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'No evidence' to support removal of any groups from category at highest risk of severe Covid-19

A HIQA report has advised public health officials that the evidence for including over 70s in the highest risk category for Covid-19 is strong.

ADVICE GIVEN TO the National Public Health Emergency Team (NPHET) has identified no evidence to support the removal of any group from the category that are considered “extremely medically vulnerable” to risk of severe illness from Covid-19.

Individuals under the “extremely medically vulnerable” category were advised earlier this year to cocoon to protect themselves against Covid-19.

The Health Information and Quality Authority (HIQA) provided a report to NPHET in November, released today, on “evidence underpinning the categorization of extremely medically vulnerable groups who may be at risk of severe illness from Covid-19″.

HIQA said there was strong evidence supporting the inclusion of people aged 70 and older in the highest risk category for Covid-19.

The groups of society that were categorised as extremely medically vulnerable in Ireland were based on the definitions made by Public Health England, where the groupings were originally guided by looking at groups at highest risk of complications from influenza.

HIQA said that “as the pandemic has progressed, the course of Covid-19 has been investigated and more evidence is becoming available on those at risk of severe illness”. 

Reviews and studies examined by HIQA consistently reported a significantly increased risk of severe illness in people aged 70 or over.

“Evidence was available for six of the eight groups listed by the HPSC and HSE as being ‘extremely medically vulnerable’ with the strongest evidence supporting the inclusion of those aged 70 years and older in the highest risk category.” 

HIQA observed that there was pooled evidence on patients with cancer were inconclusive, but that the most consistent finding among studies of cancer patients was that those receiving chemotherapy were at a significantly increased risk of severe illness due to Covid-19 compared to those who are not on chemotherapy.

People with severe respiratory conditions, people on immunosuppression therapies that significantly increase risk of infection, and patients with end-stage renal failure or undergoing dialysis are at significantly increased risk of severe illness from Covid-19, according to a small number of primary studies that have been carried out.

HIQA noted that those studies have consistent findings, but that the small number of studies and their designs meant that the results should be interpreted cautiously.

People with rare diseases and inborn errors of metabolism and pregnant women with significant heart disease are also included in the extremely medically vulnerable group.

HIQA said that evidence was not identified from systematic or rapid reviews or primary studies for people with those conditions to be included in the category – however, it said that “given the rarity of some conditions and the likely ongoing cocooning of certain patient groups which has reduced their exposure to SARS-CoV-2, an absence of evidence of severe Covid-19 in these conditions should not be interpreted as an absence of a true association”.

The report has recommended that a framework outlining the process that occurs if risk categorisations are changed should be established.

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