Guidance on shielding for extremely vulnerable people

Posted June 10, 2020

Below is information for people who have received letters from their GP or hospital care team advising them to shield as they are considered to be at the highest risk from coronavirus (COVID-19).
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What is shielding

People considered to be at the highest clinical risk from coronavirus (COVID-19) received letters from their GP or hospital care team to inform them:

they should stay at home at all times
avoid all face-to-face contact for a period of at least 12 weeks

This is known as shielding.

Shielding guidance update

The Covid-19 virus still poses a high risk if someone who is shielding is exposed to it. However, infection levels in the community are now falling so the risk of exposure is significantly less than it has been.

As the risk is lower, on 8 June 2020 the Chief Medical Officer for Northern Ireland updated the guidance for those who are shielding.

People advised to shield can now go outdoors while maintaining strict social distancing:

with members of their household

if they live alone they can meet one person from another household (preferably the same person each time)

People who are shielding remain vulnerable and should continue to take precautions. It is still best to stay at home as much as possible.

People advised to shield

People who fall into the highest clinical risk group include:

solid organ transplant recipients
people with specific cancers:
people with cancer and are having chemotherapy
people with lung cancer and are having 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
people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
people with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)
people on immunosuppression therapies sufficient to significantly increase risk of infection
women who are pregnant with significant heart disease, congenital or acquired
people who have had a splenectomy

Those undergoing renal dialysis were added to the list on 23 April 2020, and Northern Ireland’s Chief Medical Officer decided that those with Motor Neurone Disease should also be considered to be extremely vulnerable. Those affected by these conditions should also follow the shielding advice.

This guidance may feel strict. But it is there to protect those who are at highest clinical risk and should be followed closely by those in this group.

Shielding is a severe intervention that may be difficult to follow for such a long period of time.

The additional benefit gained from shielding needs to be weighed against any impact on your mental and physical wellbeing from a significant loss of social contact and needing to stay in the home for a long period of time.

That is why you are not advised to shield unless it is absolutely necessary.

Other relevant conditions

A person’s immunity remains compromised for some time after finishing chemotherapy. If you have completed chemotherapy in the last 3 months, please contact your care team to discuss your circumstances.

People with metastatic cancer in the lungs could also be more vulnerable and therefore at highest clinical risk from COVID-19.

Vulnerability will depend on the type of cancer and treatments that you have had. If you have not received a letter from your GP, you should contact them, or your hospital care team, for advice.

Those who are currently on targeted therapies for lung cancer are also classed as the highest clinical risk.

If you have experienced any of these conditions, you should follow the advice on shielding, by staying at home as much as possible.

Shielding in the house and going outside

If you are shielding, it is still recommended that you stay at home as much as possible.

When you are outside your home, you:

should take extra care to minimise contact with others by keeping 2 metres apart, when you are spending time outdoors (ie not in other buildings, households or enclosed spaces).
should remain 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).
should remain vigilant when leaving home: washing your hands regularly, maintaining social distance and avoiding gatherings of any size.
should not attend any gatherings, including gatherings of friends and families in private spaces, for example, parties, weddings and religious services.
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).

You may also choose to remain in your own home at all times if you still do not feel comfortable going outside. When you are at home, you can continue to follow the previous advice by:

trying to spend time with the windows open to let in the fresh air
arranging spaces to sit and see a nice view (if possible) and get some natural sunlight
getting out into any private space, keeping at least 2 metres away from your neighbours and household members if you are sitting on your doorstep.

However, prolonged shielding can have detrimental effects on both physical and emotional well-being and time outside in the fresh air is likely to make you feel better in yourself.

Shielding letters

You should contact your GP or hospital care team, if you have not yet received a letter or been contacted directly by them, for the following reasons:

you think you fall into one of the categories of people considered to be at highest clinical risk
you are concerned your underlying condition makes you at risk of severe illness should you contract Covid-19.

You can discuss with them whether you should be added to the list.

In the meantime, continue to follow the social distancing guidance.

You should also contact your GP or hospital clinician if you think you have received a letter in error, to discuss how you can stay safe during this time.

In the meantime, you are strongly advised to follow the shielding advice and stay at home as much as possible, unless advised otherwise by a healthcare professional.

Concerns about shielding

If you have received a letter, you are strongly encouraged to follow the guidance it contains.

If you have any concerns/queries about the content of the letter you have received; your condition, or shielding, and what this might mean for you, please get in touch with your GP or hospital health professional.

If you have received a letter and subsequently fall ill from COVID-19, or any other condition, requiring treatment in hospital, you will still be treated as normal. You will not be denied any medical treatment because you are in the shielding group.

Support for those who are shielding

There is information and help available for those who are shielding as well as those people who are considered vulnerable. You can find information on how to get advice and help with things, including food shopping and medicines at:

https://www.nidirect.gov.uk/articles/coronavirus-covid-19-advice-vulnerable-people

Advice for vulnerable people

You can also get advice on a range on issues, including benefits, health services and looking after your mental health during this time at:

https://www.nidirect.gov.uk/campaigns/coronavirus-covid-19

Living with someone who is shielding

If you live with someone who has been identified as being at highest clinical risk, you should read and familiarise yourself with the shielding guidance below, and strictly follow social distancing guidance.

The rest of the household do not need to start shielding themselves. However, you should do what you can to support the person shielding to stay safe, and follow guidance on social distancing. In your home, those who are shielding should:

minimise the time spent in shared spaces (kitchen, bathroom and sitting areas) and keep shared spaces well ventilated;
aim to keep 2 metres (3 steps) away from others, and encourage others to sleep in a different bed where possible;
use separate towels from other people in the house and, if possible, use a separate bathroom from the rest of the household, or clean the bathroom after every use;
avoid using the kitchen when others are present, take their meals back to their room to eat where possible, and ensure all kitchenware is cleaned thoroughly.

If your family member is already getting health and care services and you have any concerns about the cared for person, you should contact their named worker who will be best placed to give advice and support. More information for carers can be found on the Department of Health’s website(external link opens in a new window / tab).

If you are a key worker, you may have concerns about social distancing at work. In such cases, you should discuss your circumstances with your line management and HR Department.

They will be best placed to advise on measures for your particular role and workplace at this time. This might include, for example, if there is scope to redesign your job, working pattern or location or to reduce your contact with others.

If you do not want to shield

The restrictions imposed by shielding are difficult, both for you and for your family members and/or carers. Public Health England has issued shielding guidance, strongly advising you to stay at home as much as possible. This is the safest thing to do to protect you from illness/complications of COVID-19.

This is guidance and whether you follow the guidance or not is a personal decision for you to make.

Before deciding, it is recommended you discuss the matter with your GP or hospital specialist and those that may provide care for you. This may be particularly relevant for patients who are receiving end of life care. Please do talk to somebody before you decide what to do.

If, having discussed the matter with your GP or hospital specialist, you decide not to follow the shielding guidance, you should still follow the same social distancing and hygiene measures as everybody else

Information for those not registered with a GP

The health service is making every effort to identify all individuals who should be on the highest clinical risk list.

The easiest way to make sure you get all the help you need is by registering with a GP, if you are not already registered.