By Dr Nick Brown, GP and

North Wilts Covid lead

Just as for Hamlet’s soliloquy, the response to this simple question is not straight forward.

In common with all viral respiratory diseases, some patients are most at risk of the consequences of Covid 19 and the correct identification of these patients, the assessment of this risk and the nature of the advice and help offered represent the challenges of this national policy. The intention is to protect those who are considered to be most vulnerable, primarily by strict isolation from the risk of coronovirus contact, until as such time as the pandemic peters out naturally or an effective vaccine is developed to allow active protection of patients through immunisation in a similar manner to the annual flu jab campaign.

As the country was preparing for social distancing, the NHS was able to identify patients with a number of these high risk conditions and a central decision was made to send them a letter explaining this risk. It was a good idea in principle but in practice it identified the patients by disease type rather than by severity and this information is only known by GPs or hospital specialists. It didn’t take account of the complicated drug regimes used in inflammatory conditions such as Rheumatoid arthritis where some combinations are more significant than others or where the dose of steroid prescribed signifies severity. Some rare conditions were not on the list at all. Multiple morbidity increases risk cumulatively. So what started out as a well-intentioned attempt to sort this out without involving specialists and GPs, did not go well and clinicians have since spent a lot of time identifying those who should have received, and those who should have not received, the letter. It would have been much more satisfactory if this task had been given to GPs in the first place.

The NHS has identified three levels of increased risk. Many medical conditions occupy all levels depending on their severity and at all of these levels patients should observe strict social distancing or may choose social isolation and would need strict measures to allow return to the work place. The numbers of patients at increased risk is huge as it includes people over the age of 70 and those who are severely obese. Other factors such as sex and ethnicity have since become apparent. Shielding – or absolute isolation of a patient or a patient and their carers/ family with strict use of PPE where external contact is necessary - is a very onerous task appropriate only for those at the very highest risk, and the particular problem is that we really don’t know how long this distressing situation will need to be maintained. These patients are the people who need to have access to the specific help including food and medical deliveries, when there are no other social options available.

I can only apologise to the large number of my patients who were incorrectly categorised, and the much smaller number who initially were missed off the list and therefore had some delay in receiving their help.