Guidance

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

Updated 28 October 2020

Who this guidance is for

This guidance is for everyone who has been identified as clinically extremely vulnerable. If you are in this group, you will previously have received a letter from the NHS or from your GP telling you this. You may have been advised to shield in the past.

Introduction

This guidance has been updated to support the clinically extremely vulnerable in protecting themselves from exposure to coronavirus (COVID-19). It replaces previous guidance on shielding. The guidance is set out in 2 parts:

1. Updated advice on protecting the clinically extremely vulnerable, based on the local COVID alert level in your area. This advice is less restrictive than previous shielding advice.
2. Updated shielding advice that is more targeted and will only apply in some of the worst affected areas and only for a limited period of time. You are only advised to follow shielding advice if you receive a new written shielding notification.

What has changed

While previous shielding guidance helped protect those most at risk from COVID-19, many people reported that they found the advice very restrictive.

Since the introduction of shielding, many new measures have been introduced in our communities, including the rule of 6, COVID-secure workplaces, and the widespread use of face coverings, all of which have reduced the need for such restrictive shielding advice.

The government also has better data on new infections and has introduced local COVID alert levels, with rules and advice based on the level of risk in a local area. This updated guidance offers additional advice to the clinically extremely vulnerable over and above local COVID alert level guidance. This new guidance aims to strike a better balance between providing practical steps to help keep you safe while reducing some of the potentially harmful impacts on mental and social wellbeing that were associated with previous strict shielding. It sets out the steps clinically extremely vulnerable people can take to protect themselves at each local COVID alert level.

In the future, the government will only reintroduce formal shielding advice in the very worst affected local areas and for a limited period of time. This will only apply to some, but not all, very high alert level areas and will be based on advice from the Chief Medical Officer. The government will write to you separately to inform you if you are advised to shield. You are not advised to follow formal shielding advice again unless you receive a new shielding notification advising you to do so. From now, refer to the new local COVID alert levels for your area.

What level of advice should you follow

Check the COVID alert level of your local area or search by postcode.

If you are required to travel into an area at a different local COVID alert level (for example to go to work or school), you should follow the guidance for whichever area has the higher alert level. For example, if you live in a medium alert area but work in a high alert area, follow the work advice for local COVID alert level: high. If you live in a high alert area but work in a medium alert area, continue to follow the advice for high alert areas.

General advice for clinically extremely vulnerable people at all local COVID alert levels

These general principles apply at all local COVID alert levels. In addition to the rules you and your community must follow at each level, you can take additional precautions to protect yourself.

Socialising inside and outside the home

Continue to maintain strict social distancing, wash your hands regularly and avoid touching your face.

Try to keep the number of social interactions that you have low. The fewer social interactions you have, the lower your risk of catching COVID-19.

Continue to observe strict social distancing with anyone outside of your household or support bubble. The more you socially distance from others, the less likely you are to catch COVID-19. You do not need to maintain social distancing within your home with members of your household but should stay at least 2 metres away from other people visiting your home.

If the rules allow you to meet with others outside your household, your risk of catching COVID-19 is lower if you meet them outdoors. If you meet indoors, keep the area well ventilated with fresh air, for example by opening the window.

Try to reduce the amount of time you spend in settings where you are unable to maintain social distancing, or where other people’s activities may reduce the likelihood of individuals maintaining social distancing.

Work

Everyone is currently advised to work from home where possible.

If you need support to work at home or in the workplace you can apply for Access to Work. Access to Work will provide support for the disability-related extra costs of working that are beyond standard reasonable adjustments an employer must provide.

If you cannot work from home, you can still go to work. However, if you live or work in an area where formal shielding advice has been put in place, and you have received a new shielding notification informing you of this, we advise that you do not go to work.

Your employer is required to take steps to reduce the risk of exposure to COVID-19 in the workplace and should be able to explain to you the measures they have put in place to keep you safe at work.

Where employers are not managing the risk of COVID-19, the Health and Safety Executive (HSE) and local authorities will take action which can range from the provision of specific advice, issuing enforcement notices, stopping certain work practices until they are made safe and, where businesses fail to comply with enforcement notices, this could lead to prosecution.

If you have concerns about your health and safety at work you can raise them with your workplace union, the Health and Safety Executive or your local authority.

Consider how to get to and from work. If you need to use public transport, you must wear a face covering unless you are exempt. Consider travelling outside peak hours to reduce the number of people with whom you come into contact.

If you have concerns you can get advice on your specific situation and your employment rights by visiting the Acas website or calling the Acas helpline on 0300 123 1100.

School

The UK Chief Medical Officers have issued a statement on schools and childcare reopening which states that there is a very low rate of severe disease in children from COVID-19. Schools have their own measures in place to limit the risk of transmission which can be found in guidance on reopening of schools.

All pupils and students should continue to attend education settings at all local COVID alert levels unless they are one of the very small number of pupils or students under paediatric or other specialist care and have been advised by their GP or clinician not to attend an education setting.

Travel

If you need to travel, walk or cycle if you can. For longer journeys, or if you are unable to walk or cycle, try to minimise the number of people you come into close contact with. Travelling by car is likely to mean fewer social contacts than travelling by public transport. You should avoid sharing a car with people outside of your immediate household or support bubble.

Going to shops and pharmacies

Consider shopping or going to the pharmacy at quieter times of the day. You must wear face coverings in all shops unless you are exempt.

You might also want to ask friends, family or volunteers to collect medicines for you.

The NHS Volunteer Responders programme is available to help support those who need it. Volunteers can collect and deliver shopping, medication and other essential supplies. Call 0808 196 3646 between 8am and 8pm, 7 days a week to self-refer or visit www.nhsvolunteerresponders.org.uk for further information.

If you require additional care and support

Whatever the current local COVID alert level in your area, it is important that you continue to receive the care and support you need to help you stay safe and well. Providers of social care and medical services are making every effort to ensure services remain open and as safe as possible.

You should continue to seek support from the NHS for your existing health conditions. You can access a range of NHS services from home, including ordering repeat prescriptions or contacting your health professional through an online consultation. To find out more visit www.nhs.uk/health-at-home, or download the NHS App. If you have an urgent medical need, call NHS 111 or, for a medical emergency, dial 999.

It is also important to look after your mental health. Go to the Every Mind Matters website for advice and practical steps that you can take to support your wellbeing and manage your mental health during this pandemic. If you or someone you care for are experiencing a mental health crisis, we urge you to make contact with a local health professional immediately.

Any carers or visitors who support you with your everyday needs can continue to visit. They should follow social distancing guidance where close or personal contact is not required.

If your carer is a paid carer visiting you in your home, they will find information on the provision of home care and personal protective equipment (PPE) in the provision of home care guidance and PPE for care workers delivering homecare guidance. If you provide unpaid care, visit the Guidance for those who provide unpaid care to friends or family.

You should continue to access support from local charities and organisations, as well as NHS Volunteer Responders. As well as helping with shopping and medicines delivery, NHS Volunteer Responders can help with a regular, friendly phone call, either with someone else who has previously been advised to shield or with different volunteers and transport to medical appointments.

Call 0808 196 3646 between 8am and 8pm to arrange support or visit NHS Volunteer Responders website. Speak to your health care professional to arrange transport support.

Further advice at local COVID alert level: medium

Socialising inside and outside the home

At local COVID alert level: medium, when seeing friends and family you do not live with (or have formed a support bubble with) you must not meet in a group of more than 6, indoors or outdoors.

In addition, we advise clinically extremely vulnerable people to take extra precautions by strictly maintaining social distancing, meeting outside if possible, and keeping the number of different people they meet low.

You do not need to maintain social distancing with members of your own household.

Work and school

You should continue to work from home where possible.

If you cannot work from home, you can still attend your workplace as your workplace should be COVID-secure. The general advice on work has further details about what to do if you have concerns.

All pupils and students should continue to attend education settings at all local COVID alert levels unless they are one of the very small number of pupils or students under paediatric or other specialist care and have been advised by their GP or clinician not to attend an education setting.

Travel

There are no restrictions on travel at local COVID alert level: medium. We advise clinically extremely vulnerable people to limit journeys on public transport where possible.

Going to shops and pharmacies

We advise clinically extremely vulnerable people to consider shopping or visiting the pharmacy at quieter times of the day. You can further protect yourself by strictly observing good hand hygiene and maintaining social distancing as much as possible.

If you require additional care and support

At all times, you should continue to access the social care and medical services you need. Providers of these services are making every effort to ensure services remain open and as safe as possible.

You should continue to access the NHS services that you need, and you should contact the NHS if you have an urgent or emergency care need.

Further advice at local COVID alert level: high

Socialising inside and outside the home

At local COVID alert level: high, you must not meet with people indoors in any setting unless they are part of your household or support bubble. This includes private homes, and indoors in hospitality venues, such as pubs and restaurants.

You may continue to see friends and family you do not live with outside, including in a garden or other outdoor space. If you do so, you must not meet in a group of more than 6. In England, this limit of 6 includes children of any age.

At this alert level, our additional advice for clinically extremely vulnerable people is that you keep the number of different people you meet with low. The fewer people you meet, the less likely you are to catch COVID-19.

You are encouraged to continue to go outside with your household and/or support bubble because of the benefits of exercise. If you do choose to meet other households outside of your support bubble, this must be outside, must be in groups of less than 6 people and we advise you to keep the numbers low.

You do not need to maintain social distancing within your household.

Work and school

The advice is the same as for local COVID alert level: medium.

You should continue to work from home where possible. If you cannot work from home, you can still attend your workplace as your workplace should be COVID-secure. The general advice on work has further details about what to do if you have concerns.

All pupils and students should continue to attend education settings at all local COVID alert levels unless they are one of the very small number of pupils or students under paediatric or other specialist care and have been advised by their GP or clinician not to attend an education setting.

Travel

At local COVID alert level: high, all people are advised to minimise travel.

In addition, we advise clinically extremely vulnerable people to avoid travel where possible except for going to work, school, or for essential shopping.

If you need to travel, walk or cycle if you can. If this is not possible, travelling in a private car with your own household or bubble is generally lower risk than public transport because you are likely to come into contact with fewer people.

Going to shops and pharmacies

You are advised to reduce the number of shopping trips you make. If you do go to the shops, consider doing so at quieter times of the day.

Consider using online delivery slots for food shopping or ask friends and family to help deliver shopping or collect medicines for you.

If you need further assistance with food shopping, NHS Volunteer Responders may be able to help.

If you require additional care and support

You should continue to receive care at home, either from professional social care and medical professionals, or from friends and family within your support bubble.

You should continue to access the NHS services that you need, and you should contact the NHS if you have an urgent or emergency care need.

Further advice at local COVID alert level: very high

Socialising inside and outside the home

The rules at local COVID alert level: very high apply to everyone and state that you can only meet friends and family who are not in your household or support bubble in certain outdoor public spaces. You can find a list of these places in the local COVID alert level: very high guidance.

At local COVID alert level: very high, we still advise clinically extremely vulnerable people to continue to go outside for exercise, but to avoid busy areas to minimise the chance of coming into close contact with others. Otherwise, we advise you to stay at home as much as possible.

You may want to maintain social distance within your household if practical.

Work and school

Where at all possible you are strongly advised to work from home, because the rate of transmission of the virus in your area is very high.

If you cannot work from home, and are concerned about going into work, you may want to speak to your employer about taking on an alternative role or change your working patterns temporarily (for example, to avoid travelling in rush hour).

If there is no alternative, you can still go to work. Your employer is required to take steps to reduce the risk of exposure to COVID-19 in the workplace. Your employer should be able to explain to you the measures they have put in place to keep you safe at work.

Where some employers are not managing the risk of coronavirus, the Health and Safety Executive (HSE) and local authorities will take action which can range from the provision of specific advice, issuing enforcement notices, stopping certain work practices until they are made safe and, where businesses fail to comply with enforcement notices, this could lead to prosecution.

If you have concerns about your health and safety at work you can raise them with your workplace union, the Health and Safety Executive or your local authority.

All pupils and students should continue to attend education settings at all local COVID alert levels unless they are one of the very small number of pupils or students under paediatric or other specialist care and have been advised by their GP or clinician not to attend an education setting.

Travel

At local COVID alert level: very high, everyone may continue to travel to venues or amenities which are open, as well as for work or to access education. However, everyone should aim to reduce the number of journeys they make.

In general, we advise clinically extremely vulnerable people to stay at home as much as possible and avoid any travel into or out of a local COVID alert level: very high area.

Going to shops and pharmacies

You are advised to significantly reduce your shopping trips. Where possible, you should consider shopping online. If you do need to go to the shops, try to do so at quieter times and maintain strict social distancing.

You are advised to ask people in your household or support bubble to collect food and medicines for you. If you need more help with accessing food or medicines, NHS Volunteer Responder are still available to assist you.

If you require additional care and support

You should continue to receive care at home, either from professional social care and medical professionals, or from friends and family within your support bubble.

You should continue to access the NHS services that you need, and you should contact the NHS if you have an urgent or emergency care need.

We recognise that a small number of individuals may require additional support to follow the guidance at local COVID alert level: very high. Please contact your local authority if you need assistance. You can find the contact details by looking on your local council’s website.

Shielding

We may advise more restrictive formal shielding measures for the clinically extremely vulnerable in the worst affected very high alert areas, based on advice from the Chief Medical Officer. This will only apply to some very high alert areas, and the government will write to you separately to inform you if you are advised to shield. You are not advised to follow this revised shielding advice unless you receive a new shielding notification advising you to do so.

Further support will be made available from your local authority and community pharmacies to help protect you during this period of heightened risk.

Work

You are strongly advised to work from home because the risk of exposure to the virus in your area is significantly higher. If you cannot work from home, then you should not attend work.

If you cannot attend work for this reason, you may be eligible for Statutory Sick Pay (SSP) or Employment Support Allowance (ESA). The formal shielding notification you receive will act as evidence for your employer of the Department of Work and Pensions that you are advised to shield and may be eligible for SSP or ESA.

School

Clinically extremely vulnerable children are advised not to attend school, because the risk of exposure to the virus in your area is currently very high.

Your school will make appropriate arrangements for you to be able to continue your education at home.

Socialising

You can go outside, but try to keep all contact with others outside of your household to a minimum, and avoid busy areas.

You are advised to stay at home as much as possible.

You can still meet your support bubble, but you cannot meet with friends and family you do not live with unless they are part of your support bubble. This is part of the wider regulations in place in your area.

Try to stay 2 metres away from other people within your household, especially if they display symptoms of the virus or have been advised to self-isolate.

Travel

You are advised to stay at home as much as possible and not to travel unless essential.

Shopping

You are advised not to go to the shops. Use online shopping if you can, or ask others to collect and deliver shopping for you (friends and family, or NHS Volunteer Responders).

If you cannot access food, your local authority can offer support. You will receive further information about how to request support from your local authority in the shielding notification letter we will send to you if your area is advised to shield.

Medicines

You are strongly advised not to go to a pharmacy because the risk of exposure to the virus is significantly higher in your area.

If friends and family are not able to collect your medicines for you, then you will be eligible for free medicines delivery. Please contact your pharmacy to inform them that you are clinically extremely vulnerable and need your medicines delivered, and they will arrange this free of charge.

Care and support

You may be eligible for extra care and support from your local authority. You will receive further information about how to request support from your local authority in the formal shielding notification letter we will send to you if your area is advised to shield.

You can still receive informal care at home from people within your support bubble.

You can still receive care at home from professional social care and medical professionals.

If formal shielding is introduced in your area, we will write to you setting out how you can access support if you need it in order to follow advice, for example, support to access food, medicines deliveries, advice or any additional wellbeing or practical support you may need.

Definition of clinically extremely vulnerable groups

People who are defined as clinically extremely vulnerable are at very high risk of severe illness from coronavirus. There are 2 ways you may be identified as clinically extremely vulnerable:

1. You have one or more of conditions listed below, or
2. Your clinician or GP has added you to the Shielded Patient List because, based on their clinical judgement, they deem you to be at higher risk of serious illness if you catch the virus.

If you do not fall into any of these categories, and have not been contacted to inform you that you are on the Shielded Patient List, follow the general staying alert and safe guidance for the rest of the population.

If you think there are good clinical reasons why you should be added to the Shielded Patient List, discuss your concerns with your GP or hospital clinician.

People with the following conditions are automatically deemed clinically extremely vulnerable:

• solid organ transplant recipients

• 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 that 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
• people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
• people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)
• people on immunosuppression therapies sufficient to significantly increase risk of infection
• women who are pregnant with significant heart disease, congenital or acquired
• other people who 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