Who is clinically extremely vulnerable (the shielding group)?

People are regarded as clinically extremely vulnerable if they are at very high risk of severe illness as a result of coronavirus and may need be admitted to hospital. People with a range of long-term lung conditions are in this group if their condition is severe. 

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

University of Oxford risk assessment tool

A new risk assessment tool has been applied across NHS records for people living in England. It aims to find people who have multiple risk factors that, when put together, make them more vulnerable to COVID-19. This tool means that new people, which could include people with lung conditions, will be considered clinically extremely vulnerable (CEV) and advised to shield for the first time, and will be offered a vaccine very soon. You can read more about the coronavirus vaccine in our detailed FAQ.

People who will be picked up through this risk assessment tool are people who have a combination of conditions that alone wouldn’t classify them as being CEV, but when put together increase their risk. Or, someone who has condition that puts them at risk, and also is at higher risk because of their age, gender, body weight, ethnicity or other factor. It’s likely that people affected by this change will already be in priority group 6 or higher. 

Anyone who is identified as being at high risk through this tool will receive a letter or email explaining that they are considered at high risk and given advice to shield. If you fall into this group, your GP will have already been notified. You can read more about the risk assessment tool on the NHS website. At the moment, this is only being rolled out in England, but in the future this tool might be applied across the 4 UK nations.

We understand that only now being told you are at a high risk from COVID-19 might be a cause for concern. At the start of the pandemic, the CEV list (previously known as the shielded patient list) was created based on a list of conditions agreed by the Chief Medical Officers and other senior clinicians, including senior respiratory clinicians. A lot more is known now about the virus and what makes a person more vulnerable, including the significance of a combination of risk factors. The introduction of this risk assessment tool will allow more high-risk people to get the vaccine sooner, and the quickest way to do this is to include them within the CEV list. It’s also important that people who we now know are high risk are given the correct support and advice to protect themselves from COVID-19.

The government guidance for people who are CEV is different to the rest of the population – you’re advised to stay at home as much as possible, only leaving for exercise and health appointments, including your vaccine. It’s advised people in this group follow this guidance even after they’ve been vaccinated. You can read the full guidance for people who are CEV on the government website.

If you are now in a position where you cannot work from home and are being advised to not attend work, we would encourage you to have an open conversation with your employer to discuss your options. We have more information on the support that’s available to people who are CEV.

People with severe COPD

Current NHS medical records do not hold perfect data to specifically identify how severe your COPD is. To work around this, letters have been sent to people with COPD based on the medications that they are taking. This is because there are good records of prescriptions that people have received. These include:

• People on what is sometimes called triple therapy. This means taking a long acting beta agonist (LABA) and a long acting muscarinic agonist (LAMA) and an inhaled corticosteroid (ICS) in either November or December 2019. These could be prescribed as either 3 separate medicines or combinations of single and dual or combination medicines or as triple therapy.
• People who’ve had a prescription for Roflumilast most recently in November 2019 or December 2019. 

But some people who take this sort of medicine may only have mild COPD. And not everyone who has severe COPD is on triple therapy. If you have received a letter and have been prescribed either triple therapy or Roflumilast and think your COPD is not severe, talk to your GP or hospital specialist.

GPs and hospital clinics have identified people with severe COPD who have been missed by the medication approach to add them to the list. This review was informed by NICE’s definition of severe COPD, which 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

Read more about what you should do if you live with COPD.

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 regarded as vulnerable, and should have received a letter from their specialist or GP. Read our detailed information about what you should do if you live with an ILD.

Sarcoidosis 

Everyone with sarcoidosis affecting their lungs is regarded as vulnerable, and should have received a letter from their specialist or GP. Read our detailed information about your care. 

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

If you meet any of these then it is likely your condition makes you especially vulnerable to coronavirus. If you have not received a letter, seek advice from your health care team.

Last updated: Tuesday 16 February 2021