Safety of the AstraZeneca Vaccination

Recently, there have been reports of a very rare condition involving blood clots and unusual bleeding after vaccination. Although this condition remains extremely rare there appears to be a higher risk in people shortly after the first dose of the AstraZeneca (AZ) vaccine.

Around 4 people develop this condition for every million doses of AZ vaccine doses given. This is seen slightly more often in younger people and tends to occur between 4 days and 2 weeks following vaccination. This is being carefully reviewed but the risk factors for this condition are not yet clear.

This condition can also occur naturally, and clotting problems are a common complication of COVID-19 infection. An increased risk has not yet been seen after other COVID-19 vaccines but is being carefully monitored.

Following advice from the Joint Committee on Vaccination and Immunisation (JCVI), we will be offering people under 30 who have not yet had their first COVID-19 vaccination, a choice of vaccine other than AZ. If you choose to have an alternative vaccine you may have to wait to be protected. You may wish to go ahead with the AZ vaccination after you have considered all the risks and benefits for you.

This leaflet from Public Health England provides more information about the benefits and risks of the AZ COVID-19 vaccination.

If you have already had a first dose of AZ vaccine without suffering a blood clot as a side effect, you should have your second dose. This includes people aged 18 to 29 years who are health and social care workers and unpaid carers.

The benefits of the AstraZeneca Covid-19 vaccine outweigh any risks for the vast majority of people and you should still book your COVID-19 vaccine when asked to do so.

Click this link: Healthier Together

This week, updated guidance has been issued on calling pregnant woman to receive their COVID-19 vaccination. It has been agreed that all pregnant women will be called for vaccination, according to their age cohort unless they are in a higher risk category.

The Royal College of Obstetricians has a decision aid you can read: Decision Aid

Community midwives are reassuring pregnant women of the safety of being vaccinated while pregnant

If women have spoken to a midwife and/or GP and are still undecided, they can be still be referred to the antenatal clinic where necessary.

Additional guidance from JCVI regarding this updated guidance will arrive on Tuesday.

To everyone in Bristol, North Somerset and South Gloucestershire (BNSSG),

As we reach a critical point in the country’s fight against coronavirus, we want to share a big thank you for continuing to do everything you can to protect yourselves and our communities; and to update you on the latest from your local health and care services.

This week, we had news of a new mutation of the Kent variant of the virus locally. The cluster of cases is being further investigated by our Local Authorities and Public Health England. The best way we can all respond is to continue to follow national guidance. Safe behaviours such as regular hand washing, wearing a face covering and social distancing give us the very best chance of minimising risk and preventing the spread of the virus.

This national lockdown is having a positive effect, with the number of new cases starting to fall. While this is reason to be optimistic, services remain under considerable pressure. Increased demand on our hospitals mean we are now supporting more people to move into the community or return home for their ongoing recovery. Community and social care services are stretched; and GP surgeries are prioritising their most urgent patients.

As well as following the national guidance, we are asking people to ‘help us help you’, by:

• Being ready to support your loved ones home from hospital as soon as they are well enough to leave.
• Not putting aside any health concerns you have. GPs (doctors) continue to provide appointments for urgent issues, such as potential signs of cancer. Your local pharmacist can offer support for a range of minor conditions.
• Clicking or calling 111 when you need urgent care and are unsure of what to do. Our Emergency Departments are very busy, and we have less space in our waiting rooms than we did before the pandemic. The 111 First service is staffed by clinicians, and will ensure you get to the right service for your needs, faster.

Family support is particularly vital at this time. We know the best bed is your own bed in terms of ongoing recovery and retaining independence. If you have a loved one being admitted to hospital, please start preparing for their discharge at the outset. Clinicians will be on hand to support you, and have the conversations you need about rehabilitation and recovery.

Finally, we are pleased to be making great strides with coronavirus vaccination – our way out of the pandemic. 140,000 people in BNSSG have now received their first dose, and every care home in our area has been offered the vaccination. You can find out more about the local roll-out here, and the NHS will be in touch with you when it’s your turn to be vaccinated.

It’s also really important that in these extraordinary circumstances we remember to be kind and support one other. The next page of this letter highlights the further support available to you, including the mental health and wellbeing resources available at this time.

Thank you – on behalf of the Executives in Healthier Together

Thank you for all you’ve done so far and here’s how to continue helping us, to help you:

• If you start to experience any coronavirus symptoms, including a new continuous cough, a high temperature or a loss or change in your sense of smell or taste, you should book a test as soon as possible. You can also get a test for someone you live with if they have symptoms.
• Tests can be booked at https://www.gov.uk/get-coronavirus-test or by calling 119. You can order a home test kit if you cannot get to a test site. If you’re getting a test because you have symptoms, you and anyone you live with must self-isolate until you get your result. This also applies to anyone in your support bubble (where someone who lives alone, or just with their children, can meet people from one other household).
• Having flu and coronavirus at the same time more than doubles the chances of people dying from coronavirus. The flu vaccine is a safe and effective way to protect yourself against catching flu. If you are in an eligible priority groupyou can access a flu vaccine free through your GP practice or pharmacy.
• Your mental health and wellbeing is important, and there is support available for you locally:
  • The VITA 24/7 helpline can help you with emotional support. The line connects you with a mental health counsellor and relevant groups in your local area. Call 0800 012 6549 (textphone users should dial 18001 followed by 0800 0126549). Translators are available.
  • The AWP Mental Health 24/7 response line is there for adults or children under the care of AWP and worried about their own or someone else’s mental health: 0300 303 1320
  • SilverCloud is a free online platform offering valuable mental health and wellbeing support: https://bnssg.silvercloudhealth.com/onboard/
  • Bump2baby wellbeing helps you find the right support during pregnancy, birth and beyond: bump2babywellbeingguide.org

• If you’ve been notified that you that you have a medical condition which makes you clinically extremely vulnerable to coronavirus, please register your details at the following website: https://www.gov.uk/coronavirus-shielding-support You can use this service to get access to priority supermarket deliveries or ask for someone to contact you about other local support.
• If this does not apply to you but you still feel you require support, please get in touch with your local authority using the contact details below. You can also contact them if you have any other questions or concerns:
  • Bristol: We are Bristol: 0800 694 0184
  • North Somerset: North Somerset Together: 01934 427 437
  • South Gloucestershire: 0800 953 7778
• If you are receiving care in your home, including district nurses, therapists and support workers, and need to discuss your needs, please call: 0300 125 6789.
• Remember: if you are experiencing domestic abuse, household isolation rules do not apply. You are allowed to leave your home and NextLink can provide support and accommodation. Call 0800 4700 280 (24/7) or go to: nextlinkhousing.co.uk

Over the next few weeks Connexus practices (Birchwood Medical Practice, Nightingale Valley Practice, Priory Surgery, Stockwood Medical Centre and Wells Road Surgery) will be receiving large amounts COVID-19 vaccine.  In order to minimise impact on our day-to-day service we will be running joint clinics for our patients from Stockwood Medical Centre and Riverside Surgery.

We will contact you by text or phone to book an appointment if you are in our eligible cohort.  

Getting vaccinated is so important in our fight against COVID-19.  Good uptake of the vaccine is our best chance of staying well, avoiding hospital admission and severe illness, and life returning to normal.  Please work with us and accept your offer of a COVID-19 vaccine at one of our vaccine hubs and attend your appointment when booked.

• A number of patients have recently reported to practices that they have received phone calls from a company claiming to be the National Immunisation Management System (NIMS), asking for details about their COVID-19 vaccination.
  
  
• We've bene advised that this is very likely a scam call, so please inform your patients accordingly if you hear of this happening.

• Please be advised that the surge testing in five postcode sectors in South Gloucestershire is going to be extended until Sunday 14 March. This is in order to maximise the opportunity for eligible residents to take part should they wish. The target postcode areas remain the same.
  
  
• The two existing testing facilities in Stoke Gifford and Patchway will remain in place for the remainder of the programme and the five community-based collect & drop sites will remain open. Home delivery will also be an option for those unable to attend a site.
  
  
• As you know, the surge testing was put in place following the identification in the area of a COVID-19 variant of concern first identified in Manaus, Brazil. Through extensive enhanced contact tracing work, Public Health England and South Gloucestershire Council have identified a small contained group of contacts around the confirmed cases of the Brazilian variant. While the risk to the community of ongoing transmission remains low, the surge testing programme will allow us to identify any cases of asymptomatic COVID-19 in the targeted areas. All positive PCR tests undertaken in these areas during the surge period are being sent for further genomic sequencing to identify the specific variant of the virus present.
  
  
• For further details please visit the South Gloucestershire web page.

We are getting lots of enquiries requesting early Covid -19 vaccination from patients or the families of patients who have illnesses that do not meet the criterial for call for vaccination before their age-group.

A higher age remains the greatest risk factor for getting more severe effects from Covid-19 infection. The current system is based on prioritizing those most at risk for early vaccination, that is for vaccination before they would otherwise become eligible for vaccination due to their age: this is set centrally by the government and set-out in the  JCVI Green Book.

There is some clinical discretion in decision making, but where there is clear central guidance then local vaccination decisions are required to be based on that central guidance.

We are getting lots of enquiries requesting early Covid -19 vaccination from patients or the families of patients who have asthma.

The current system is based on prioritising those most at risk for early vaccination, that is for vaccination before they would otherwise become eligible for vaccination due to their age: this is set centrally by the government and set-out in the  JCVI Green Book.

There is some clinical discretion in decision making, but where there is clear central guidance then local vaccination decisions are required to be based on that central guidance.

For asthma, this guidance is that the patients who are prioritised for early vaccination are those who require continuous or repeated use of systemic steroids or who have had a previous hospital admission for an exacerbation of asthma. Inhaled steroids are not considered systemic steroids even if some absorption might have a small systemic effect, therefore, for these patients, it is not a criterion for higher priority for vaccination.

The government has also used a more sophisticated risk score called Q-Covid for identifying those who are at the very highest risk (Clinically Extremely Vulnerable). We hope it is reassuring to note that this shows that the score for risk (adjusted hazard ratio) for asthma is 0.84-0.97 that is below the average risk of 1.0, which shows that people with asthma generally do not have increased risk of severe disease from asthma.

Individuals with a learning disability (internationally referred to as individuals with an intellectual disability) are those who have:

• a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), with;
• a significantly reduced ability to cope independently (impaired adaptive and/or social functioning), and;
• which is apparent before adulthood is reached and has a lasting effect on development. 

Learning disability is different from a specific learning difficulty (such as dyslexia), or autism or a mental health condition.  Some people have all of these and also have a learning disability. (Courtesy of R Snow-Miller National Transformation Lead for LeDeR)

In Bristol, North Somerset and South Gloucestershire we are using special medical system searches which go beyond the Green Book, offering the COVID-19 vaccine to people with mild, moderate, severe and profound learning disabilities as part of the Priority Group 6 vaccination rollout, if they have not already been offered it as part of an earlier cohort.  This does include more people than the exact definition in the Green Book but we have agreed that this cohort of our population is a priority. Invitations should be sent by the GP. People should not contact the NHS.

Although chronic neurological conditions are included in Cohort 6 this does not mean that all chronic neurological conditions are included, and currently ME /CFS is not a specified condition within that guidance.

We are currently being told that ME/CFS is not included in Cohort 6.

It may be that this changes, as we know some of the ME/CFS support organisations are lobbying for the inclusion of ME/CFS.

Even if this does change, it is likely that people will have to demonstrate severe functional impairment, as well as ME/CFS, to be included in a cohort which is not simply age related.  

The Clinical Reference Group of the BNSSG Vaccination Programme has requested further urgent clarification for this cohort.

 Why have I received this letter?

NHS England had used a risk assessment tool called QCOVID to calculate peoples risk of getting COVID.  This is a complex tool that looks at a variety of different factors to assess peoples’ risk.  Because you have received this letter, you are one of the patients identified by the tool as being at high risk if you were to get COVID.  You can see all the information your GP received here.

What in my medical records has caused me to be added to this list?

Unfortunately, your GP surgery has no current way of replicating the analysis that has been done by NHS Digital and so we are unable to tell you why you have been added to this list.  This situation may change over time, but we have no way of knowing when.

What should I do now?  Should I go to work?  Should I go out?

You should follow the advice detailed here.  This will mean that you need to take extra measures above and beyond those which you probably have been taking.  The guidance covers:

• Social activities
• Work
• Educational settings
• Travel
• Shopping
• Medicines
• Accessing care and support
• Registering for additional support

You may be eligible for additional support and should be able to receive statutory sick pay for time off from work.

What about vaccination?

If you are under 65 you should be prioritised for vaccination ahead of others in cohort 6 which is people who are at risk because of a variety of medical conditions.  If you are over 65 you will have already been in group 5, so this won’t affect the priority with which you’re given the vaccine.

What if I think they’ve added me incorrectly?

At the moment, the best way to review this is through discussion with your GP.  Please bear in mind that GPs are incredibly busy at the moment vaccinating patients as well as trying to provide as normal a service to patients as possible.  Because of this it may not be possible to immediately deal with enquiries about this and you may be asked to submit your details in an online form. 

Do I have to follow this guidance?

Patients at high risk of severe outcomes from COVID-19 infection are strongly encouraged to follow shielding guidance. However, this is advice, and not the law. Patients can choose whether or not they want to follow it.

Why on earth am I only now being identified as high risk?

This tool has only just been approved for use in assessing patients risk of COVID 19.  Until now we haven’t had sufficient scientific evidence to run population-based tools that can accurately assess peoples risk of developing COVID.

(Shared from Primary Care Pathways)