Certain health and demographic factors mean some people are more likely to develop and/or suffer serious consequences from COVID-19. These include age, sex, ethnicity, where you live, deprivation, occupation and medical conditions.
This guidance will mainly focus on medical conditions, or “co-morbidities”, that place people at greater risk of severe illness from COVID-19. However, we also have a briefing on the role of ethnicity in COVID-19 health and safety.
What health conditions put people at increased risk?
Early on in the pandemic, the government and NHS placed people with health conditions that put them at increased risk from COVID-19 into two categories:
- clinically extremely vulnerable – people who fall into this category were asked to “shield”; and
- clinically vulnerable – people who fall into this category were asked to follow physical distancing guidance particularly stringently.
These have since been replaced with the Shielded Patient List – a record of vulnerable patients thought to be at high risk of complications from COVID-19.
The initial lists were based solely on co-morbidities, but this was subsequently updated and expanded with the COVID-19 population risk assessment. This combines a number of factors such as age, sex registered at birth, ethnicity, body mass index (BMI) and specific health conditions and treatments to estimate the risk of a person catching coronavirus and becoming seriously unwell.
Those who are on the Shielded Patient List and therefore clinically extremely vulnerable will have previously received a letter from the NHS or their GP telling them of this.
Vaccines and immunocompromised people
Evidence suggests that the COVID-19 vaccines do not work as well in people who have a medical condition which means their immune system doesn’t function optimally and those who take medication that suppresses their immune system.
A coalition of patient organisations has warned that many immunocompromised or immunosuppressed people have not been informed that they may still be more vulnerable to COVID-19 after they have been vaccinated, and that awareness of this issue among employers and the general public is also low.
This is another reason why employers need to have effective control measures in place to mitigate the risk of COVID transmission, and not rely on vaccination as the main control measure.
What can employers do to keep vulnerable people safe?
Governments in England, Scotland, Wales and Northern Ireland each have their own guidance for vulnerable people in the workplace. Now that shielding arrangements have ended, they all provide broadly similar advice.
It is important that employers take steps to ensure that those who are at increased risk are protected. Despite many legal restrictions having been relaxed, employers still have a duty to protect their staff
Employers must carry out a COVID-19 risk assessment, in consultation with union representatives, and implement measures to reduce risk to the lowest level reasonably practicable.
The assessment should have particular regard to whether the people doing the work are vulnerable to COVID-19, and everyone should benefit from the highest standards of protection.
Employers should make this as easy as possible for people to follow physical distancing measures, for example by ensuring they can continue to work from home. In England, the UK government is no longer advising people to work from home where possible. The governments in Scotland, Wales and Northern Ireland continue to advise that those who can work from home should do so. Nevertheless, this is an effective way to reduce the risk of vulnerable people being exposed to the virus.
If those who are extremely clinically vulnerable cannot work from home, the government says they should be offered the option of the safest available on-site roles that enable them to adhere to physical distancing guidelines. It may be appropriate for clinically extremely vulnerable individuals to take up an alternative role or adjusted working patterns temporarily.
Additionally, many clinically vulnerable employees will qualify as disabled for the purposes of the Equality Act, and continued homeworking may be a reasonable adjustment.
Employers should also consider those who live with clinically extremely vulnerable individuals when they are arranging work and schedules.
One-to-one conversations between workers and their line managers will help managers understand how the risks and mitigation measures affect those who report into them. Workers may require additional support and reassurance that their safety is a priority. This should provide an opportunity to discuss workers’ wider geographical, social and economic contexts that may place them at a higher risk.