What is social shielding and who needs to do this?
Some people, including children, with long-term lung conditions who are at very high risk of severe illness from coronavirus, are now advised to rigorously follow shielding measures to keep themselves safe.
Shielding is a way to protect people who are extremely vulnerable from coming into contact with coronavirus by minimising all interaction between them and other people.
People in this group will receive a letter by Sunday 29 March in England, or 30 March if you are in Scotland or Wales, and later next week in Northern Ireland. They, or their carer, will also be able to register for a new service to get coronavirus support over the week beginning 23 March 2020.
We strongly recommend you follow this guidance if you are in one of the high-risk groups.
In the meantime, you should stay at home and avoid contact with others. The decision to shield is a deeply personal one. We are not able to advise individuals about whether they should shield or not.
The government has now published advice for people who are at very high risk of severe illness from coronavirus. You can check if you are at high risk using the criteria below. We've had guidance from the Department of Health and Social Care about who is in this vulnerable group. Based on this, our medical directors and other medical experts have helped us to create this information. It is to be used as a guideline only and we will update it if we get any new information or if the guidance changes.
Who is regarded as extremely vulnerable?
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 are also extremely vulnerable if they have multiple long-term health problems. This group will include people with any long-term lung condition which they are treated for (including asthma, COPD, lung cancer, bronchiectasis, pulmonary fibrosis and others who are offered an annual flu jab) who also have diabetes or heart disease. If you’re not sure ask your respiratory team or GP for further advice.
This is because they are at very high risk of severe illness as a result of coronavirus (COVID-19), and may need be admitted to hospital.
- 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 amount of air you can blow out in one second is less than 50% of the normal range of values, it is classed as severe. Severe or very severe airflow obstruction is sometimes described as GOLD grade 3 or GOLD grade 4.
- People who are limited by breathlessness – this means that you can’t walk as fast as other people of your age because of breathlessness. This may be described in clinic letters as an MRC breathlessness score of 3, 4 or 5.
- People who have had to be admitted to hospital in the past because of an acute attack of the lung condition.
- People who have had 2 or more exacerbations or flare-ups in the past year that needed emergency treatment with steroids or antibiotics from the GP or hospital.
- People who are on regular steroid tablets, called prednisolone to treat their condition
- People who have oxygen therapy at home
- People who use non-invasive ventilation at home – using a mask connected to a ventilator, sometimes called BiPAP, to support their breathing at night
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
- use nebulised treatments
This includes people who:
- are limited by breathlessness – this means that you can’t walk as fast as other people of your age because of breathlessness. This may be described in clinic letters as an MRC breathlessness score of 3, 4 or 5.
- have had to be admitted to hospital in the past because of an acute attack of the lung condition
- have had 2 or more exacerbations or flare-ups in the past year that need emergency treatment with steroids or antibiotics from the GP or hospital
- are on regular steroid tablets, called prednisolone to treat their condition
- have oxygen therapy at home
- has low lung function - this is defined as an FVC (size of the lungs) of less than 80% or a TLco (gas transfer) of less than 60% - these numbers are likely to be on your clinic letters
- with pulmonary hypertension, which raises blood pressure in the lungs
- takes the following treatments:
- Mycophenolate Mofetil and Mycophenolate Sodium
- have in the last 6 months has received intravenous Cyclophosphamide, Rituximab or Infliximab
- live with IPF and take Pirfenidone or Nintedanib
Your specialist team may be able to give you specific advice.
What should people in this group do?
People who are extremely vulnerable should:
- stay at home at all times and avoid any face-to-face contact for at least 12 weeks, from the day they receive their letter.
- get all essential items delivered, and have the person leave them at the door. If you can’t do this, from 24 March you can register for help with daily living tasks, such as social care and shopping. You can do this online or call 0800 0288327, the government’s dedicated helpline
- use phone or online services to contact your GP or specialist or other services
- at home, minimise all non-essential contact with people you live with
- 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.
If you are in this group and think you have developed symptoms of coronavirus, such as a fever or new continuous cough, get advice from the NHS 111 online service or call NHS 111. Do this as soon as you get symptoms.
Please read the detail in the government social shielding advice. This is the best way to protect people at particular risk of serious complications from coronavirus.
Some people in England and Wales have already been sent a letter and texts from the government asking them to shield. If you think you are at risk, but haven’t had a letter yet, please wait until after 29 March to get in touch with your GP. In the meantime, you should stay at home and avoid contact with others.
People in Scotland and Wales should receive letters by Monday 30 March 2020 and people in Northern Ireland later in the week.
This ACAS advice for employees who want to shield may be useful when talking to your employer.
Following the government announcement, the Department of Health and Social Care shared further recommendations about which people with lung conditions should shield and our clinical leads used this to develop this advice. However, your own clinician is ultimately responsible for deciding whether to recommend you shield or not.
You may feel frustrated if you think you should be shielding, but your GP does not agree. You can still choose to shield but you won't be eligible for government support. But you can get support from a the mutual aid network and you should talk to your employer. This ACAS advice for employees who want to shield may be useful when talking to your employer.
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.
What to read next:
- What is 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 and social distancing?
Current on: Friday 27 March 2020
Last updated: Friday 27 March 2020
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