Hello All, thank you for taking the time to read and any thoughts would be appreciated! (Sorry this is a long one).

I work in a very busy cargo company and we have stations across the whole of the UK. With a company being the size that we are we have had a lot of people who initially fell into the vulnerable category and had to shield for 12 weeks.

A few weeks ago the shielding guidance changed and those that no longer fell into that category recieved a letter stating this, we as a company however have had them remain at home.

We are now starting to think about returning those people that have been shielding for the last 12 weeks and am looking for your thoughts please.

I know the situation currently remains in place until the 30th June that the highly vulnerable are to remain shielding, but, cannot find any guidance for those people who were high category but no longer are.

Although they are still classed as having a moderate risk of developing complications should they catch COVID, surely those that are no longer high risk can come back to work and would be covered with our COVID RA and measures put in place?

Have any of you found yourselves in this situation? I hope I have made myself clear!

Thank you Sam

The only real option you have from what youn describe is to ask permission to send a letter to thier GP asking if they are fit to undertake thier duties...you can ask specific questions about thier roles and if they can complete their current tasks/ duties in thier current clinical categorisation...if they need adjustments etc....you can't ask specifcally about thier condition but you can ask about how it affects working....from that you can make a plan to get them back in work with either in stages or making some adjustments...  I can send you over some guidance on basic OH case management which gives some standard letters to send..again you need PT consent to do it...PM me if you need anythuing else  :)

The BAME issue still has me scratching my head. There is currently no evidence (as far as I am aware) as to the reason the BAME groups are disproportionally affected by COVID. Many studies point to social economic reasons (the type of work they do, the closer family groups that have, they may use public transport more, they may distrust our systems, and therefore seek help later etc.). The latest I looked at, relating to Bangladeshi people suggested that it may be the higher rate of diabetes found in these communities, for example.

As such I would be worried about discrimination if I specifically targetted these groups without anyunderlying medical reason to single them out for specific controls. Obviously the other side of the coin is that we need to protect our workers, and if there is a reason to be more concerned this must overide other worries.

So (relating to this question) if anybody has more information regarding the higher death rates in BAME communities then please share them with me.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30228-9/fulltext

It isn't clear, more evidence from fiscal studies unit than medical risk research....not saying it isn't there I am just saying I look at medical risk rather than ethnanticity...some of the studies referenced in the news were about pregnancy in COVID-19 not necessarily specifically about BAME...in one report 56% of the cohort identified as BAME..hence the headline

I haven't fully digested this as it wasn't in my reading list before...but looks like more research..

https://www.rcpsych.ac.uk/about-us/responding-to-covid-19/responding-to-covid-19-guidance-for-clinicians/risk-mitigation-for-bame-staff

So my organisation takes a slightly different approach.

Those who are in the highly vulnerable category, or those employees living with someone in that category, have been told they should work from home.  If they can't then a discussion is to take place with line management around invoking family leave policies etc. 

Anyone in the vulnerable category, or living with someone in the vulnerable category has also been advised to continue to remain working from home.  Where they can't work from home or want to return to work, we have made an arrangement with our Occupational Health provider whereby those individuals will receive a medical based assessment which will inform us what measures we need to take to protect them at work.

Another level of confusion is appearing https://www.bbc.co.uk/news/health-53097676 BAME may be too broad a grouping for hospital related deaths arising from Covid-19.

Your ethnic background is a big factor in your risk of developing heart and circulatory diseases. Research funded by the BHF has shown that in the UK:

• People with South Asian (including people of Indian, Pakistani, Bangladeshi, or Sri Lankan) background may be more likely to develop coronary heart disease than white Europeans, and risk factors for coronary heart disease are also more prevalent in young South Asians
• People with African or African Caribbean background may be at higher risk of developing high blood pressure (hypertension) and having a stroke
• People with African, African-Caribbean and South Asian background more commonly have Type 2 diabetes than the rest of the population.

https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/behind-the-headlines/coronavirus/coronavirus-and-bame-patients

Basically (and sorry for hi-jacking this thread) I see no conclusive evidence that if I had a white British man, and a BAME British man of the same age, with the same life style, same job, same work culture and no medical concerns then the BAME British man is at any more risk of dying than the white British man.

Due to this I don't see how I could justify a specific risk assessment for a BAME based on nothing more than their skin colour. All the studies I have seen so far have hypothosised various reasons, but no genetic link (or otherwise) has been found (or even looked for, i think). The studies seem to suggest various increased risk factors within the BAME communities that may increase the risk (such as diabetes rates, obesity rates, heart disease rates), but nothing that suggest it is just based on which ethnicity they are born into.

The method described in this link is probably the best thing I have seen about managing COVID-19 risks so far. Tangible and seems to be backed up by reasonably reliable statistics https://alama.org.uk/cov...medical-risk-assessment/

It is from the Association of Local Authority Medical Advisors (ALAMA). I had never heard of them previously.

You state those of advanced age at at higher risk. Yet the statistics I have seen indicate that whilst a fatal outcome is more common in the elderly, the majority of these had some other health condition. Since it is  more common that as we age health conditions become more prevalent can we argue that it is essentially the age or more probably the higher incidence of the presence of other health issues that is the reason for the higher death rate? After all, there have been cases of the extemely elderly (in oue case over 100) who have survived COVID-19.

Another factor concerns me with the statistics and that is the real reason for the death. Someone who has tested positive to C19 dies from a heart attack due to an underlying heart condition. Can anyone state for certain which is the real cause of death, the heart attack or the infection? Might they have died anyway due to the heart attack even without the infection? I note that some statisticians are careful to state that the death was due to xx and they had also tested positive to C19. In other words they are not definitively attributing the death to C19. So how do we interpret the statistics? After all, more elderly die in hospital that those of younger age, even without C19.

To be fair, my BAME observations are redundant where I work as I feel we would not meet any diversity criterea. We have 85 workers, all of which are white. Of the 70 employed on the factory floor (or driving), we don't have a single female (although I missed the womens' march where they demanded more women on factory floors, FLT drivers, lorry drivers etc.) and only three of which that don't have british citizenship (Two Polish and 1 Estonian).

As such I am not in a situation that requires me to make that choice, so it is a lot easier for me to preach.

in carrying out a COVID 19 clinical personal risk assessment (i.e not for Non Medically Trained Staff)  the following factors are key:

• Age
• Ethnicity
• Biological Sex
• Disability
• Health conditions 
• Pregnancy

And as always being a man (biologically) increases the risk... :)