What is social shielding and who needs to do this?
Some people, including children, 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’.
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.
- How long is shielding guidance in place for?
- What should people in the shielding group do?
- Going back to work (including children and school staff)
- What support will I get now shielding has been paused?
- I feel anxious about shielding being paused
- Who should be in the shielding group?
As lockdown restrictions ease, there may be different guidance in your area if there is a localised outbreak. For up to date advice in your area, check your local council or local newspaper website. In England, you can check this government page on local restrictions.
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.
We will update this information if shielding is reinstated across the UK. 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 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.
How long do I have to shield for?
- In England, Scotland and Northern Ireland, shielding was paused on 1 August.
- In Wales, shielding was paused on 16 August.
The list of people in the clinically extremely vulnerable group remains 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. Some people may still need to shield, if they’ve been told by their GP they need to do so.
What should people in this group do?
People in the shielding group 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.
Shielding guidance has now been paused. People in the shielding group can instead follow strict social distancing, rather than full shielding measures. 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. People in the shielding group should have received a letter outlining these changes. The government will monitor the virus continuously and if it spreads too much, might advise to shield again. Some people may need to continue to shield, if they’ve been told by their GP they need to do so.
You should still be cautious, as you may be at risk of severe illness if you do catch coronavirus. It’s advised you try and limit the number of people you meet, shops you visit and non-essential journeys you make.
The decision to go outside is yours. The best ways to protect yourself if you do go outside are to:
- ideally spend time in open areas
- keep your distance from other people
- do not share or exchange personal belongings (such as cups) with other people
- only 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.
You should continue to work from home if you can. But, if you can't work from home, you can go back into work, on the basis your workplace is COVID-safe. Your employer should support you to return to work safely.
For more information on returning to work, take a look at the ACAS website.
Children and school staff
Children who have been shielding will return to school, college or nursey when they reopen.
For more detail on children shielding returning to school, nursery or college, take a look at this webpage from our sister charity, Asthma UK.
People who have been shielding in England will no longer receive food boxes and medicine deliveries from the National Shielding Service. However, the NHS Volunteer Responders can continue to help with food and prescription deliveries if you need it. You will still be eligible for priority supermarket slots if you registered by 17 July.
In Scotland, lots of shielding support will remain open. The national COVID-19 helpline will remain open Monday to Friday, 9am to 5pm. The number for this helpline is 0800 111 4000. People who have been shielding in Scotland will 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.
People shielding in Northern Ireland who registered for food boxes will no longer receive them. 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 won’t receive any more food boxes from the government. However, they can still benefit from priority supermarket delivery slots. The volunteer medicine delivery scheme will also be available until the end of September.
We know for some people the ending of shielding will be welcome news. But others will be understandably 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.
We encourage anyone with concerns or who is feeling anxious about going outside to contact their health care professional. 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. You can also get support from these organisations:
For more information on understanding your COVID-19 risk, go to our sister charity website, Asthma UK. While the content is aimed at people with asthma, there is information on risk factors and making decisions that is relevant to all people with lung conditions.
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
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 your care.
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: Monday 17 August 2020
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