Guidance

Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19

Updated 18 May 2020

Background and scope of guidance

This guidance is for people who are clinically extremely vulnerable, including children. It’s also for their family, friends and carers.

People who are clinically extremely vulnerable should have received a letter telling them they’re in this group or been told by their GP.

It’s for situations where a clinically extremely vulnerable person is living at home, with or without additional support. This includes clinically extremely vulnerable people living in long-term care facilities for the elderly or people with special needs.

If you have been told that you’re clinically extremely vulnerable, you should:

• follow the advice in this guidance
• register online even if you do not need additional support now

Symptoms of coronavirus (COVID-19)

The most important symptoms of coronavirus (COVID-19) are recent onset of any of the following:

• a new continuous cough
• a high temperature
• a loss of, or change in, your normal sense of taste or smell (anosmia)

If you have any of the symptoms above you should self-isolate at home.

Who is ‘clinically extremely vulnerable’?

Expert doctors in England have identified specific medical conditions that, based on what we know about the virus so far, place someone at greatest risk of severe illness from COVID-19.

Clinically extremely vulnerable people may include the following people. Disease severity, history or treatment levels will also affect who is in this group.

1. Solid organ transplant recipients.

2. People with specific cancers:
   • people with cancer who are undergoing active chemotherapy
   • people with lung cancer who are undergoing radical radiotherapy
   • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
   • people having immunotherapy or other continuing antibody treatments for cancer
   • people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
   • people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs

3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD).

4. People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell).

5. People on immunosuppression therapies sufficient to significantly increase risk of infection.

6. Women who are pregnant with significant heart disease, congenital or acquired.

People in this group should have been contacted to tell them they are clinically extremely vulnerable.

If you’re still concerned, you should discuss your concerns with your GP or hospital clinician.

Check this is the right guidance for you

If you are not clinically extremely vulnerable.

• you do not have any of the conditions that makes you clinically extremely vulnerable
• you have not been told by your GP or specialist that you’re clinically extremely vulnerable or received a letter

You should follow the guidance on staying alert and safe (social distancing)

Staying at home and shielding

If you’re clinically extremely vulnerable, you’re strongly advised to stay at home at all times and avoid any face-to-face contact to protect yourself.

This is called ‘shielding’ and the advice is:

1. Do not leave your house.
2. Do not attend any gatherings, including gatherings of friends and families in private spaces, for example, family homes, weddings and religious services.
3. Strictly avoid contact with someone who is displaying symptoms of coronavirus (COVID-19).

The Government is currently advising people to shield until 30 June 2020 and is regularly monitoring this position.

Handwashing and respiratory hygiene

There are general principles you should follow to help prevent the spread of airway and chest infections caused by respiratory viruses, including:

• wash your hands frequently with soap and water for at least 20 seconds or use a hand sanitiser. Do this after you blow your nose, sneeze or cough, and before you eat or handle food
• avoid touching your eyes, nose, and mouth with unwashed hands
• cover your cough or sneeze with a tissue, then throw the tissue in a bin
• clean and disinfect frequently touched objects and surfaces in the home

Register for support

Everyone who has received a letter advising that they are clinically extremely vulnerable should register online. This will enable support to be provided to you if you need it, for example, essential groceries delivered to your home.

Register even if:

• you do not need support now
• you’ve received your letter from the NHS

Register for support

• register online
• call 0800 028 8327

Have your NHS number with you when you register. This will be at the top of the letter you have received letting you know you are clinically extremely vulnerable or on any prescriptions.

Letters to clinically extremely vulnerable people

The NHS in England has contacted clinically extremely vulnerable people to provide further advice.

If you have not received a letter or been contacted by your GP but you’re still concerned, you should discuss your concerns with your GP or hospital clinician.

Help with food and medicines if you’re shielding

Ask family, friends and neighbours to support you and use online services.

If you cannot get the help you need, the government can help by delivering essential groceries and support. It may take time for support offered through this service to arrive. If you have not received a letter from the NHS then you may not be able to receive the support offered through this service. If you urgently need food or care, contact your local council.

Getting your prescriptions

Prescriptions will continue to cover the same length of time as usual.

If you do not currently have your prescriptions collected or delivered, you can arrange this by:

1. Asking someone who can pick up your prescription from the local pharmacy (this is the best option, if possible).
2. Contacting your pharmacy to ask them to deliver your prescription to you or to help you find a volunteer (who will have been ID checked) to deliver it.

You may also need to arrange for collection or delivery of hospital specialist medication that is prescribed to you by your hospital care team.

If you receive support from health and social care organisations, such as having care provided for you through the local authority or health care system, this will continue as normal.

Your health or social care provider will be asked to take additional precautions to make sure that you are protected. The advice for formal carers is included in the home care provision.

Visits from essential carers

Any essential carers or visitors who support you with your everyday needs can continue to visit unless they have any of the symptoms of coronavirus (COVID-19). Essential carers coming to your home should follow advice on good hygiene: wash their hands with soap and water for at least 20 seconds on arrival to your house and often while they are there (or use hand sanitiser), avoid touching their face, catch any coughs or sneezes in a tissue (or their sleeve), and put used tissues immediately in the bin and wash their hands afterwards. They should keep 2 metres away where close or personal contact is not required and where this is possible.

If your main carer becomes unwell

Speak to your carers about back-up plans for your care in case your main carer is unwell and/or needs to self-isolate.

You should have an alternative list of people who can help you with your care if your main carer becomes unwell. You can also contact your local council for advice on how to access care.

Living with other people

The rest of your household do not need to start shielding themselves, but they should do what they can to support you in shielding and to carefully follow guidance on staying alert and safe (social distancing).

At home you should:

1. Minimise the time other people living with you spend in shared spaces such as kitchens, bathrooms and sitting areas, and keep shared spaces well ventilated.

2. Keep 2 metres (3 steps) away from people you live with and encourage them to sleep in a different bed where possible. If you can, use a separate bathroom from the rest of the household. Use separate towels from the other people in your house, both for drying yourself after bathing or showering and for hand-hygiene purposes.

3. If you share a toilet and bathroom with others, it’s important that they are cleaned every time after use (for example, wiping surfaces you have come into contact with). Consider drawing up a rota for bathing, with you using the facilities first.

4. If you share a kitchen with others, avoid using it while they’re present. If you can, take your meals back to your room to eat. If you have one, use a dishwasher to clean and dry used crockery and cutlery. If this is not possible, wash them using your usual washing-up liquid and water and dry them thoroughly. If you are using your own utensils, remember to use a separate tea towel for drying these.

5. Everyone in your household should regularly wash their hands with soap and water for 20 seconds, avoid touching their face and clean frequently touched surfaces.

Encourage the rest of your family or household to follow the advice as far as they are able. There is no need for them to follow the shielding measures themselves.

If you do not want to be shielded

Shielding is for your personal protection. It’s your choice to decide whether to follow the measures we advise.

For example, if you have a terminal illness, or have been given a prognosis of less than 6 months to live, or have some other special circumstances, you may decide not to undertake shielding.

This will be a deeply personal decision but we advise calling your GP or specialist to discuss this.

If you develop symptoms

If you think you have symptoms of coronavirus (COVID-19), seek clinical advice using the NHS 111 online coronavirus service or call NHS 111. Do this as soon as you get symptoms. Do not visit the GP, pharmacy, urgent care centre or a hospital but if you need treatment, hospitals are still there to support and advise you.

In an emergency, call 999 if you’re seriously ill. Explain that you are clinically extremely vulnerable to coronavirus and are likely to get very unwell.

Prepare a single hospital bag. This will help the NHS provide you with the best care if you need to go to hospital as a result of catching coronavirus (COVID-19). Your bag should include:

• your emergency contact
• a list of the medications you take (including dose and frequency)
• any information on your planned care appointments
• things you would need for an overnight stay (for example, medication, pyjamas, toothbrush and snacks)
• your advanced care plan (only if you have one)

Hospital and GP appointments if you’re shielding

Everyone should access medical assistance online or by phone wherever possible.

However, if you have a scheduled hospital or other medical appointment during this period, talk to your GP or specialist to ensure you continue to receive the care you need and determine which of these appointments are absolutely essential.

Your hospital may need to cancel or postpone some clinics and appointments. You should contact your hospital or clinic to confirm appointments.

Looking after your mental wellbeing

Social isolation, reduction in physical activity, unpredictability and changes in routine can all contribute to increasing stress.

Many people, including those without existing mental health needs, may feel anxious. Reasons for increased anxiety may include potential effects on support with daily living, ongoing care arrangements with health providers, support with medication and changes in daily routines. It is important that you take care of your mind as well as your body and that you get further support if you need it.

If you’re receiving services for your mental health, learning disability or autism and are worried about the impact of isolation, contact your key worker or care coordinator or provider to review your care plan. If you have additional needs, contact your key worker or care coordinator to develop a safety or crisis plan.

Understandably, you may find that shielding and distancing can be boring or frustrating. You may find your mood and feelings are affected and you may feel low, worried, anxious or have problems sleeping, and you might miss being outside with other people. Follow the advice that works for you in the guidance on how to look after your mental health and wellbeing during coronavirus (COVID-19). At times like these, it can be easy to fall into unhealthy patterns of behaviour which in turn can make you feel worse.

Constantly watching the news can make you feel more worried. If you think it is affecting you, try to limit the time you spend watching, reading or listening to media coverage of the outbreak. It may help to only check the news at set times or limit this to a couple of times a day.

Try to focus on the things you can control, such as where you get information from and actions you can take to help you feel prepared. The Every Mind Matters page on anxiety and NHS mental wellbeing audio guides provide further information on how to manage anxiety.

If you’re still struggling after several weeks and it’s affecting your daily life, contact NHS 111 online. If you have no internet access, you should call NHS 111.

Staying mentally and physically active

There are simple things you can do that may help, to stay mentally and physically active during this time such as:

• you can find free 10 minute workouts from PHE or other exercise videos to try at home on the NHS Fitness Studio
• spend time doing things you enjoy such as reading, cooking, other indoor hobbies or listening to favourite radio programmes or watching TV
• try to eat healthy, well-balanced meals, drink enough water, exercise regularly, and try to avoid smoking, alcohol and drugs
• try spending time with the windows open to let in the fresh air, arranging space to sit and see a nice view if possible, and get some natural sunlight or get out into any private space, keeping at least 2 metres away from your neighbours and household members at all times

Staying connected with family and friends

Use support you might have through your friends, family and other networks during this time. Try to stay in touch with those around you over the phone, by post or online.

Let people know how you would like to stay in touch and build that into your routine. This is also important in looking after your mental wellbeing and you may find it helpful to talk to them about how you are feeling.

Remember, it is OK to share your concerns with others you trust and in doing so you may end up providing support to them, too. Alternatively, you might want to try an NHS recommended helpline.

Unpaid carers who provide care for someone who is clinically extremely vulnerable

If you’re caring for someone who is clinically extremely vulnerable, there are some simple steps that you can take to protect them and to reduce their risk.

Ensure you follow advice on good hygiene:

• only provide care that is essential
• wash your hands when you arrive and often, using soap and water for at least 20 seconds or use hand sanitiser
• cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
• put used tissues in the bin immediately and wash your hands afterwards
• do not visit or provide care if you are unwell and make alternative arrangements for their care
• provide information to the person you care for about who they should call if they feel unwell, how to use NHS 111 online coronavirus service and leave the number for NHS 111 prominently displayed
• find out about different sources of support that could be used; further advice on creating a contingency plan is available from Carers UK
• look after your own wellbeing and physical health during this time. See further information from Every Mind Matters

More information on providing unpaid care is available.

People living in long-term care facilities, for the elderly or people with special needs

This guidance also applies to clinically extremely vulnerable people living in long-term care facilities. Care providers should carefully discuss this advice with the families, carers and specialist doctors caring for such people to ensure this guidance is strictly adhered to.

Parents and schools with clinically extremely vulnerable children

This guidance also applies to clinically extremely vulnerable children in mainstream and special schools. If you live with a child who is clinically extremely vulnerable you should try to follow the advice on living with other people and you should continue to have physical contact to provide essential care. See guidance on supporting children and young people’s mental health and wellbeing.