Where does brain injury sit in relation to the Covid-19 vaccination programme?

A poll by Calvert Reconnections indicates that the majority (61%) of case managers are unclear about where brain injury sits in relation to the Covid-19 vaccination programme and the high risk (clinically extremely vulnerable) and moderate risk (clinically vulnerable) categories.

Lorna Mulholland, Registered Manager at Calvert Reconnections, says there are clear contradictions between the Government, who fund the vaccination programme, and the NHS who are delivering it.

With more than 1 in 3 adults in the United Kingdom now vaccinated against Covid-19 one question remains unanswered. Where does acquired brain injury (ABI) sit in relation to the vaccination programme?

According to NHS Guidance, those who have a condition that affects the brain or nerves come under the heading of moderate risk (clinically vulnerable). Also included in this group are those with heart disease, individuals taking steroids, people with diabetes, lung, heart, kidney and liver disease. Similarly, people with a high risk of getting infections, obesity and pregnancy are incorporated.

This moderate risk group is advised that they will not receive a letter for their vaccination and need to continue to follow social distancing guidelines.

As the NHS is implementing the vaccination, should this guidance be listened to or should Government advice take priority?

Contrary to NHS guidance, the Government states that chronic neurological conditions are considered as high risk and are a priority for the vaccination programme. This publication states that severe neurological disability, conditions similar to motor neuron disease and epilepsy are just a few of many neurological conditions that are clinically extremely vulnerable and therefore require a vaccination as soon as possible.

Individuals with an ABI are often diagnosed with secondary conditions. When a person is diagnosed with an ABI the initial diagnosis takes precedence and there is the potential that secondary symptoms are lost in clinical notes, thus removing ailments from diagnosis statistics. This could make it almost impossible for clinical notes to collect the information and address the need to vaccinate patients with an ABI as a priority during the vaccination rollout programme. Following the guidance from NHS England, could we be leaving a highly vulnerable section of the population to fight an illness when they are not strong enough to do so?

According to 2018 data, there were 1.4 million people living with a brain injury in England. Symptoms or subsequent complications that can be caused by the injury include cognitive deterioration, behavioural changes which can include disinhibition, psychiatric symptoms and an alteration to their level of consciousness. These are all conditions which create a susceptibility for clients with an ABI to be vulnerable to catching and transmitting Covid-19.

Professionals who work with clients that are within this category understand the increasing concerns of individuals and families.

During a time when social isolation is the prescribed route; the behavioural, emotional, and psychological effects caused by the ABI are extremely more pronounced. One nurse has explained that some people with ABI cannot comprehend social distancing and are therefore at a higher risk of contracting Covid-19 and transmitting it. If schizophrenia and bipolar disorders are clinically extremely vulnerable due to a lack of capacity regarding distancing, those with an ABI should be too.

If chronic respiratory disease is a diagnosis that requires a vaccination to avoid mortality then persons affected by the ‘symptom’ of an inability to breathe or swallow effectively, should also be provided for. Should these clients accept NHS Guidelines?

A Professor of Neurosurgery; Peter Hutchinson, stated to one organisation that “I encourage all brain injury survivors and carers to get vaccinated at the earliest opportunity”.

There are clearly a multitude of contradictions between the Government, who fund the vaccination programme, and the NHS who are delivering it.

With the two main bodies unable to reach agreement and follow identical guidelines, the recommended course of action for anyone with an ABI is to seek the support of their GP in order to become prioritised for vaccination.

Lorna Mulholland, Registered Manager, Calvert Reconnections.