Vulnerability to COVID-19

 

Dr Robin Cordell, a director of the Council for Work and Health, and a Fellow of the Royal College of Physicians has this week brought our attention to the following piece within the President of the Royal College of Physicians of London most recent update to members of the Royal College.

 

In this update, Professor Andrew Goddard MD PRCP highlights the importance of assessing those who are more vulnerable should they be infected with COVID-19, so informing individual risk assessment by management as to how such people may be protected in their work.

 

We were very pleased that the President of the Royal College of Physicians has highlighted the essential work done by occupational health staff, and that he made a specific point of thanking occupational physicians (the Faculty of Occupational Medicine being a faculty of this Royal College) and so by extension all those supporting health and work at this time.

 

This is the key part of this message from the President of the Royal College of Physicians:

“The creation of a list of 1.8 million people as a ‘clinically extremely vulnerable’ group who need ‘shielding’ from COVID-19 was both a mammoth task and one that all involved should be proud of. Risk, though, is not a binary thing. As our understanding of what makes people more vulnerable to the effects of COVID-19 improves, we may need to be a bit more flexible about who needs shielding and who does not. This will be especially true as the rest of the population comes out of lockdown and being shielded may be seen by some of the shielded as a curse rather than a blessing.

 

Such risk needs to take into account the susceptibility of an individual to infection and the severity of disease that results. Some of this will be defined by obvious parameters such as age, comorbidities, medications, ethnicity and sex. The risk will also depend on the exposure risk in the community (will we have a local COVID-19 level as we do for pollen, pollution and UV exposure?), occupation and means of commuting. Lastly, each of us has our own perception of what we will accept when it comes to risk. As we refine ‘shielding’ it will need to be as personalised and thought about as any shared decision we make about a treatment in clinic or on the ward.

 

The role of ethnicity remains something that many are rightly worried about. There are several pieces of work going on in both PHE and NHSE looking at this. Occupational medicine has a large role to play for us as physicians and the letter from Simon Stevens formally tasked trusts with risk assessing staff. Anne de Bono, president of our Faculty of Occupational Medicine, is working hard on this with colleagues, including the Society of Occupational Medicine. This is going to be a massive amount of work for an understaffed part of our workforce.

 

This week’s shout out therefore goes to them. Thank you to all our occupational physicians.”