HIQA publishes the advice it submitted to NPHET on extremely medically vulnerable groups with respect to COVID-19

Date of publication:

Health Information and Quality Authority (HIQA) has today published the advice it submitted to the National Public Health Emergency Team (NPHET) to support its response to COVID-19. The publication of this advice is accompanied by a supporting evidence synthesis report.

The Health Protection Surveillance Centre (HPSC) and Health Service Executive (HSE) have categorised groups of individuals, who may be at highest risk of severe illness from COVID-19, as ‘extremely medically vulnerable’. NPHET asked HIQA to review the international evidence to determine if the current definition of what constitutes ‘extremely medically vulnerable’ in relation to COVID-19 is appropriate.

HIQA examined the evidence from scientific research studies as well as investigating the evidence used by international organisations to inform the classification of those at highest risk of severe illness from COVID-19. The most consistent finding was that those aged 70 years and older are at an increased risk of severe illness from COVID-19. For other patient groups, the current evidence is more limited, so a precautionary approach should continue to be adopted.

Dr Máirín Ryan, HIQA’s Director of Health Technology Assessment and Deputy Chief Executive, said: “The evidence identified in this scoping review does not currently support the removal of any of the groups categorised as ‘extremely medically vulnerable’. These groups should be extra vigilant and follow HSE Infection Prevention and Control Guidance due to the potentially increased risk of experiencing severe illness due to COVID-19.

However, it is important for individuals to consider their own level of risk. For example, adults aged 50 years and older with multiple chronic conditions, living under circumstances of increased deprivation are not included in the ‘extremely medically vulnerable’ category, but are at increased risk of severe disease if they develop COVID-19.”

HIQA advised NPHET on the need for clarity of communication regarding the groups listed as ‘extremely medically vulnerable’, particularly in relation to the criteria for being included within one of these categories.

HIQA is also publishing an international review of public health measures and strategies to limit the spread of COVID-19. With a resurgence of coronavirus cases across Europe and an increase in hospitalisations, many countries have renewed their public health policies and restrictions to limit the spread of COVID-19. HIQA examined the measures and strategies taken by 17 jurisdictions that were experiencing a second wave of coronavirus cases from October 2020.

The documents published today are available here.

Further information:
Marty Whelan, Head of Communications & Stakeholder Engagement
01 814 7480/085 805 5202, mwhelan@hiqa.ie

Notes to Editor:

  • HIQA has today published the following documents to inform NPHET’s response to COVID-19:
    • Advice to the National Public Health Emergency Team: What is the evidence underpinning the categorisation of ‘extremely medically vulnerable’ groups, who may be at risk of severe illness from COVID-19?
    • Review of the evidence for categorisation of ‘extremely medically vulnerable’ groups who may be at risk of severe illness from COVID-19.
    • An international review of public health measures and strategies to limit the spread of COVID-19
  • At the beginning of the pandemic, the HPSC and HSE identified people at higher risk from COVID-19. The two levels of higher risk are ‘very high risk’ (also called extremely vulnerable) and ‘high risk’. The composition of the categories was based upon Public Health England’s definitions, which were originally based on those groups at highest risk of complications from influenza. As the pandemic has progressed, the course of COVID-19 has been investigated and more evidence is becoming available on those at risk of severe illness.
  • HIQA’s scoping review identified five systematic and rapid reviews and 24 relevant primary research studies along with eight international organisations that cited evidence informing the categorisation of groups as being at risk of severe illness due to COVID-19.
  • Overall, evidence was identified for six of the eight groups listed by the HPSC and HSE as being ‘extremely medically vulnerable’ with the strongest evidence supporting the inclusion of those aged 70 years and older in the highest risk category. Evidence was not identified for people with rare diseases and inborn errors of metabolism or for pregnant women who have significant heart disease. Given the rarity of some conditions and the likely ongoing cocooning of certain patient groups which has reduced their exposure to SARS-CoV-2, an absence of evidence of severe COVID-19 in these conditions should not be interpreted as an absence of a true association.
  • Continued review of the international evidence as well as Irish data on morbidity and mortality is needed to update and refine the composition of the risk categories. This is particularly the case for diverse groups, such as those with respiratory conditions or who are taking immunosuppressant medications where the relative and absolute risk of serious illness from COVID-19 may differ substantially.
  • Since September 2020, HIQA has provided evidence based advice in response to requests from NPHET.
  • HIQA’s advice to NPHET is informed by research evidence developed by HIQA’s COVID-19 Evidence Synthesis Team, with expert input from HIQA’s COVID-19 Expert Advisory Group.
    • The topics HIQA researches are outlined and prioritised by NPHET to ensure that they have rapid access to the best available evidence relevant to the SARS-CoV-2 outbreak.
  • HIQA’s COVID-19 Evidence Synthesis Team produces a variety of outputs including rapid health technology assessments, scoping reports, rapid reviews of public health guidance, and evidence summaries, supplemented by an evidence-to-advice framework to guide the development of advice, where appropriate.
  • HIQA’s COVID-19 Expert Advisory Group is a multidisciplinary group, comprising nominated representatives from the relevant clinical specialties and areas of expertise, methodology experts, and public representation.