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During the COVID-19 pandemic, one of BSR’s priorities has been helping to guide you on the management of your patients. With the emergence of two COVID-19 risk tools to help calculate vulnerability, we speak to Prof Karen Walker-Bone, Professor and Honorary Consultant in Occupational Rheumatology at the University of Southampton. Here she talks about the risk assessment tools, who they're for, and her advice to the rheumatology community.


Can you explain the two COVID-19 risk tools?

The COVID-19-age tool was developed earlier in the year and tells you how vulnerable a person may be to hospital admission and death if they got infected with COVID-19. It’s useful for employers to help them carry out a risk assessment for their employees in their workplace.


It’s a simple online tool where you can fill out the characteristics of the employee, such as their age, BMI, ethnicity, and medical conditions. It then calculates a risk rating to let you know how vulnerable the person is. 


The other tool is the QRISK tool for COVID-19 vulnerability, which was commissioned by Public Health England. QRISK tools are used all the time by GPs for conditions such as cardiovascular disease.


The QCOVID tool is available for use imminently. It’s a population-based risk algorithm using data derived from registers in UK primary care. As time's gone on, we've learnt more about the risk factors for vulnerability to the virus, like the significance of age, ethnicity and weight. These are all now factored into the risk models.


Who should be using these tools?

These tools are for workplaces, employers or GPs who don’t have the specialist knowledge across medicine. They use mass population data on common conditions like high blood pressure and obesity. But with conditions that are complex, for example rheumatoid arthritis taking a combination of DMARDS and biologics, these are yet to be featured in the tool


At the moment there aren’t enough rheumatology patients within the data. As we’ve been shielding many patients, they were less likely to get COVID-19 and get sick. This makes them look less vulnerable because they were following the guidance about shielding.


Employers and occupational health departments have had to make difficult decisions about who should be shielded and who shouldn’t be working in public-facing roles. Going forward, people have much more information and guidance to help them make those decisions.


What’s your advice to the rheumatology community?

When it comes to a patient with rheumatic disease under the care of a specialist, the rheumatologist’s knowledge about their individual patient surpasses both tools. These tools aren’t designed to compete with a doctor who has known their patient for years. That doctor’s knowledge is still much better than any guidance a tool can provide.


My message to the rheumatology community is that if the specialist feels that the patient is vulnerable, then that is still the most important decision.


What guidance should we be following?

The BSR risk stratification still stands. The only thing we possibly need to reflect on is whether we were perhaps a bit conservative about steroids. Emerging evidence suggests that even lower doses of steroids, for example above 10mg, may increase the individual’s vulnerability.


Is there other emerging evidence we need to consider?

The importance of patients having their condition under control. There’s evidence from other areas, such as Crohn’s disease, colitis, renal failure and diabetes, that if your condition is poorly controlled, you'll be more vulnerable to hospital admission and death from the virus.


For our community, it’s vital we don’t hold off actively giving disease-modifying drugs. Patients with active disease are more vulnerable, so we should still be as aggressive and positive about managing their condition as we always have been.


Thank you to Prof Walker-Bone for sharing her expertise. You can find more information about the latest guidance for rheumatology here. You can also access the COVID-Age tool and information on the QCOVID tool.