Coronavirus and COVID-19

What is social shielding and who needs to do this?

Some people, including children, with long-term lung conditions who are at extremely high risk of severe illness from coronavirus may need to take extra care by following shielding measures to keep themselves safe. These people belong to a group described as ‘clinically extremely vulnerable’.

Shielding is a way to protect people who are extremely vulnerable from coming into contact with coronavirus by minimising interaction between them and other people.

The UK government and devolved administrations have published advice for people who are at very high risk of severe illness from coronavirus. Most people with lung disease who are especially vulnerable to coronavirus have been contacted by letter or text message. But more letters may be sent following review by specialist clinicians and GPs. ​

Recent updates to shielding guidance

People shielding in England and Northern Ireland:

  • can meet in a group of up to 6 people outdoors, including those from different households, while maintaining strict social distancing
  • no longer need to observe social distancing with other members of their household
  • can form a support bubble, if they are in a single adult household

From 10 July, people shielding in Scotland:

  • no longer need to observe social distancing with other members of their household
  • can meet up to 8 people from 2 different households outside, once a day
  • can form an extended household, if they’re in a single adult household

People shielding in Wales can become part of an extended household.

From 1 August, shielding guidance in England and Northern Ireland will be paused. From this date, people who are currently shielding should instead follow strict social distancing. In Scotland, if infection rates are low enough, shielding will also be paused on the 1 August. We will update our guidance when a decision is made. People in this group should remain cautious, as they’re still at risk of severe illness if they catch coronavirus. The advice will be to stay at home where possible and, if you do go out, follow strict social distancing.

As lockdown restrictions ease, there may be different guidance in your area if there is a localised outbreak. For up to date advice on your area, check your local council website.

Current advice from governments across the UK is that​:

  • If you have already got a letter or text message, follow the social shielding advice that applies where you live
  • If you have not been contacted and you’re concerned, you should discuss your concerns with your GP or hospital clinician. In the meantime, follow the social distancing rules very carefully, or you could choose to make a personal decision to shield.

The decision to shield is a deeply personal one, and it’s your choice whether you choose to shield or not. If you decide not to shield, the NHS recommends discussing your decision with your GP or hospital clinician.​

Across the 4 nations the criteria for shielding are very slightly different. Read more about criteria in Scotland, Wales or Northern Ireland. Please contact your doctor or hospital clinician to discuss your concerns if you think you may need to shield and haven't yet received a letter.

We will update this information if shielding is reinstated, either across the UK or because of local outbreaks. We are working with the NHS and professional bodies to make sure people with long-term lung conditions get the best advice and support.

If you are in the shielding group and think you have developed symptoms of coronavirus, such as a fever or new continuous cough or a loss or changes 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.

How long do I have to shield for?

  • In England and Northern Ireland, shielding guidance will be paused from 1 August. Everyone in the clinically extremely vulnerable category will be written to explaining the next steps. From this date, people who are currently shielding should instead follow strict social distancing. People in this group should remain cautious, as they’re still at risk of severe illness if they catch coronavirus. The advice will be to stay at home where possible and, if you do go out, follow strict social distancing.

    From this date, food and medicine boxes from the National Shielding Service will stop. However, people in this group can still benefit from priority supermarket slot, the NHS Volunteer Scheme and other local volunteer groups. In England, to benefit from priority supermarket slots you need to register for support before 17 July so that help can reach you in time. If you’re concerned about support after 1 August, you should contact your local authority.

    From this date, people shielding can go into work if they cannot work from home. This is only if their workplace is COVID-safe and they can keep a safe distance from others.

    The list of people in the clinically extremely vulnerable group will remain in place and people in this group should follow the advice specific to them. The government will monitor the virus continuously and if it spreads too much, might advise the group to shield again.

    We know for some people the ending of shielding will be welcome news. But others will be understandably be feeling anxious about it. This relaxation allows people who have been shielding to see more people, enjoy the summer and be more active – this is important as we all move towards normality, and for this group to boost their physical and mental fitness. However, shielding is a personal decision and we encourage anyone with concerns to speak to their health care professional about what is right for them.

  • In Wales, shielding guidance will be in place until at least 16 August. If you live in Wales and are shielding, you will receive a letter telling you this and the next steps. You will then get another letter advising you what to do after 16 August.
  • In Scotland, shielding guidance will be in place until 31 July. If infection rates are low enough. shielding might be paused from 1 August. We will update our guidance when a decision has been made, and the Scottish government contact people through text and letter shielding to let them know when shielding is paused.

    Until 31 July, people shielding will continue to receive any support they have been getting, including priority delivery slots, pharmacy deliveries or free weekly food boxes.

    The Scottish government has advised employers they need to make workplaces COVID-safe. They are looking into whether it will be safe for people shielding to return to work safely from 1 August and will announce more advice about returning to work before the end of July.

What should people in this group do?

People who are extremely vulnerable should:

  • keep up-to-date with current advice from the government. There is different advice around the UK in England, Scotland, Wales and Northern Ireland, and it is kept under review.
  • get all essential items delivered, and have the person leave them at the door
  • use phone or online services to contact your GP or specialist or other services. If you’re not sure how to do this, take a look at our technology for lung health guide
  • people who provide essential support to you, such as health care, personal support for daily needs and social care should continue to visit. But carers must stay away if they have any symptoms of coronavirus. Hand washing remains essential: all people coming to the house should wash their hands with soap and warm water for at least 20 seconds when they arrive, and often while they are there.
  • if someone else lives with you they do not have to follow the shielding guidance. They should follow the social distancing guidance very closely and do what they can to support you. They should read through this NHS guidance on living with someone who is clinically extremely vulnerable. People shielding in England no longer need to practise social distancing with other members of their household.

Please read the detail in the current advice from the government in the nation you live in. This is the best way to protect people at particular risk of serious complications from coronavirus.

The purpose of shielding is to reduce the risk of you becoming infected with coronavirus. This is most likely to happen if you are in face-to-face contact with someone who has the virus. The most important thing is that you continue to take steps to keep yourself safe – physical distancing from other people and hand hygiene. 

There has been a slight easing of the shielding regime in all 4 nations, with more changes to come as shielding begins to wind down.

In England the government guidance says that people shielding:

  • can meet in a group of up to 6 people outdoors, including those from different households, while maintaining strict social distancing
  • no longer need to observe social distancing with other members of their household
  • form a support bubble, if they are in a single adult household

There is different, and changing, advice around the country.

  • In Wales, people who are shielding can go outside for an unlimited amount of time. People shielding in Wales can form part of an extended household.
  • In Northern Ireland, the advice is similar to England. People shielding can meet in a group of up to 6 people outdoors, including those from different households, while maintaining strict social distancing. People shielding no longer need to observe social distancing with other members of their household and they can form a support bubble, if they are in a single adult household.
  • In Scotland, people shielding can spend time outside for an unlimited amount of time. People shielding can meet one other household a day outdoors, as long as there are no more than 8 people in the group. From 10 July, people shielding no longer need to observe social distancing with other members of their household and can form part of an extended household. 

Find out the full details if you live in Scotland, Northern Ireland and Wales.

The decision to go outside is yours. If you do decide to go out, the best ways to protect yourself are to: 

  • go outside when there are fewer people around, such as early in the morning
  • ideally spend time in open areas
  • keep your distance from other people
  • take particular care to minimise contact with other people
  • do not share or exchange personal belongings (such as cups) with other people
  • don’t go into enclosed spaces, as well as shops and other buildings  
  • spend as long as you feel comfortable outside. 

To help you to get used to being outside more you may want to try short trips outside or spend time in the company of friends, family or neighbours. If you would prefer not to go outside, try spending time with the windows open, to let in fresh air and get some natural sunlight. 

The governments have said the change in advice is based on evidence that the risk of catching COVID-19 is now lower than when shielding was first introduced. Measures will be kept under review as general lockdown measures are eased. Transmission has also been shown to be lower outside. 

Can I be part of a support bubble?

Support bubble (or extended household) is when two households join to form one household. In England, Northern Ireland and Scotland, one of the households must be a single adult household.
Everyone in the ‘bubble’ can then act as if you’re all in one household: spending time indoors and staying overnight. 

People shielding in England, Northern Ireland and Wales can become part of a support bubble. From 10 July, people shielding in Scotland can become part of an extended household.

Children and school staff

Your GP or specialist may get in touch to say your child doesn’t need to shield any more. This is because new guidance has shown many children have a low risk of catching coronavirus. However, some children will still need to shield. 

For more detail on children shielding returning to school, nursery or college, take a look at this webpage from our sister charity, Asthma UK.

Who is regarded as extremely vulnerable (the shielding group)?

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:

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 

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: 

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 your care.

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:

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 if I think I’m in this group but I don’t get a letter or text?

If you think that you should be in this group but have not been contacted, it may be because your GP or hospital clinician is still working through their patient lists or have judged, on the basis of the guidance, that you do not fall into the extremely clinically vulnerable group. If you are still concerned, you should discuss this with your GP or hospital clinician.

There is no cut-off point for being added to the shielding group – you can be added any time, if you have one of the conditions in the agreed clinical list described above.  

You may feel frustrated if you think you should be shielding, but your GP or your specialist does not agree. If you want to continue shielding once the support ends, you can make the personal decision to shield but you won't get any government support. You can get support from the mutual aid network and you should talk to your employer.

Please bear in mind shielding is a severe step to take

Think about the extra benefit you will get from shielding as opposed to social distancing and weigh it against the impact on your mental and physical wellbeing of the significant loss of social contact and staying at home for a long time. 

We will update this advice if anything changes and we will continue to push for support for people with lung conditions who need to shield. We will also monitor how all guidance is being implemented to ensure people with lung conditions are sufficiently protected and supported.

How can I get support while I’m shielding?

What to read next:

Last updated: Thursday 9 July 2020

We hope you have found this content useful

We hope you have found this content useful. Our team of health experts is working tirelessly on a daily basis to provide the latest and most up to date health advice concerning coronavirus (COVID-19).

Record numbers of people now need our support. As a charity, we rely on donations from people like you. We do not yet know if we will be eligible for government help. However, our help and advice are only possible thanks to kind donations from people like you.

If you can, and are able, please donate now. Every pound will make a difference.

DONATE NOW

We use your comments to improve our information. We cannot reply to comments left on this form. If you have health concerns or need clinical advice, call our helpline on 03000 030 555 between 9am and 5pm on a weekday or email them.

Last medically reviewed: July 2020. Due for review: July 2020

This information uses the best available medical evidence and was produced with the support of people living with lung conditions. Find out how we produce our information. If you’d like to see our references get in touch.