Who is clinically extremely vulnerable (the shielding group)?

This page explains the criteria that was previously used to decide who should be considered as ‘clinically extremely vulnerable’ from coronavirus.

At the start of the pandemic, some people were considered to be at high-risk of severe illness from coronavirus. These people belonged to the shielding group and were considered ‘clinically extremely vulnerable’. The shielding programme has now ended in England. You can read more about this on our information for people in high-risk groups.

People with severe long-term lung conditions in this group include people with:

• all types of cystic fibrosis
• severe asthma
• severe chronic obstructive pulmonary disease (COPD)
• lung cancer and mesothelioma, who are having active chemotherapy or radical radiotherapy
• severe bronchiectasis
• interstitial lung disease, including pulmonary fibrosis and sarcoidosis

People with severe COPD

NICE’s definition of severe COPD includes:

• Everyone who has severe or very severe airflow obstruction. This is measured using a breathing test called spirometry where you blow out as hard as you can. If the lung damage means that the amount of air you can blow out in 1 second is less than 50% of what it should be, it is classed as severe. Severe or very severe airflow obstruction is sometimes described as GOLD grade 3 or GOLD grade 4.
• People who have been admitted to hospital in the past because of an acute attack of their lung condition.
• People who are very limited by breathlessness – this means that even walking normally at your own pace you have to stop after 100 yards or a few minutes on level ground. Health care professionals sometimes use a measure called the MRC score. This scores breathlessness on a scale of 1 to 5. If you have a score of 4 or 5 you should be shielding. 
• People who have multiple medical problems – many people with COPD have other medical problems, such as heart disease, high blood pressure and diabetes. Each of these may increase an individual’s risk.
• People who need to use oxygen therapy at home 
• People who need to use non-invasive ventilation at home – a mask ventilator, sometimes called BiPAP, to support their breathing at night

Lung cancer and mesothelioma

This applies to people who are undergoing chemotherapy or radiotherapy for their lung cancer or mesothelioma or if they meet any of the criteria that are on the list under COPD.

Severe bronchiectasis

This includes people with bronchiectasis who: 

• meet any of the criteria that are on the list under COPD
• are taking long-term antibiotics such as inhaled antibiotics or macrolides
• have long-term Pseudomonas infections, long-term pulmonary aspergillosis or are taking treatment for non-tuberculous mycobacteria pulmonary disease (NTM) 
•  have 3 or more flare-ups or exacerbations a year
• use nebulised treatments 

Tuberculosis

There is currently no evidence that if you have active or latent TB, you're more at risk from COVID-19.

But if your lungs are extensively damaged or inflamed as a result of active TB or past TB, you may be more at risk of developing a chest infection after a coronavirus infection. For example, some people develop severe bronchiectasis after extensive active TB and in that case, you are advised to practise social shielding, following the current guidance on severe bronchiectasis.

It is important not to stop your TB medication if you feel worse, but to seek advice from your local TB team.

Interstitial lung disease, including pulmonary fibrosis 

Everyone with pulmonary fibrosis and other types of interstitial disease is at higher risk of severe illness from COVID-19.

Sarcoidosis 

Everyone with sarcoidosis affecting their lungs is at higher risk of severe illness from COVID-19.

Pulmonary hypertension

People with a diagnosis of pulmonary hypertension are regarded as vulnerable. Please visit PHA UK for more information.

Immunosuppressive drugs 

People on immunosuppressive drugs for any reason should practise social shielding. These include:

• Prednisolone
• Methotrexate
• Azathioprine
• Mycophenolate Mofetil and Mycophenolate Sodium
• Cyclosporin
• Sirolimus
• Tacrolimus
• Having in the last 6 months received intravenous Cyclophosphamide, Rituximab or Infliximab

Other lung conditions

The groups listed above cover most lung conditions. If your condition is not included or you are not sure, have a look at these criteria:

• you need to use oxygen at home
• you use non-invasive ventilation
• you have to stop walking after 100m or so because of breathlessness, even at your own pace
• you have had to be admitted to hospital in the last year because of an acute attack of the lung condition
• you are taking immunosuppressive drugs

Last updated: Thursday 30 September 2021