Advertisement

Millions with health conditions at risk from Covid-19 'if forced back to work'

<span>Photograph: Mike Hewitt/Getty Images</span>
Photograph: Mike Hewitt/Getty Images

Eight million people with underlying health conditions should be exempted from plans to get the country back to work and normal life, according to scientists who warn that easing lockdown too quickly could propel the Covid-19 death toll to 73,000 this year.

About 80% of the population have little to fear from a return to work, but 20% are vulnerable from one or more common conditions such as diabetes, obesity and heart problems, say researchers from University College London (UCL) in a Lancet study published on Wednesday.

Most of those are not considered clinically extremely vulnerable by the Department of Health and so instructed to shield entirely for 12 weeks.

NHS England originally said the shielding list included 1.5 million people. On Monday, the government said it numbered 2.5 million across the UK. The list focuses on people whose immune systems are impaired, for instance by chemotherapy or taking anti-rejection drugs after organ transplantation.

graphic

Dr Amitava Banerjee from the UCL Institute of Health Informatics, who led the study, said the government is “only ever talking about the extremely vulnerable – they are rare in the population, whereas these diseases we are looking at are some of the commonest chronic diseases.”

He added: “If we are going to start getting out of lockdown, we need clearer guidelines – definitely for this group. I could not find this high-risk group in the 50-page document. If a man is under 70 and has diabetes or heart disease or kidney disease, which is a substantial proportion of the population, we need a clear message that nothing has changed.

“We all know people at work who have these conditions. It is a given. These are exactly the people who we need to give clear guidance to.”

Someone who is on the minimum wage and has COPD (chronic obstructive pulmonary disorder), who is at high risk of sickness or death from coronavirus, may otherwise head back to work, Banerjee warned.

Union leaders have voiced concerns over Boris Johnson’s exhortations to people in manufacturing and other jobs that cannot be done from home to return to work from Wednesday.

Figures from the Office for National Statistics this week showed that people in some of the lowest-skilled occupations had the highest death rates, with 21.4 deaths per 100,000 men. Men working as security guards had one of the highest rates, with 45.7 deaths per 100,000.

In their study, Banerjee and colleagues have calculated the number of over-30s who have underlying conditions and are likely to die either from Covid-19 or because they are not seeking the treatment they need.

They look at three scenarios: doing nothing in the hope of creating herd immunity, which would lead to up to 80% of the population becoming infected; mitigation, which was the strategy before the lockdown, when people were asked to keep their distance and wash their hands, which is presumed to have led to a 10% infection rate; and suppression during the lockdown.

Returning to an infection rate of 10% would lead to 37,000 deaths over the year if the relative risk of dying is twice that people with underlying conditions usually run. It is 73,000 if the risk is tripled. The relative risk of death from the virus is currently uncertain.

Prof Harry Hemingway, senior author, said: “Vaccines and drugs will take time to develop and evaluate. What works right now is two things. Firstly keeping the population infection rate as low as possible, and avoiding infection in the people at highest risk (direct effects of infection).

“Secondly we need to continue to deliver high-quality medical care to vulnerable people to prevent excess deaths in those who are not infected with coronavirus (indirect effects of the emergency).”

Sarah Harper, professor of gerontology at the University of Oxford, said it was an important paper showing how taking account of combinations of age and underlying conditions might show some people to be more vulnerable to Covid-19 than those on the official extremely vulnerable list.

“For example, a man aged 66-70 years with no underlying conditions is not currently considered high-risk. Yet he has a higher background one-year mortality (1.07%) than that of a woman aged 56-60 years with one underlying condition (0.91%), who is considered high-risk. Similarly, it shows that generally women’s mortality risk at any given age is the same as men’s who are around five years younger,” she said.

“The blanket and arbitrary use of age – for example age 70 as a rough cut-off for the high-risk mortality category – has been questioned by many already. This paper highlights the difference between men and women, and the importance of identifying underlying health conditions.

“Importantly, the authors suggest that this enables a publicly available tool for individuals to use to develop better understanding of who is at risk based on reliable health data. The association between population risk and individual risk is complex, but a transparent public health approach enabling people to understand the evidence behind government messages would be welcomed by many.”

It comes after warnings that the 2.5 million who are shielding themselves, and their family members, face an “impossible choice” between paying the bills and their health. Rishi Sunak, the chancellor, extended the furlough scheme but the 2.5 million – as well as people living with them – do not have an automatic right to be paid via the scheme, it emerged.