Haemophilia Scotland has been working to establish who in our community are being advised to take additional precautions in relation to coronavirus (COVID-19).
The Scottish Government has provided us with the following information about who should be considered to be in which risk category. Since we received that the legally enforceable lockdown has started meaning that everyone has now been asked to isolate. However, apart from that, we believe the general advice to still be appliable. We have asked for further clarification in relation to children with ports and lines.
Those at high risk: anyone who has a liver or other transplant due to the immunosuppressant medication they will be taking. This group will be contacted next week with some advice, but are strongly encouraged to self-isolate.
Those at increased risk (but not in the high-risk category):
- Anyone with hepatitis c who has not achieved a sustained viral response (SVR)
- Anyone who has achieved SVR following treatment, but has liver cirrhosis
- Anyone with hepatitis b
- Anyone who is HIV positive with a CD4 count less than 350/mm3
- Anyone with other risk factors, such as being aged over 70 years old or pregnant or who is offered the annual flu jab for any other reason
For those who are coinfected with hepatitis c and HIV, they should focus on the HIV advice above.
Anyone in any of these categories does not need to completely self-isolate (although obviously can if they feel more comfortable doing so), but should carefully follow government and NHS Inform advice on social distancing to minimise their risk of infection.
Those not in any of these categories:
- Anyone who had HCV, but has achieved SVR and doesn’t have cirrhosis
- Anyone who has HIV, but with a CD4 count>350/mm3 and an undetectable viral load
People in these categories should follow the general public health advice on minimising risk but are not at particular risk if they contract covid-19. Advice from HCV experts is that previous treatment (such as interferon) is not known to impact on people’s risk from covid-19.
We expect some members of the Scottish bleeding disorders community to receive copies of the letters about to be sent by the Government to all those at increased risk offering additional advice and support.
The Scottish Government has also acknowledged that the routine monitoring required by those at increased risk of liver cancer as a result of their contaminated blood or blood products infected with hepatitis C is a higher priority than many other routine screening appointments. This is because of the need to pick up any tumours before they are too large to be operable or for someone to be eligible for a transplant. We are, therefore, hopeful this will be taking into consideration when decisions are made about what the NHS does and does not continue to do as services are prioritised to maximise the resources available to treat coronavirus patients.
Updated: 24 March 2020
Updated Guidance on Shielding from NHS Inform 14 May
Practical guidance for the in‐hospital management of PWH published in Haemophilia 13 May 2020
(COVID-19) – Important advice for people with chronic liver disease 6 April 2020
Port-a-cath, central lines and COVID-19 1 April 2020
COVID-19 Shielding impact and experience survey – Scotland – 11 June