COVID-19

The following is archival information for historical purposes only. For a current guide on COVID-19 safety guidelines and advice for people with longterm illnesses please visit the COVID-19 .gov page

COVID UPDATE, DECEMBER 2021

In view of the recent increase in COVID infections in the UK, we would like to share a message of caution to red cell teams and patients with haemoglobinopathies and inherited rare anaemias in the UK. Sickle cell disease and thalassaemia patients are extremely vulnerable to getting very ill; in the 1^st and 2^nd waves of the COVID pandemic, over half of those with sickle cell disease who caught COVID-19 needed to be admitted to hospital and 10% required intensive care treatment, including help with breathing. For those with thalassaemia who contracted COVID-19, over 20% needed treatment in hospital, with around 5% needing intensive care.

We don’t yet have data from the current wave of the pandemic, or details of how the omicron variant will affect patients with haemoglobinopathies, but our advice is to book your first, second and booster COVID vaccinations if you have not yet had them.

Please contact your local haematology team if you would like more information.

COVID VACCINE UPDATE, JUNE 2021

In view of the recent increase in COVID infections in the UK we would like to issue a word of caution to red cell teams and to patients with haemoglobinopathies and inherited rare anaemias in the UK.

When we look at the patients who are admitted to hospital with COVID infections at the moment, these tend to be younger patients than were admitted during the first or second wave (70% of patients are aged less than 45). Of additional concern is the fact that very few patients being admitted to hospital have had their vaccines. We know that patients with haemoglobinopathies and rare inherited anaemia may be at increased risk of hospitalisation from COVID and we therefore urge you to book your first and second COVID vaccinations if you have not yet had them both. Please contact your local haematology team if you would like more information.

COVID-19 Vaccination in patients with Haemoglobinopathies and Rare Inherited Anaemias:

This information has been produced following virtual meetings with representatives from the Haemoglobinopathy Co-ordinating Centres (HCCs) for Haemoglobin Disorders, the Clinical Reference Group for Haemoglobin Disorders and the National Haemoglobinopathy Panel as well as national experts on Sickle Cell Disease, Thalassaemia and Rare Anaemias.

This updates previous advice from this group and should be read in conjunction with updated government advice and the document ‘Advice to clinicians on risk assessment for severe COVID-19 in patients with haemoglobinopathies and inherited rare anaemia’ published on 28.08.20.

This document covers

Updated advice on shielding
Advice on children and young people
Advice for the clinically extremely vulnerable and Local COVID alert level
Guidance if shielding is re-introduced
Additional patient information

1 Updated advice on shielding

The National Haemoglobinopathy Panel previously advised that all people with Sickle Cell Disease (SCD) and some of those with Thalassaemia and Rare Anaemias were ‘clinically extremely vulnerable’ and should shield

From the 1^st August shielding was paused and those shielding were encouraged to cautiously increase activity outside the home whilst maintaining social distancing.

Updated government advice was published on 15^th October 2020 ‘Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19 ‘

This gives updated advice on protecting the clinically extremely vulnerable, based on the local COVID alert in your area. It also gives more targeted shielding advice that is more targeted and will only apply for a limited period of time. Patients are only advised to follow shielding advice if they receive a new written shielding notification.

2 Advice for children and young people

The government advice says that evidence indicates that the risk of serious illness for most children and young people is low. Children and their families were advised to speak to their paediatric specialist or general practitioner over the summer.

The Royal College for Paediatrics and Child Health has regularly updated guidance on shielding, most recently on 22.09.20. The guidance can be seen here.

Paediatricians have been asked to review the lists of patients classified as clinically extremely vulnerable and remove patients who are inappropriately listed.

Individual risk assessment on which shielding advice is based should be undertaken by an experienced member of the local or specialist haemoglobinopathy clinical team (medical staff or clinical nurse specialists). The discussion with the children and their families should be clearly documented. Further advice is available in the risk assessment document from 28.08.20

The majority of children and young people with haemoglobinopathies and inherited anaemias have been removed from the shielding lists and will NOT need to shield if shielding is re-introduced. It is essential that the shielding lists are kept up to date to ensure we don’t cause harm by keeping children away from school unnecessarily.

Children and young people or their families who are unclear about their shielding status should contact their GP or their specialist team for discussion.

Children and young people with haemoglobinopathies and rare anaemia should continue to follow advice on social distancing, dependent on their local COVID alert level.

3 Advice for the clinically extremely vulnerable and Local COVID alert level

The government document from 15.10.20 provides advice for the ‘clinically extremely vulnerable’ depending on the Local COVID Alert Level. This advice applies to patients classified as ‘clinically extremely vulnerable’ and who remain on the shielding lists.

All Local COVID alert levels:

Socialising: Continue to maintain strict social distancing, wash your hands regularly

Try to keep the number of social interactions you have low

Continue to observe strict social distancing with anyone outside of your household/social bubble

Meet people outside if possible

Work: Work from home where possible

Travel: Walk or cycle if you can

Shopping: Consider shopping at quieter times of the day and wear a face covering.

Medium Local COVID Alert Level:

Socialising:When seeing friends and family you do not live with, you must not meet in a group of more than 6 indoors or outdoors

Strictly maintain social distancing, meet outside if possible, keep the number of people you meet low

Work:Work from home if possible

If you have to attend work, this should be COVID-secure

Travel: Limit journeys on public transport where possible

Shopping: Consider shopping at quieter times of the day. Maintain social distancing.

High Local COVID Alert Level:

Socialising: You must not meet people in any setting indoors unless they are part of your household/support bubble

You may see friends and family you do not live with outside, but only in groups of six or less

You should keep the number of different people you meet with low

Work: Work from home if possible

If you have to attend work, this should be COVID-secure

Travel: Avoid travel except for going to work, school or for essential shopping.

Shopping: Reduce the number of shopping trips you make, shop at quiet parts of the day and consider on-line shopping

Very high Local COVID Alert Level:

Socialising: You can only meet friends and family who are not in your household/support bubble in certain outdoor public spaces.

You can go outside for exercise but avoid busy areas. Otherwise stay at home as much as possible.

You may want to maintain social distancing in your household

Work: You are strongly advised to work from home.

If you cannot work from home speak to your employer about taking on an alternative role or changing your working patterns. If there is no alternative you can go to work but your employer should discuss the steps they have taken to reduce your risk of exposure to COVID-19.

Travel: Stay at home as much as you can. Avoid travel into or out of a very high alert area

Shopping: Reduce your shopping trips. Go at quieter times and shop on-line if possible.

4 Guidance if shielding is re-introduced

The government document from 15.10.20 says that they may advise more restrictive formal shielding measures in the worst affected very high alert levels, based on advice from the Chief Medical Officer. If this happens the government will write to patients on the shielding list. Patients should only shield if they receive a new shielding notification. In this situation they will also be given additional advice on how to access support.

In this situation the following advice for patients will apply:

Work: You will be strongly advised to work from home.

Socialising: You can go outside, but keep all contacts outside your household to a minimum. Try to stay 2 m away from other people in your household.

Travel: Stay at home as much as possible and only travel if essential

5 Additional patient information

Refer patients to up to date advice on the NHSE and PHE websites. There are also resources on the UKTS, Sickle Cell Society and Diamond Blackfan patient society web pages. Further resources will be added to the National Haemoglobinopathy Panel web pages as they are made available. The British Society for Haematology also has a useful repository.

Oxford University Hospital have also produced this useful document. Covid-19: Day to day Life: making decisions about your risk of exposure

Haemoglobinopathy Co-ordinating Centres 19.10.20