This guidance represents the professional advice from the British Association for the Study of the Liver, British Society of Gastroenterology, British Transplantation Society, NHS Blood & Transplant and input from the British Liver Trust.
The patients in the groups below are advised to shield and should consult the government website for advice on what that entails:
1. Patients with chronic liver disease who are on immunosuppressants
Data: There are as yet no large enough datasets to support/refute this approach and thus this is based on clinical judgement.
2. Any patient with liver cirrhosis and decompensation or complication as defined by presence/recent history (within 12 months) of ascites, hepatic encephalopathy, hepatocellular carcinoma, variceal bleed or synthetic liver dysfunction
Data: This is supported by data from the COVID-HEP registry that indicates that patients with decompensated liver cirrhosis have an unadjusted mortality rate 5-28 times higher than patients with liver disease without cirrhosis.
3. Patients who are actively on the liver transplant waiting list or who have received a liver transplant
Data: This is supported by data from NHSBT that indicates that patients who have had liver transplant have an unadjusted mortality rate of 25%.
Shielding is for a patient’s protection rather than a legal obligation. The need for shielding can be flexed further on a case by case basis in consultation with your healthcare team.
Application of this guidance
There are 3 elements:
Categorisation as high vulnerability – the guidance above should clarify that. This should be notified to employers etc.
Recommended response to that categorisation – This is nationally set, under review and changing with updated guidance from PHE and the CMO. Recommendations are based on complex factors including the current national categorisation of the pandemic, geography, occupation, local and national disease prevalence, R rates, risk factors for exposure etc.
Patient choice – Based on the above, patients, with support from clinical teams, will need to make personal decisions about what they will then do. Issues to weigh up will include looking at other risk factors (such as age; any other pre-existing medical conditions, morbidities and concurrent medication; ethnicity, sex, BMI; smoking, alcohol etc); home and family circumstances including age range of others at home and nature of accommodation, the person’s mental health, overall wellbeing, employment status and financial position.