Guidance

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

Updated 31 May 2020

What has changed

The government has updated its guidance for people who are shielding taking into account that COVID-19 disease levels have decreased over the last few weeks.

People who are shielding remain vulnerable and should continue to take precautions but can now leave their home if they wish, as long as they are able to maintain strict social distancing. If you choose to spend time outdoors, this can be with members of your own household. If you live alone, you can spend time outdoors with one person from another household. Ideally, this should be the same person each time. If you do go out, you should take extra care to minimise contact with others by keeping 2 metres apart. This guidance will be kept under regular review.

Read further information on schools and the workplace for those living in households where people are shielding. This guidance remains advisory.

Who this guidance is for

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

People who are clinically extremely vulnerable are at high risk of getting seriously ill from coronavirus (COVID-19). They should have received a letter advising them to shield or have been told by their GP or hospital clinician.

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 for support even if you do not need additional support right now

This guidance is still advisory. You will not be fined or sanctioned if you prefer to follow the guidance on staying alert and safe (social distancing). You may also choose to remain in your own home at all times if you do not feel comfortable with any form of contact with others. However, careful time outside in the fresh air is likely to make you feel better in yourself.

Clinically extremely vulnerable groups

Expert doctors in England have identified specific medical conditions that, based on what we know about the virus so far, place some people at greatest risk of severe illness from coronavirus. Disease severity, history or treatment levels will also affect who is in this group.

Clinically extremely vulnerable people may include:

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 disease (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.
7. Other people have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decisions.

More information about who has been classed as clinically extremely vulnerable is available on the NHS Digital website.

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

Check this is the right guidance for you

You are not clinically extremely vulnerable if:

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

If you are not clinically extremely vulnerable you should follow the guidance on staying alert and safe (social distancing).

Staying at home and shielding

People classed as clinically extremely vulnerable are advised to take additional action to prevent themselves from coming into contact with the virus. If you’re clinically extremely vulnerable, you’re strongly advised to stay at home as much as possible and keep visits outside to a minimum (for instance once per day).

This is called ‘shielding’ and the advice is now updated:

1. If you wish to spend time outdoors (though not in other buildings, households, or enclosed spaces) you should take extra care to minimise contact with others by keeping 2 metres apart.
2. If you choose to spend time outdoors, this can be with members of your own household. If you live alone, you can spend time outdoors with one person from another household (ideally the same person each time).
3. You should stay alert when leaving home: washing your hands regularly, maintaining social distance and avoiding gatherings of any size.
4. You should not attend any gatherings, including gatherings of friends and families in private spaces, for example, parties, weddings and religious services.
5. You should strictly avoid contact with anyone who is displaying symptoms of COVID-19 (a new continuous cough, a high temperature, or a loss of, or change in, your sense of taste or smell).

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 before you eat or handle food and always immediately when you return home
• 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 if you need any extra support, for example, having 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

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

If you’d like help with your shopping, NHS Volunteer Responders are also here for you. You can choose what products you want and when you want them, and an NHS Volunteer Responder will then pick up and deliver your shopping to you. They can also pick up prescriptions or any other essentials you need. Call 0808 196 3646 (8am to 8pm) to arrange volunteer support.

If you cannot get the help you need, the government can help by delivering essential groceries and support. For further information about how to get food and other essential supplies, please see the guidance on accessing food and essential supplies. 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.

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 COVID-19 (a new continuous cough, a high temperature, or a loss of, or change in, their normal sense of taste or smell). 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 you need support from a carer to leave the house, you can still meet one person from another household (ideally the same person each time).

If your main carer becomes unwell

Speak to your carers about back-up plans for your care in case your main carer is unwell 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 still:

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.

You and the rest of your family or household should try to follow this advice as far as you are able. There is no need for other members of your household to follow the shielding measures themselves.

If you do not want to be shielded

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

If you develop symptoms

If you have any of the symptoms of COVID-19, (a new continuous cough, a high temperature, or a loss of, or change in, your normal sense of taste or smell), you must self-isolate at home and arrange to have a test to see if you have COVID-19 – go to testing to arrange or contact NHS 119 via telephone if you do not have internet access

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 COVID-19. Your bag should include:

• details for getting hold of 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

The government has advised that those shielding can now spend time outdoors if they wish to do so. Despite these measures, however, continued social isolation, reduction in physical activity, and changes in routine can all contribute to increased 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.

Follow the advice that works for you in the guidance on how to look after your mental health and wellbeing during 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.

If you are receiving services for your mental health, learning disability or autism and are worried about the impact of isolation, contact your key worker, 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.

Staying mentally and physically active

There are simple things you can do that may help you 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

Spending time outdoors

You may now wish to go outside of your property to exercise, walk, or spend some time outdoors. If you do so, the best way to protect yourself is to:

• keep the number of visits outside to a minimum (for instance once per day)
• go on your own, or with members of your household. If you live alone, you can spend time outdoors with one person from another household (ideally the same person each time)
• go outside when there are fewer people around, such as early in the morning
• ideally spend time in open areas
• always keep a social distance of 2 metres
• take particular care to minimise contact with others
• do not share or exchange personal belongings (such as cups) with others
• avoid going into enclosed spaces and other households, shops and buildings
• spend as long as you feel comfortable outside
• if you would prefer not to spend time outside of your property, try spending time with the windows open to let in fresh air and get some natural sunlight or get out into any private space (such as a garden or balcony), 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.

NHS Volunteers are also available if you would like a friendly chat or just want someone to talk to. If you have been advised to shield or are self-isolating, or are caring for someone who is, you can call them to arrange volunteer support.

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

If you are 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:

• do not visit or provide care if you are unwell and make alternative arrangements for anyone you care for
• 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
• provide information to the person you care for about who they should call if they feel unwell and 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. Further information from Every Mind Matters

More information on providing unpaid care is available.

Additional advice for unpaid carers who are contacts of cases of coronavirus

If you are notified by the NHS Test and Trace that you are a contact of a person who has tested positive for coronavirus:

• you must self-isolate for 14 days
• follow the advice in this guidance
• do not provide any further care for the clinically extremely vulnerable person and inform them, and their GP or hospital doctor, that you are a contact of a coronavirus case

Advice for young carers supporting someone who is clinically extremely vulnerable

If you are a young carer supporting someone who is clinically extremely vulnerable, guidance for how you can help protect them is available.

Looking after your own wellbeing and physical health is very important during this time. There is more information and advice especially for young people at Rise Above and Young Minds.

Clinically extremely vulnerable 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 or those supporting people with special needs. 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.

Any assessment of a resident’s needs and subsequent decisions made must consider individual circumstances and ethical implications, ensuring that the resident is treated with respect so that their human rights, personal choices, safety and dignity are upheld.

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. Guidance on supporting children and young people’s mental health and wellbeing is available.

Work and employment for those who are shielding

If you usually work, you should talk to your employer as soon as possible if you:

• have been advised to start shielding
• think you might need to start shielding

You should make every effort to work from home and your employer is expected to help you to do this.

If you are unable to work from home, you should discuss and agree your options with your employer.

At times, it may be appropriate for you to take up an alternative role or adjust your working patterns temporarily.

Some employers may also be able to offer different types of leave. Beyond your statutory annual leave entitlement, this will be at the employer’s discretion.

If you were employed before 19 March 2020, you may be eligible for the Coronavirus Job Retention Scheme, under which you can be furloughed at 80% of your salary (maximum of £2,500 per month) up to the end of August after which time employers are paying an increased proportion of furloughed staff salaries until the furlough scheme ends, as currently planned, at the end of October.

Statutory Sick Pay is available as a safety net in cases where you are unable to work or to be furloughed under the Coronavirus Job Retention Scheme.

Employees have protections against unfair dismissal and may have certain entitlements around redundancy. It is breaking the law to discriminate, directly or indirectly, against anyone because of a protected characteristic such as age, sex or disability. Employers also have particular responsibilities towards disabled workers and those who are new or expectant mothers. Find out more about the rights you have at work.

To support the self-employed through the coronavirus outbreak the Government has announced the Self-employment Income Support Scheme.