Dear members,

Please accept our very best wishes for 2021 to you all from all on BSPGHAN council.

As we enter the third national lockdown, with surges of cases of the new variant of Covid19 and rates of transmission high nationally, government has issued guidance on shielding for adults. https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Importantly, since the first wave, our knowledge of COVID-19 has grown. We now know that very few children and young people are at highest risk of severe illness due to the virus. This means that the National Guidance for children and young people issued December 21 is current at the time of writing and I hope that it is useful for you to review it here- https://www.rcpch.ac.uk/resources/covid-19-guidance-clinically-extremely-vulnerable-children-young-people

The RCPCH guidance sets out that the evidence gathered since the start of the pandemic indicates that the risk of severe disease caused by SARS-CoV-2 or Covid19 infection in children is extremely low and although no one group of conditions has been identified as being at particular risk, specialists have identified those conditions which may make the child or young person CEV as set out in group A list (see the list on the link). 

Group A
These children are usually CEV under normal (non-pandemic) circumstances, and at risk of severe disease due to a variety of infections which would result in mild disease in the majority of the population. 

Group B
Lists conditions that require discussion between the clinician and the child and their family/carer to establish whether they are clinically extremely vulnerable (CEV) on a case by case basis. This decision will depend on the severity of the condition and knowledge that the secondary and tertiary care clinical teams have of the particular circumstances of the child. Of note, the majority of children with conditions listed in Group B will not be CEV.

Group B Paediatric gastroenterology, hepatology and nutrition

Paediatric inflammatory bowel disease (IBD) patients who meet one or more of the following criteria:

• Commencement of biologic therapy plus immunomodulatory or systemic steroids within previous six weeks
• Moderate to severely active disease not controlled by moderate risk treatments who may require an increase in treatment

Intestinal failure patients requiring Home Parenteral Nutrition (HPN) who meet one or more of the following criteria:

• Primary immunodeficiency or immunodeficiency induced by drugs as part of their therapy.
• Other significant conditions or other organ involvement (renal, haematology, cardiac, GI, respiratory, diabetes mellitus)

Liver disease who meet one of more of the following criteria:

• Decompensated liver disease

Receiving post-transplant immunosuppression or on Liver/small bowel/multivisceral transplant waiting list

• Liver disease and other significant conditions or other organ involvement (renal, haematology, cardiac, GI, respiratory, diabetes mellitus)
• Active or frequently relapsing autoimmune liver disease where they are likely to need increase in treatment.

As far as I am aware, the guidance shared here for children has not been updated but of course it may be updated at any time. We understand that when a considerable proportion of the most vulnerable groups have been vaccinated, there is the prospect of relaxing some of the lockdown measures, but the vaccine time table according to Prof Chris Whitty reamins “realistic but not easy”.

Please get in touch if you hear further updates and we can share with members.

Sue Protheroe

President BSPGHAN 5th January 2021