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COVID-19: Who is Highly Vulnerable?

Professional Societies Define Vulnerable Liver Disease Patients

The professional medical societies for liver disease include the British Association for the Study of the Liver, British Society of Gastroenterology, British Transplantation Society, NHS Blood & Transplant.

These experts have now revised their professional advice about which people with liver disease are most vulnerable.

They now advise that the following groups of people should follow the government guidance for 'extremely  clinically vulnerable' people:

  • Patients with chronic liver disease who are on immunosuppressants

Data: There is not enough evidence to support this yet and it is based on the professional opinion of medical experts.


  • Any patient with decompensated cirrhosis or ascites, hepatic encephalopathy, liver cancer, variceal bleed or synthetic liver dysfunction (now or in the last 12 months)

Data: This is supported by data from a registry of patients who have liver disease and have had COVID-19.


  • Patients who are actively on the liver transplant waiting list or who have received a liver transplant

Data: This is supported by data from NHSBT.


  • Other medical conditions

You may have other conditions that mean you are extremely clinically vulnerable. Always check the relevant guidance for each condition.


But shielding is pausing. Why is this news important now?

Shielding is expected to pause in the coming weeks. However, if there are local areas where circumstances change, shielding might be temporarily restarted for that area. The government will maintain a list of everyone who is 'extremely clinically vulnerable' and use it to issue new shielding guidance for that area only. We are understanding more and more each week as new evidence emerges, so it is important to ensure that the lists of people who are most vulnerable is kept up-to-date.


If you think you are now 'extremely clinically vulnerable'

If you now think that you should be classed as 'extremely clinically vulnerable' (and want to be), get in touch with your consultant to discuss as you may need a letter for your employer. You do not need to do anything if you have already received a shielding letter and therefore already know you are classed as vulnerable.


Shielding is not compulsory

The guidance issued to healthcare professionals emphasises that choosing not to shield is a personal choice, and asks them also to consider many other factors when classifying you, such as:

  • age
  • any other pre-existing medical conditions and medications
  • ethnicity
  • sex
  • BMI
  • smoking status
  • alcohol intake
  • home and family circumstances including age range of others at home and nature of accommodation
  • mental health
  • overall wellbeing,
  • employment status
  • financial position