Coronavirus risk level advice for SID patients

Understanding your risk

Knowing your risk level will allow you to manage your risk and make decisions about going about your daily life.

Based on consensus view from immunology specialists, secondary immunodeficiency (SID) patients have been classified into two risk groups:

1.     An extremely vulnerable group (highest at-risk group)
2.     Moderate risk group

The guidance on who falls into which group is available at:
https://www.ukpin.org.uk/docs/default-source/default-document-library/ukpin_risk_stratification_covid19_finalac6baa9cd4eb6fe9b40eff00005026c1.pdf

For many people, it may not be the SID but co-morbidities that define their risk.

What are co-morbidities?

A co-morbidity is any other diagnosis that reduces the overall wellbeing of an individual.

What are the important co-morbidities in COVID-19?

  • Over 70 years of age
  • Diabetes mellitus
  • Any ‘significant’ pre-existing lung disease
  • Impaired kidney function
  • History of heart disease (heart failure, angina or heart attack)
  • Uncontrolled hypertension
  • Chronic liver disease

What is ‘significant’ lung disease’?

Significant or severe lung disease (bronchiectasis or COPD) encompasses:

  • People who use nebulised treatments.
  • Everyone who has severe or very severe airflow obstruction. This is measured using a breathing test called spirometry, where you blow out as hard as you can. If the amount of air you can blow out in one second is less than 50% of the normal range of values, then airflow obstruction is classed as severe. Severe or very severe airflow obstruction is sometimes described as GOLD grade 3 or GOLD grade 4.
  • People who are limited by breathlessness – this means that you can’t walk as fast as other people of your age owing to breathlessness. This may be described in clinic letters as an MRC breathlessness score of 3, 4 or 5.

  • People who have had to be admitted to hospital in the past because of an acute attack of the lung condition.

  • People who are on regular steroid tablets, called prednisolone, to treat their condition.

  • People who have oxygen therapy at home.

  • People who use non-invasive ventilation at home – using a mask connected to a ventilator, sometimes called BiPAP, to support their breathing at night.

Keep yourself up to date

It is important you keep up with the latest government advice at:  https://www.gov.uk/coronavirus

Frequently asked questions

How is COVID-19 spread?

The disease can spread from person to person through small droplets from the nose or mouth, which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets.

Am I specifically at risk of catching COVID-19 with my immune deficiency?

Having many immune problems does not specifically predispose you to increased risk of acquiring this type of viral infection; the risk comes from being exposed to it.

Are SID adults or children at greater risk of becoming very sick?

As indicated by the advice above, specific SID conditions and major health problems, as a consquence of SID, or as well as having a SID, are the major risk factors alongside increasing age.

I think I have COVID-19, what do I do?

Stay calm; the majority of people do not have severe disease.  Maintain household hygiene measures to protect those around you, but isolate yourself as much as possible.

Check your symptoms on 111.NHS.UK/Covid-19 or NHS 24 for the latest advice.

For most patients who are following basic measures of rehydration and medicine to lower temperature and who are improving, no further action will be necessary.  If you are not getting better check again with NHS111/24 and then contact your SID centre to see if they need to provide more specific advice.

I have a SID and think a household member has COVID-19, what do I do?

Stay calm; the majority of people do not have severe disease.  Maintain household hygiene measures to protect the person with a SID.  The current advice is to manage the person at risk somewhere else if possible (e.g. they go to a family member).  Where this is not possible e.g. a child with SID looked after by a parent with COVID-19, then minimising contact as much as possible, ensuring hand and household hygiene are key.

Check 111.NHS.UK/Covid-19 or NHS 24 for the latest advice.

If your family member is not getting better contact NHS111/NHS24 and follow their advice.

I think I have COVID-19 can I go to my Immunologist for review?

Access online 111.NHS.UK or NHS 24 and follow their advice. Contact your immunology centre by phone to update them if you are not getting better. Hospitals now have specific arrangements for receiving patients with suspected COVID-19 and these are outlined on NHS 111/24.  You should not be attending your immunology centre with suspected COVID-19.

Advice updated July 2021