Response from Scotland CMO to British Liver Trust call for decompensated liver disease patients to be included in shielding advice

Posted on: 22nd May 2020

The British Liver Trust is campaigning to ensure that those with decompensated liver disease are included in the Government’s advice for 'extremely vulnerable' people and asked to shield from COVID19. As part of this work, we wrote to the Chief Medical Officers in each of the UK nations.

The Trust has now received a reply from the Scottish Government and this has confirmed that GPs and hospital clinicians in Scotland can provide those patients that they feel are extremely vulnerable with a letter indicating that they are in the highest risk group. These people can now get access to support from their local authority if needed.

As a result of this advice, the British Liver Trust has written to all clinicians in Scotland advising them of this change.

If you live in Scotland and have decompensated liver disease or are concerned that you are extremely vulnerable for other reasons and have not received a letter, please contact your doctor or specialist nurse.

The Trust has also responded to the CMO in Scotland and written again to government officials in England, Northern Ireland, Wales highlighting the worry and confusion that arises from the variation in practice across different parts of the UK, with regards to the shielding category. The British Liver Trust has asked for the development of a consistent approach to deliver equity of treatment and advice to liver patients across the UK, regardless of location. We think it is reasonable to expect the four nations to liaise on this and facilitate co-ordinated advice.

With new information and research emerging and novel data providing better evidence on the behaviour of coronavirus, we have also requested greater clarity on the process of evidence review being used to inform and adapt shielding guidance. The majority of shielding guidance was developed at the start of the coronavirus pandemic and we are now receiving many calls and queries from patients asking how long they will be asked to shield, and the evidence regarding risk that this is based on.

The shielding advice involves strict social isolation with no contact from the outside world beyond that absolutely necessary, until at least the end of June. We understand that his significantly impacts on quality of life, increases social isolation, and may have associated physical and mental health risks. It is therefore vital that the shielding advice is as evidence-based as possible now that more data on viral behaviour becomes available.

The Trust has sought advice from senior liver clinicians and they have acknowledged that patients with decompensated cirrhosis are vulnerable and high risk. The British Liver Trust is therefore advising that all patients with decompensated cirrhosis follow the shielding guidance even when it is not part of the formal guidance.

Professor Stephen Ryder, Medical Advisor to the British Liver Trust said, “Coronavirus is a new disease and we are still learning every day about the risks. There is very little published data relating to cirrhosis, however if you have severe liver disease or ‘decompensated cirrhosis’ I would advise that you are vulnerable and potentially at risk of suffering from severe complications if you're infected with the coronavirus.

If patients are concerned about their own situation, please contact your own liver specialist to obtain specific advice from them.”

The British Liver Trust Helpline is here for anyone affected by a liver condition. Call 0800 652 7330 between 10am and 3pm Monday to Friday (excluding bank holidays) or email (emails can be sent at any time and are answered during helpline hours).