is reviewing shielding policy as it learns more about COVID19 and the risk factors involved to ensure patients are given the most helpful advice for their condition. In England, until this review is concluded, no further clinical guidance will be issued, and the criteria will remain unchanged.
The British Society for Haematology published guidance on 6 May identifying the specific sub-groups of patients who have had full, or partial, splenectomies that they consider to be clinically extremely vulnerable. Due to the current shielding policy review, the guidance has not been formally issued to GPs and hospital trusts. However, it is available on the Society’s website as their current position and advice.