{"id":2144,"date":"2020-09-16T09:23:35","date_gmt":"2020-09-16T09:23:35","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=2144"},"modified":"2020-09-23T09:52:00","modified_gmt":"2020-09-23T09:52:00","slug":"on-clinical-vulnerability-during-covid-19","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2020\/09\/16\/on-clinical-vulnerability-during-covid-19\/","title":{"rendered":"On \u201cclinical vulnerability\u201d during COVID-19"},"content":{"rendered":"

Blog entry written on: ‘Asthma and COVID-19: a review of evidence on risks and management considerations’<\/em><\/a> (bmjebm-2020-111506)<\/p>\n

Authors: Jamie Hartmann-Boyce, James Gunnell, Jonny Drake, Afolarin Otunla, Jana Suklan, Ella Schofield, Jade Kinton, Matt Inada-Kim, F D Richard Hobbs, Paddy Dennison<\/em><\/p>\n

\n

Not all reasonable assumptions prove true. At the beginning of the COVID-19 pandemic all people with asthma were considered at higher risk of severe infection \u2013 in other words, they were vulnerable<\/em><\/a>. COVID-19 is a respiratory illness, and people with asthma tend to be at higher risk of respiratory infections more generally.<\/p>\n

However, in our recent review, \u201cAsthma and COVID-19: a review of evidence on risks and management considerations 10.1136\/bmjebm-2020-111506\u201d, we found that though some studies suggest asthma is indeed a risk factor, others show the opposite, or show no relationship. This could be genuine, or because of problems with the studies, or could reflect differences in asthma severity in the populations studied, as risk appears higher<\/a> in people with more severe asthma.<\/p>\n

Despite this uncertainty, not <\/em>identifying asthma as a vulnerability at the outset of the pandemic could have been viewed as violation of the precautionary principle<\/a>. But months into the pandemic, with the evidence still unclear for people with milder forms of asthma, we need to recognise that harm from this pandemic is not just from acute infection. Labelling someone as \u201cvulnerable\u201d comes with side effects which are difficult to quantify, but present none-the-less.<\/p>\n

Because of pre-existing conditions, some people are making difficult choices, and turning down opportunities. Since I\u2019ve been working on rapid reviews of the evidence on long-term conditions and COVID-19<\/a>, people living with asthma<\/a> and diabetes<\/a> have reached out to me asking what they should do. Should a doctor return to work? Should an undergraduate leave university? Should a child return to school? I\u2019m not a clinician and those aren\u2019t decisions I can advise on, but as someone with type 1 diabetes who also falls into this \u201cclinically vulnerable\u201d category, I can relate. The hard decisions people with pre-existing conditions have made and will continue to make in this pandemic will have ripple effects. I don\u2019t want to imagine a scenario where people with long-term conditions are perpetually anxious to engage in the world around them<\/a> \u2013 and those around them are missing out on all they contribute.<\/p>\n

I hope that when we apply the precautionary principle to risk stratification in COVID-19, we are thinking not just about the harms of infection, but the potential unintended impacts of labelling someone as \u2018vulnerable\u2019. And I hope we do something to mitigate these impacts, which will vary based on individual context and societal factors, and will intersect with the profound health inequalities<\/a> this pandemic has, once again, highlighted. Health inequalities in COVID-19 are related to existing inequalities in chronic diseases<\/a>; as such inequalities have an important role in determining who is clinically vulnerable in the first place.<\/p>\n

As well as vulnerability to infection, all people with long-term conditions are vulnerable in another way – to disruptions to the healthcare systems that keep us alive. Fortunately, these disruptions can be managed and mitigated. Unfortunately, they are often not. Universal healthcare (for me, the NHS) means that even if I\u2019m not seeing my GP as much, I\u2019m still accessing essential medications. In other parts of the world if people with long-term conditions lose their jobs due to the COVID-19 recession<\/a> \u2013 or because they have to care for children during school closures<\/a> – \u00a0they may also lose their healthcare<\/a>. <\/u>\u00a0Losing jobs can mean losing inhalers<\/a>, losing insulin<\/a>. \u00a0We can be vulnerable to diseases, and we can be vulnerable to systems. Science is doing all it can to fight this disease. Let\u2019s focus on fixing the systems while we\u2019re at it.<\/p>\n

\"Hand<\/a><\/p>\n

\n

Jamie Hartmann-Boyce, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford<\/p>\n

Conflicts of interest: none to declare<\/p>\n

\"Image<\/a><\/p>\n

\n

DISCLAIMER<\/b><\/p>\n

The views and opinions expressed on this site are solely those of the original authors. They do not necessarily represent the views of the BMJ and should not be used to replace medical advice. All information on this blog is for general information, is not peer-reviewed, requires checking with original sources and should not be used to make any decisions about healthcare. No responsibility for its accuracy and correctness is assumed by us, and we disclaim all liability and responsibility arising from any reliance placed on such commentary or content by any user or visitor to the Website, or by anyone who may be informed of any of its content. Any reliance you place on the material posted on this site is therefore strictly at your own risk.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Blog entry written on: ‘Asthma and COVID-19: a review of evidence on risks and management considerations’ (bmjebm-2020-111506) Authors: Jamie Hartmann-Boyce, James Gunnell, Jonny Drake, Afolarin Otunla, Jana Suklan, Ella Schofield, Jade Kinton, Matt Inada-Kim, F D Richard Hobbs, Paddy Dennison Not all reasonable assumptions prove true. At the beginning of the COVID-19 pandemic all people […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":405,"featured_media":2145,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14414,14375,14415,14351],"tags":[],"class_list":["post-2144","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-asthma","category-bmj-ebm-spotlight","category-covid-19","category-ebm"],"yoast_head":"\nOn \u201cclinical vulnerability\u201d during COVID-19 - BMJ EBM Spotlight<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2020\/09\/16\/on-clinical-vulnerability-during-covid-19\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"On \u201cclinical vulnerability\u201d during COVID-19 - BMJ EBM Spotlight\" \/>\n<meta property=\"og:description\" content=\"Blog entry written on: ‘Asthma and COVID-19: a review of evidence on risks and management considerations’ (bmjebm-2020-111506) Authors: Jamie Hartmann-Boyce, James Gunnell, Jonny Drake, Afolarin Otunla, Jana Suklan, Ella Schofield, Jade Kinton, Matt Inada-Kim, F D Richard Hobbs, Paddy Dennison Not all reasonable assumptions prove true. 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