Covid-19 messaging may be too focused on healthy people over 70, report warns

Eight groups categorised as ‘extremely medically vulnerable’

People who are over 70 are classified as “extremely medically vulnerable” but many are healthy. File photograph: iStock/Getty.

People who are over 70 are classified as “extremely medically vulnerable” but many are healthy. File photograph: iStock/Getty.


Messaging around Covid-19 poses a danger of “medicalisation” of older people who are in good health, a report by the State’s health watchdog has warned.

People who are 70 years and up are classified as “extremely medically vulnerable” to the virus but the Health Information and Quality Authority report notes a concern this risk may required “more nuanced communication”.

“There is a concern that the current broad approach results in a poor risk-benefit balance in those older adults who are otherwise healthy and in individuals for whom actions such as cocooning may have a significant negative impact on their wellbeing,” an expert advisory group which reviewed the evidence compiled for the report warns.

Conversely, the report says, less healthy people, such as those aged over 50 with multiple chronic conditions or living in deprivation are at increased risk of severe disease, “yet this risk may not be sufficiently acknowledged”.

Cocooning is recommended for those categorised as ‘extremely medically vulnerable’ but the report says this has implications for wider society.

For example, they may need to be facilitated to work at home, which presents challenges for workforce planning. “They may also be advised to reduce or limit social interactions, leading to significant social isolation if implemented over a prolonged period of time.”

Eight groups in the population, who may be at highest risk of severe illness from Covid-19, are categorised as “extremely medically vulnerable”. Public health officials asked Hiqa to review this definition in the light of international evidence.

The categories include those aged 70 and over, organ transplant recipients, many cancer patients, People on immunosuppression therapies sufficient to significantly increase risk of infection. people with severe respiratory conditions, rare diseases or who are on immunosuppression therapies, pregnant women with significant heart disease and those on dialysis.

The watchdog found the most consistent finding in international studies was that those aged 70 years and older are at an increased risk of severe illness from the virus. For other patient groups, current evidence is more limited, so a precautionary approach should continue to be adopted.

“The evidence identified in this scoping review does not currently support the removal of any of the groups categorised as ‘extremely medically vulnerable’,” according to Dr Máirín Ryan, Hiqa’s director of health technology assessment.

These groups should be extra vigilant and follow HSE infection prevention guidelines 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,” Dr Ryan said.

There is a 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, according to Hiqa.

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