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What next for shielding after 30 June?

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Hi All,

I had a telephone consultation with my specialist a few days ago and raised the issue of what next for shielding after 30 June the date that the Public Health England advice runs to for all of us that are classified as extremely vulnerable.As we have been informed various forms of unlocking will take place in June in UK with different speeds for England ,Scotland, Wales and Northern Ireland;now we have the prospect of local lockdowns if hot spots emerge in the future.None of us are sure whether tkis are in any way mildly  immuno-suppressive and nor is it clear whether drugs like imatinib and dasatinib might act as a protector and be a very strong prophylactic to ward off the CV19 virus from affecting us.

My haematologist suggested that it would be useful to do an individual risk assessment and to then decide the extent to which one might continue to lockdown say until September or until the end of the year.I have gathered some data from the Horizon programme that appeared about a week or so ago on Covid 19 .First age and being in  my mid 70 s I am very much at risk (very few Covid related deaths occur in the under 45 s);being male increases the risk over being female by 2 .I am blood type O so that according to Chinese research is less risky than being in A group.It is the co- morbitities that are really interesting as NHS data so far places those with diabetes at a risk ratio of 2.3 above normal;obesity 2.25;stroke/dementia 1.75;cancer 1.6;heart issues 1.25 and asthma 1.25.Hypertension should be there somewhere also.The cancer figure includes all types and probably those on active chemo as well as those having been historically treated-so hopefully for CML we should not be at too much extra risk?

Two months ago I had my Vitamin D taken alongside the usual bloods and was found to be deficient but we have now rectified that and  am back to normal.I would strongly suggest that if you are going to have any bloods soon see if the VIt D test can be slipped in

.There are now some very interesting presentations coming up on You Tube on Vitamin D and Covid 19 and not being an immunologist will not attempt to go into great  detail.The immune system has innate and adaptive arms.Covid 19 being an enveloped virus initially as a pathogen attacks the cell membrane and if VIt D is down the innate arm is ill equipped to initially ward it off;on the adaptive arm it takes a while for the T and B cells to organise their defence and without a strong innate arm the response is a harsh one from the adaptive arm and the oft quoted  cytokine storm.Anyway that is how I understand it.

Some elements of a specific diet might help to build up Vit D such as oily fish,cod liver oil,sun grown portobello mushrooms  taken raw and egg yolks and then Vit D  fortified drinks like almond milk etc.However diet wont alone correct any deficiency it seems- only supplements and sun ( but more effective for some ethnic groups than others) .

I am going to continue my own risk analysis and as well stay out of circulation for some time yet.

If we have further advice after the end of June then no doubt we will adhere to it but if not what will you do?

Best wishes

John

 

Thank you, John. My summarisation of the situation would be exactly the same as yours.

I think the risk factors that you quote are entirely correct but not mutually exclusive and not mathematically additive. There may, for instance, be some crossover between diabetes and obesity. There are also some racial risk factors.

Nonetheless, I did discuss this with my consultant and she considered that being male, over 50 with diabetes were appreciable risk factors and thought that shielding would be appropriate having regard for all of the circumstances.

For my part, I have been taking rural walks without contact with people outside of my household. I think that weight control and exposure to the sun is important.

I would like to start swimming again after 30 June but I would continue to exercise considerable care.

The way I look at it the time since diagnosis has hampered life somewhat and I’ve decided not to let COVID add to an already stressful time. Of course I will keep 2 meters from people but I won’t be locked up like a hermit. Life wouldn’t be worth living for me to carry on this way. Just ensure you follow the distancing measures but don’t overly worry about COVID unless you have other underlying conditions. If someone told me 2 years ago I’d be diagnosed with Cancer and the world would be on complete lockdown I would have laughed, now the jokes on me haha.

Stay safe and carry on.

Alex