COVID-19: guidance for people whose immune system means they are at higher risk

Updated 13 November 2023

Applies to England

This guidance only applies to people living in England. There is separate guidance available for people living in Scotland, Wales and Northern Ireland.


The success of the COVID-19 vaccination programme has meant that the requirement for shielding and identifying people as clinically extremely vulnerable (CEV) is no longer necessary.

Most people who were part of this CEV patient cohort are no longer at substantially greater risk than the general population and are advised to follow the same guidance as everyone else on staying safe and preventing the spread of COVID-19 and other respiratory infections, as well as any further advice received from their healthcare professional.

However, there remains a smaller number of people whose weakened immune system means they may be at higher risk of serious illness from COVID-19, despite vaccination.

Enhanced protection measures, such as those offered by specific treatments or additional vaccinations alongside other protective behaviours, may benefit these individuals. This guidance is for those individuals who remain at higher risk.

This page contains information on:

  • who this guidance is for
  • keeping yourself safe
  • COVID-19 vaccines
  • COVID-19 treatments
  • COVID-19 testing
  • what to do if you test positive for COVID-19
  • what to do if you test negative for COVID-19 and still feel unwell

Who this guidance is for

Immunosuppression means you have a weakened immune system due to a particular health condition or because you are on medication or treatment that suppresses your immune system. People who are immunosuppressed, or who have specific other medical conditions, may have a reduced ability to fight infections and other diseases, including COVID-19.

Most people with immunosuppression will be under the care of a hospital specialist and/or known to their GP. As a result of this they will usually be eligible for either or both of:

  • additional vaccines including COVID-19 boosters

  • COVID-19 treatments

Further information on who is included in these groups of people is included in the sections on vaccination and treatments below. If you are in one of these groups, consider following the guidance below on keeping yourself safe.

Keeping yourself safe

The following advice on ‘keeping yourself safe’ is aimed at adults. Children and young people are recommended to continue to attend education, unless they are advised otherwise by their clinician. Attending education is hugely important for children and young people’s health and their future.

If you have been advised by the NHS that you are in one of these groups, you are advised to:

  • ensure you have had all of the vaccines you are eligible to receive
  • continue to follow any condition-specific advice you may have been given by your specialist

You are advised to try to avoid contact with people who have symptoms of COVID-19 or other respiratory infections. A detailed description of COVID-19 symptoms can be found in guidance for people with symptoms of a respiratory infection including COVID-19.

If you have visitors to your home, consider ventilating your rooms by opening windows and doors to let fresh air in. More advice on ventilating your home can be found on GOV.UK.

Consider asking visitors to your home to take additional precautions, such as keeping their distance. COVID-19 tests are no longer free for the general public, but you may wish to ask visitors to take a lateral flow device (LFD) test before visiting. You might also consider asking them to wear a face covering and you may want to wear a face covering yourself.

If it feels right for you, work from home if you can. If you cannot work from home, speak to your employer about what arrangements they can make to reduce your risk. It may be that you are entitled to a Reasonable Adjustment under the Equality Act. See Public health principles for reducing the spread of COVID-19 and other respiratory infections in the workplace

If you are too ill to work, you may be eligible for Statutory Sick Pay.

When out and about, you may want to try to keep your distance from others if that feels right for you, and consider reducing the time you spend in crowded spaces or anywhere that is enclosed or poorly ventilated. Wash your hands regularly and avoid touching your face.

Consider wearing a well-fitting face covering in crowded public spaces. Although face coverings are primarily worn to protect others, because they cover the nose and mouth, which are the main routes of transmission of the virus that causes COVID-19 infection, they may also provide some limited protection to the wearer.

Further advice about face coverings can be found in guidance on living safely with respiratory infections including COVID-19.

COVID-19 vaccines

If you have a weakened immune system due to a health condition or medical treatment, and you are aged 6 months or over, you are eligible for a COVID-19 vaccination this autumn if it has been at least 3 months since your last vaccination.

This is to help improve any protection you may have built from previous vaccination or infection.

By having a further dose of vaccine, you may reduce your chance of catching the COVID-19 infection. If you do catch COVID-19, the symptoms may be less severe and the illness shorter than if you had not had the extra vaccination.

Further information, including about those who may need an extra dose this autumn, is available. You should receive a letter inviting you to book. If not, check with your GP or specialist whether you are eligible.

The autumn campaign began on 11 September 2023 in England, with those with a weakened immune system being able to book from this date. Vaccination of residents in care homes also started on 11 September 2023.

How to book

Those eligible for a vaccine can book on the national system. It might help to take the vaccination invite letter, or an NHS letter describing your condition or treatment, or a repeat prescription slip with you.

If you can’t book online, phone 119 free of charge, 9am to 6pm Monday to Friday or 9am to 1pm Saturday and Sunday. You can ask someone else to do this for you. Please ensure you have your NHS number at hand. If you need an interpreter, use text phone 18001 119 or the NHS British Sign Language interpreter service.

The NHS strongly encourages those with a weakened immune system to take up their offer for the autumn 2023 COVID-19 vaccination as soon as possible to ensure they have the highest possible level of protection.

Further information on COVID-19 vaccinations is available on NHS.UK.

COVID-19 treatments

The NHS is offering treatments to those people with COVID-19 who are at highest risk of becoming seriously ill and who are aged 12 years or above. Not all treatments are suitable for people aged 12 to 17 years.

The list of eligible people who are offered these treatments is regularly reviewed and is available on the NHSE and GOV.UK websites. The list currently includes some people who have:

  • Down’s syndrome, or another chromosomal disorder that affects their immune system
  • certain types of cancer or have received treatment for certain types of cancer
  • sickle cell disease
  • certain conditions affecting their blood
  • chronic kidney disease (CKD) stage 4 or 5
  • severe liver disease
  • had an organ transplant
  • certain autoimmune or inflammatory conditions (such as rheumatoid arthritis or inflammatory bowel disease)
  • HIV or AIDS and have a weakened immune system
  • a condition affecting their immune system
  • a condition affecting the brain or nervous system, such as multiple sclerosis, muscular dystrophy, motor neurone disease, myasthenia gravis, Huntington’s disease, Parkinson’s disease or certain types of dementia
  • certain lung conditions or treatments for lung conditions

This list is a summary and does not cover everything.

If you were identified as being eligible for assessment for COVID-19 treatments before 27 June 2023, you will have been contacted by the NHS to make you aware of this.   

If you are newly eligible for assessment for COVID-19 treatments, (or become eligible) you will have been told about this (or will be told about this) by your doctor or specialist at the point that you were diagnosed with a qualifying condition or began a qualifying treatment. 

If you are unsure whether you are eligible, speak to your doctor or hospital specialist who can advise you.

Treatments for COVID-19 are most effective if they are started early (ideally within 5 days of you first developing symptoms). It is therefore important that you take a COVID-19 test as soon as possible if you develop symptoms so that you can access treatments early if you test positive for COVID-19. 

A broader group of patients (currently those aged 18 years and over, and with underlying health conditions) may also be able to take part in the PANORAMIC clinical study if they test positive for COVID-19 and are symptomatic.

COVID-19 testing

In England, patients eligible for COVID-19 treatments can access free LFD tests.

If you are eligible for COVID-19 treatments, please make sure you have a supply of LFD tests at home so that you can test yourself quickly if you develop symptoms of COVID-19. You can now obtain free LFD tests from your local pharmacy. You can also use tests you’ve paid for, for example, a test you’ve bought from a supermarket or pharmacy. Further information is available on NHS: Treatments for COVID-19.

Symptoms of COVID-19, flu and other respiratory infections include, among others:

  • a high temperature
  • unexplained tiredness or lack of energy
  • shortness of breath
  • a loss of, or change to, your normal sense of smell or taste

Test kits contain instructions and links to support those who need assistance in testing.

If you test positive

If you test positive, you should try to stay at home and avoid contact with other people. Further advice about staying at home can be found in guidance for people with symptoms of a respiratory infection including COVID-19.

If you are eligible for treatment, it’s important to start as soon as you can. To be effective, treatments for COVID-19 need to be given quickly after your symptoms start.

If your COVID-19 test result is positive, follow the information for accessing treatments in your area on the NHS COVID-19 treatments page.

If you test negative and you still feel unwell

If your test is negative but you still have symptoms, you should take another test on each of the next 2 days (3 tests in total over 3 days).

If you continue to feel unwell, you should seek healthcare advice via your GP or NHS 111. If it is an emergency, you should call 999.