Guidance for the clinically extremely vulnerable (the shielding group)
Some people with long-term lung conditions are at extremely high risk of severe illness from coronavirus. These people belong to a group described as ‘clinically extremely vulnerable (CEV)’, formerly known as the ‘shielding group’.
On this page:
- What should people who are clinically extremely vulnerable (CEV) do?
- What is the guidance for CEV people across the UK?
- How at risk am I of becoming seriously ill with coronavirus?
- What should I do over Christmas?
- Going into work if I'm clinically extremely vulnerable
- Children going into school
- What support can I get?
- Help if I'm feeling worried
- Who should be in the clinically extremely vulnerable group?
You’ve probably seen the news about the COVID-19 vaccines that are in the final stages of testing. This seems to be promising news, and we are waiting for more information about how any vaccination programme would be rolled out, and who would get it first.
Vaccination will be prioritised for those most at risk, including the elderly, health and social care staff, and people in clinically high-risk groups – but we don’t yet have specific details on who will be vaccinated when.
In the meantime, we urge people to continue following the guidance in their area of the country, alongside social distancing, hand washing and other hygiene measures that will help protect us against COVID-19.
If you are in the CEV group and think you have developed symptoms of coronavirus, such as a fever or new continuous cough or a loss or changed sense of normal small or taste, get advice from the NHS 111 online service or call NHS 111. Do this as soon as you get symptoms.
What should people in this group do?
We should all be doing what we can to prevent the spread of coronavirus to help protect ourselves and others. This includes:
- following the government guidance for where you live or work
- keeping your distance from anyone outside your household
- washing your hands often, using soap and warm water, or alcohol-based hand sanitiser
If you’re clinically extremely vulnerable, you should follow the government guidance stringently as you may be at risk of severe illness if you catch coronavirus.
It’s important to get out for daily exercise and find ways to boost your mood, as this will help you stay fit and well. During the winter months, the NHS recommends taking a daily vitamin D supplement, as this helps to keep your bones healthy.
Get a free flu vaccine
This year, if you live in any part of the UK and are on the shielded patients list, you and your whole household can get the flu vaccine for free.
Flu can be a serious illness, especially if you’re living with a lung condition. Read more about keeping well in the winter and why you should get the flu vaccine this year.
Unlike at the start of the pandemic, advice for people in the shielding group might differ, depending on how affected the area you live or work in is. Below, we explain the new guidance and restrictions across the 4 nations and what it might mean for people in the shielding group.
The national lockdown in England will be lifted on Wednesday 2 December. Areas in England have been placed into 3 tiers: medium, high and very high alert. Each tier has different restrictions and guidance for what you can and cannot do. You can find out which tier you are in on the government website.
Across all tiers, the guidance for people in the clinically extremely vulnerable category is:
- stringently follow the guidance for the tier you are in
- maintain strict social distancing, wash your hands regularly and avoid touching your face. The more you socially distance from others, the less likely you are to catch COVID-19
- work from home where possible. You should only go into work if you cannot work from home and your employer has made your workplace COVID-safe. Read more about going into work if you are clinically extremely vulnerable
- go outside for exercise, but try to avoid busy areas
- avoid socialising indoors with people who aren’t in your household
Within each tier, there is detailed guidance for people who fall into the clinically extremely vulnerable category, relating to socialising, going into work, shopping and travel. We strongly recommend you thoroughly read through the specific guidance for the tier you are in.
If you live in one of the worst affected local areas, you might be advised to shield again, but this time it will be for a limited period of time. The revised shielding guidance is not as strict as it was earlier in the year and you can read more about the measures on the government website. You should only follow this guidance if you are contacted by the government. This will only apply to some Tier 3 areas, and you will be written to if you are advised to shield again.
Scotland has now entered a new five-level system of coronavirus restrictions. Within each level there is specific guidance for people on the shielded patient list. The Scottish government has confirmed that for all levels they will not ask the shielding group to distance from people in their own household or stop doing exercise outside.
If you live in a level 4 area in Scotland and are on the shielded patient list, you’ll be advised to limit contact with people outside your household, avoid public transport and limit shopping trips as much as possible.
You can read more about the five-level system and what it means for you on the gov.scot website.
Wales and Northern Ireland
Shielding has been paused in Wales and Northern Ireland. However, there are restrictions in place for everyone to follow to stop the spread of coronavirus. Read more about the:
Different factors affect your risk of becoming seriously ill with coronavirus. Having a long-term lung condition is one of them. But it isn’t the only factor that increases your risk. Age is the biggest risk factor, with those aged 80 and older at a greater risk of becoming seriously ill with coronavirus.
Everyone is different, and your own level of risk depends on different factors. This makes it difficult to give blanket advice about the level of risk from having a lung condition.
All 4 nations have agreed to relax social restrictions over the Christmas period, from 23 – 27 December. During this time, up to 3 households from any part of the UK can form an exclusive ‘Christmas bubble’. You can read more about the guidance between 23 – 27 December on the government website. In some nations, there are rules about the amount of people who can be in a bubble. In Scotland, a Christmas bubble can only have 8 adults (people over the age of 11).
When you’re planning Christmas, it’s important to still take personal responsibility to reduce the spread of the virus. This is especially important for those who are clinically extremely vulnerable.
Forming a Christmas bubble is a personal decision. Try to weigh up the benefits of forming a Christmas bubble against the likelihood of catching the virus. If you do decide to form a Christmas bubble, you should encourage the other people within your bubble to be mindful of your increased risk and to be extra vigilant in the days before you get together.
It’s OK to ask questions and to say no
It’s reasonable to ask ahead about arrangements, to help your decision. You might want to ask:
- How many people will be there? Will it be possible to stay 2 metres away from people I don’t normally live with?
- How big is the space? Will it be possible to keep it well ventilated?
- What are the bathroom arrangements? Will door handles and surfaces be cleaned regularly?
You might also want to think about seating arrangements, to make sure you are sat near to people you normally live with.
And remember, if you don’t feel comfortable forming a Christmas bubble, don’t feel pressured to.
Wherever you live in the UK, you should work from home if you can.
In England, from 2 December, if you cannot work from home you can go into work, but only if your workplace is COVID-safe. This is applicable for all tiers. You might be eligible to be furloughed – we would encourage you to talk to your employer to discuss your options.
In Wales, Northern Ireland and Scotland, people in the shielding group can go into work providing your workplace is COVID-safe.
If you live in a level 4 area in Scotland and your employer cannot make your workplace COVID-safe, you can get a letter similar to a fit note for as long as your area is under level 4 restrictions. If you’re in level 0 - 3 area, it may also be possible to get a fit note by talking to your GP or clinician. However, the first thing you should do is speak to your employer to see if they can make your workplace safe.
If you live with someone who is clinically extremely vulnerable but you still need to go into work, take a look at this guidance from the Cystic Fibrosis Trust. It gives tips on things you should do when you come in from home.
Think about how you’re getting to and from work. If you have to use public transport, consider travelling outside of peak hours to avoid the amount of people you come into contact with.
If you’re concerned about your health and safety in the workplace, you should speak with your employer in the first instance. If you can’t find a resolution, you should contact your trade union, Health and Safety Executive or get advice from ACAS.
Evidence has shown there is a very low risk of children becoming seriously ill from COVID-19, even if they have an existing health condition. Most children who were originally identified as clinically extremely vulnerable have been removed from the shielded patient list, and no longer need to follow the advice for this group. If you’re unsure if you’re child still falls into this category, speak to your GP or hospital clinician.
Under government guidance children who live with someone who is clinically extremely vulnerable (in the shielding group) should still go into school. We know this might cause anxiety if a parent or grandparent is shielding. Our helpline is here to answer questions you may have and listen to your concerns. The Cystic Fibrosis Trust has developed guidance on what you can do to protect someone you live with who is clinically extremely vulnerable, if you have to leave the house for work or school.
Whatever tier you’re in, it’s important you get the care you need to keep you safe and well.
If you need extra support, you can register for support on the government website. This can help you:
- request access to a priority supermarket delivery slot
- tell your council if you need support, especially if you are unable to arrange this yourself or with the help of friends, family or other support networks
The NHS Volunteer Responders service is there to support to people who need it in England. They can help you by:
- collecting food, medicine and other essential supplies
- providing regular phone calls
- helping you get to medical appointments
In Scotland, the national COVID-19 helpline is open Monday to Friday, 9am to 5pm. The number for this helpline is 0800 111 4000. People who have been shielding in Scotland can continue to get updates from the SMS Shielding Service. The Scottish government is also developing a service that will tell you your risk of being exposed to the virus in your local area. For more information on Scotland’s COVID forecasting service, visit the government’s website.
Read more about the continued support for people in the shielding group in Scotland.
Details of the support that’s available to you will be in the letter you’ve been sent by the government. If you’re struggling and need support, you can contact the COVID-19 Community Helpline:
- phone: 0808 802 0020, or
- text: ACTION to 81025, or
- email: [email protected]
People in the shielding group in Wales can still benefit from priority supermarket delivery slots if they don’t feel comfortable going to the shops. The National Volunteer Prescription Delivery Scheme ended on 30 September, but if you need help getting your medicines you should speak to your pharmacy.
If you need support and don’t have anyone to help you, you should speak to your local council. Local councils have a list of people who are on the shielded patient list in their area and will be able to help arrange support where you need it.
We know you might be feeling anxious about what the next few months might look like. If you have concerns, contact your GP. We will continue to make sure the voices of our supporters are heard, so everyone gets the support they need.
If you’re feeling low, please take a look at our information on dealing with your mental health while living with a lung condition. The government has also created guidance for people to help look after their mental wellbeing during the COVID-19 pandemic.
You can also get support from these organisations:
To understand more about your COVID-19 risk, including advice on how you can reduce the risk of catching the virus, take a look at this webpage.
People are regarded as extremely vulnerable if they are at very high risk of severe illness as a result of coronavirus (COVID-19), 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
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.
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.
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
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.
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.
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.
People with a diagnosis of pulmonary hypertension are regarded as vulnerable. Please visit PHA UK for more information.
People on immunosuppressive drugs for any reason should practise social shielding. These include:
- Mycophenolate Mofetil and Mycophenolate Sodium
- 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.
What to read next:
- What is coronavirus?
- What if I have symptoms of coronavirus?
- What should people with a lung condition do now?
- How can I cope with staying at home?
- What’s the difference between self-isolation, social distancing and social shielding?
Last updated: Friday 27 November 2020
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