Risk Stratification Guidelines
Updated 29th May 2020
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Following the government's briefing on 22 March 2020, all high-risk patients are asked to isolate within their household until 30th June. The risk of developing severe COVID 19 disease is increased by the below factors. The extremely clinically vulnerable will encompass the high risk groups and also include other social groups in the community. See Uveitis CSG guidance if you are a doctor or patient information if you are a patient.
- Degree of immunosuppression
- Comorbidities, including cardiovascular disease, hypertension, COPD, asthma and diabetes mellitus
- Active systemic inflammatory disease activity
- Age 70 years or over
- BMI > 40
This flowchart from Leeds Teaching Hospitals NHS Trust helps doctors and their patients identify their risk level.
Guidance on social distancing, shielding and self / household isolation for people who are symptomatic of COVID 19 have all been updated. The stringency of shielding distancing recommendations have been relaxed.
For patients on immunosuppression, the British Society of Rheumatology have developed risk stratification criteria for high and moderate/low risks. The high-risk patient category for immunosuppression includes those patients fulfilling one or more of the following criteria:
i. Corticosteroid dose of ≥20mg (0.5mg/kg) per day for more than 4 weeks
ii. Any two agents among immunosuppressive medications biologic/monoclonal or small molecule including JAK inhibitors with a co-morbidity
iii. Cyclophosphamide (any route) within the last 6 months
iv. Corticosteroid dose or ≥5mg prednisolone plus another IMT.
Moderate Risk patients are those are well controlled on one IMT or two and no comorbidities. These patients only need to ‘shield'/ household isolate if other concerns or high risk circumstances. See the BSR risk stratification guidance:
British Society of Rheumatology Risk Criteria for People on Immunosuppression
Therapies which are not in a high risk category for infection are hydroxychloroquine, sulfasalazine, IVIg and intravitreal steroid implants