Shielding and protecting the extremely vulnerable from coronavirus

The information in this article should provide guidance for those who are extremely vulnerable to more severe illness from coronavirus and what NHS England and Public Health England are asking you to do at this stage.
timeline for guidance around shielding

If you are fit and well you should be following the new rules set by the Government on the 01 June 2020 to stay alert and safe.

The government has updated its guidance for people who are shielding taking into account that coronavirus COVID-19 infection rates have decreased significantly over the last few weeks. This guidance remains advisory.

People who are shielding remain vulnerable and should continue to take precautions but may now choose to leave their home, as long as they are able to maintain strict social distancing. If you choose to spend time outdoors, you may do so with members of your own household. If you live alone, you can spend time outdoors with one person from another household or you may choose to 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.

On 22 June the government set out a series of steps for further relaxing shielding guidance which will come into effect on 6 July and 1 August.

From 6 July, the government will be advising:

  • you may, if you wish, meet in a group of up to 6 people outdoors, including people from different households, while maintaining strict social distancing
  • you no longer need to observe social distancing with other members of your household
  • in line with the wider guidance for single adult households (either an adult living alone or with dependent children under 18) in the general population, you may from this date, if you wish, also form a ‘support bubble’ with one other household. All those in a support bubble will be able to spend time together inside each other’s homes, including overnight, without needing to socially distance

From 1 August the government will be advising that shielding will be paused. From this date, the government is advising you to adopt strict social distancing rather than full shielding measures. Strict social distancing means you may wish to go out to more places and see more people but you should take particular care to minimise contact with others outside your household or support bubble. In practice this means that from 1 August:

  • you can go to work, if you cannot work from home, as long as the business is COVID-safe
  • children who are clinically extremely vulnerable can return to their education settings if they are eligible and in line with their peers. Where possible children should practise frequent hand washing and social distancing
  • you can go outside to buy food, to places of worship and for exercise but you should maintain strict social distancing
  • you should remain cautious as you are still at risk of severe illness if you catch coronavirus, so the advice is to stay at home where possible and, if you do go out, follow strict social distancing

The guidance for the clinically extremely vulnerable group remains advisory. More detailed advice will be updated in this guidance as the changes in advice come into effect on 6 July and 1 August.

Unless we see a significant rise in cases we expect the shielding programme to be paused on 31 July.

Those in receipt of centrally provided food boxes and medicine deliveries will continue to receive this support until the end of July if they want it.

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

The guidance below applies until the 6 July 2020.

Shielding extremely vulnerable individuals

Guidance has been released to shield those persons who are clinically extremely vulnerable. Those that fall into this category include:

  • Solid organ transplant recipients

  • People with specific cancers:
    • people with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
    • 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.

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.

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

  • follow the advice in this guidance
  • register online or call 0800 028 8327 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.

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. From 6 July those shielding will be able to spend time outdoors in a group of up to 6 people including those outside of their household, while maintaining social distancing.Those who are shielding and live alone or are single parents with children will also be able to create a ‘support bubble’ with one other household of any size, following the same rules that are already in place for the wider population.
  4. You should stay alert when leaving home: washing your hands regularly, maintaining social distance and avoiding gatherings of any size.
  5. You should not attend any gatherings, including gatherings of friends and families in private spaces, for example, parties, weddings and religious services.
  6. 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).
  7. From 1 August, the shielding advice will relax further, allowing those shielding to do even more, such as visit shops and places of worship, and return to work provided they take particular care to maintain social distancing and minimise contact with others outside their household.

The food and medicine boxes facilitated by the National Shielding Service will stop as of 1 August, with everyone now being advised that they can visit shops and pharmacies. Other forms of support – such as priority supermarket delivery slots and the NHS Volunteers Scheme – will continue.

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. 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

If you have someone else living with you they are NOT required to adopt these shielding measures but they should  support you in shielding and stringently follow guidance on social distancing, reducing their contact outside the home.

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 themselves 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 the family’s used crockery and cutlery. If this is not possible, wash them using your usual washing-up liquid and warm 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, avoid touching their face and clean frequently touched surfaces.

If the rest of your household follows this guidance, there is no need for them to take the full protective measures to keep you safe.

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. 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 make contact to confirm appointments.

Can I (or the person I care for) be tested for coronavirus?

Testing is a key pillar of the Government's strategy to protect the NHS and save lives. The testing capacity has been expanded to include anyone with symptoms (in England).

Find out if you are eligible

How do I get assistance with food/medicines?

Please visit gov.uk/coronavirus-extremely-vulnerable or call 0800 028 8327 to register for the support that you need before the 17 July. The food and medicine boxes will stop from the 1 August as you are able to visit shops and pharmacies. 

From Tuesday 24 March, Richmond Council (LBRuT) are launching a new helpline as a first response for residents, particularly those elderly and/or vulnerable without support networks, who need support to access medical/care services and food supplies. 

If you or someone you know needs this support, please contact:

020 8871 6555 or 

covid19support@richmondandwandsworth.gov.uk.

This helpline can also be used for other enquiries related to COVID-19, for anyone in need of support.

For all medical enquiries please continue to contact the NHS on 111.nhs.uk or on 111.
For all general enquiries about Council services, please check richmond.gov.uk for updates or call the main Contact Centre on 020 8891 1411.

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 and provide transport to routine appointments. Call 0808 196 3646 (8am to 8pm) to arrange volunteer support.

Sources of information

If you have any  questions or concerns contact us by the details below and we will work to find you an answer.

020 8099 5335

info@healthwatchrichmond.co.uk

Looking for further information about coronavirus?

We have brought together the latest information about coronavirus including how you can get involved and help your community, and how to help your wellbeing during these uncertain times. 

Find out more