Shielding advice from government – 22 June 2020 - What do you need to do if you are extremely vulnerable?
The government has issued some further changes regarding shielding and vulnerable individuals today. Measures are being put in place – according to levels of vulnerability.
Matt Hancock stated the “Everybody in the ‘clinically extremely vulnerable’ categorisation will be written to from today outlining these steps.”
Here are the main points:
Shielding guidance will be relaxed in stages, subject to clinical evidence. The new advice to patients will now be:
From 6 July:
- “You may, if you wish, meet in a group of up to 6 people outdoors, including people from different households, while maintaining strict social distancing;
- You no longer need to observe social distancing with other members of your household;
- In line with the wider guidance for single adult households (either an adult living alone or with dependent children under 18) in the general population, you may from this date, if you wish, also form a ‘support bubble’ with one other household. All those in a support bubble will be able to spend time together inside each other's homes, including overnight, without needing to socially distance. This is a small advisory change that brings those affected a step nearer others in their communities.
- However, all the other current shielding advice will remain unchanged at this time. the guidance for the clinically extremely vulnerable will be relaxed to allow shielded individuals to meet up to 5 people from other households outdoors, socially distanced, and to form support bubbles if they live alone or are a lone adult with a dependent under 18.”
From 1 August:
- “The advice to ‘shield’ will be paused.
- From this date, the Government is advising you to adopt strict social distancing rather than full shielding measures. Strict social distancing means you may wish to go out to more places and see more people but you should take particular care to minimise contact with others outside your household or support bubble.
- You can go to work, if you cannot work from home, as long as the business is COVID-safe;
- Children who are clinically extremely vulnerable can return to their education settings if they are eligible and in line with their peers.
- Where possible children should practise frequent hand washing and social distancing;
- You can go outside to buy food, to places of worship and for exercise but you should maintain strict social distancing; and
- You should remain cautious as you are still at risk of severe illness if you catch Coronavirus, so the advice is to stay at home where possible and, if you do go out, follow strict social distancing.”
The food and medicine boxes facilitated by the National Shielding Service will stop as of 1 August as individuals are advised they can visit shops and pharmacies.
However, other forms of support – such as priority supermarket delivery slots and the NHS Volunteers Scheme, amongst a range of local volunteer schemes – will continue.
If an individual is concerned about support after 1 August, they should contact their local authority.
The categorisation of ‘clinically extremely vulnerable’ will remain in place and people in this cohort should continue to follow the guidance specific to them, available here. After 1 August, we will continue to maintain the Shielded Patient List. We will monitor the virus continuously over the coming months and if it spreads too much, we may need to advise this group to shield again.
Shielding guidance has been and continues to be advisory.
Everybody in the ‘clinically extremely vulnerable’ categorisation will be written to from today outlining these steps.
With regards to people in employment: Matt Hancock has encouraged employers to “do the right thing” by their vulnerable employees.
Let us know if your employer has issues, or encounters difficulties in ensuring your place of employment is covid safe enough for your potential return to work.
We will be collecting evidence of issues.
Lastly - If you are particularly anxious – here are a few words from the counsellor at King’s College Hospital:
General guidance doesn’t replace your own assessment of your individual circumstances or risks.
Speak with your healthcare team to collaborate on a plan for what is reasonable for you.
If loved ones want you to socialise more, you may feel a sense of peer pressure, or even guilt, if you’re unable to or don’t feel ready to.
You are not alone in this. Such feelings are natural.
Try to actively adopt a compassionate view towards yourself by acknowledging that you are doing your best in a difficult situation outside of your control.
Unfortunately, being vulnerable sometimes leads to others forgetting your sense of agency & autonomy in managing your health condition. It may be helpful to reclaim this.
It’s okay to be assertive. Gently and lovingly remind others that while they should do what they think is right for them, you will do the same for yourself.
Anxiety about uncertainty is normal.
You may have thoughts about how long this will last.
Focus on the short term. Allow some flexibility in your mind that you’ll respond to future changes when they arise.
Article written by Surabhi Chaturvedi, Psychotherapist in Haemato-Oncology, King’s College Hospital
- Part 1. Advice regarding the Coronavirus outbreak in UK
- Part 2. Implications for blood cancer patients
- Part 3. Implications for our MDS local patient group meetings
- Part 4. Travel precautions
The information below has been taken from the NHS websites, as well as advice given by our scientific advisors, One Cancer Voice, Bloodwise and Leukaemia Care.
Part 1. Advice regarding the Coronavirus outbreak in UK - Updated on May 31st 2020
Overview - Coronavirus (COVID-19)
COVID-19 is a new illness that can affect your lungs and airways. It's caused by a virus called coronavirus.
What's the risk of coronavirus in the UK?
The UK Chief Medical Officers have raised the risk to the public from moderate to high.
Health professionals are working to contact anyone who has been in close contact with people who have coronavirus.
Symptoms of coronavirus
The symptoms of coronavirus are:
- a cough
- a high temperature
- shortness of breath
But these symptoms do not necessarily mean you have the illness.
The symptoms are similar to other illnesses that are much more common, such as cold and flu.
How coronavirus is spread
Because it's a new illness, we do not know exactly how coronavirus spreads from person to person.
Similar viruses are spread in cough droplets.
It's very unlikely it can be spread through things like packages or food.
Guidance on how to protect extremely vulnerable people from COVID-19
Extremely vulnerable people have a high risk of getting seriously ill with coronavirus (COVID-19) requiring admission to hospital.
You are extremely vulnerable if you:
- have had an organ OR STEM CALL TRANSPLANT in the last 6 months or are still taking immunosuppressant medicine
- are having active chemotherapy or radical radiotherapy for lung cancer
- are having immunotherapy or other continuing antibody treatments for cancer
- are having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
- have blood or bone marrow cancer, such as leukaemia or MDS
- have a severe chest condition, such as cystic fibrosis, severe asthma or severe COPD.
- have a rare disease and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)
- You are on immunosuppression therapies sufficient to significantly increase risk of infection.
- You are pregnant with significant heart disease, congenital or acquired.
The NHS has identified over 1,000,000 extremely vulnerable people who should practice social shielding, and they should have all received an official letter from the NHS. If you have not received a letter or have not been contacted, but you think you fall into this group, you can register yourself on this gov.uk website. Contact your GP or clinician after you register with this service.
It is also particularly important for people who:
- are 70 or over – AS IS THE CASE FOR ABOUT 80% OF MDS PATIENTS
- have a long-term condition – MDS INCLUDED
- have a weakened immune system – AS IS THE CASE FOR MANY MDS PATIENTS
Handwashing and respiratory hygiene
There are general principles you should follow to help prevent the spread of airway and chest infections caused by respiratory viruses, including:
- Wash your hands frequently with soap and water for at least 20 seconds or use a hand sanitiser.
- Do this after you blow your nose, sneeze or cough before you eat or handle food and always immediately when you return home
- Avoid touching your eyes, nose, and mouth with unwashed hands
- Cover your cough or sneeze with a tissue, then throw the tissue in a bin
- Clean and disinfect frequently touched objects and surfaces in the home
You can spread the virus even if you don’t have symptoms.
As the situation is changing each day, please keep checking the this Government web page, or with your healthcare team if necessary, for the most up-to-date advice.
Worried about contact with coronavirus? How to self-isolate
Call 111 or use 111 online if any of these apply to you:
- You think you might have coronavirus or
- You’ve been in contact with someone with coronavirus do not leave your home. This is called self-isolation.
If you are self-isolating, you must:
- not leave your home for any reason, other than to exercise once a day – but stay at least 2 metres (3 steps) away from other people
- not go out to buy food or collect medicine – order them by phone or online, or ask someone else to drop them off at your home
- not have visitors, such as friends and family, in your home
- You can use your garden, if you have one.
- Do not visit your GP, pharmacy or hospital.
You may need to do this for up to 14 days to help reduce the possible spread of infection.
Read more coronavirus self-isolation advice.
Treatment for coronavirus
There is currently no specific treatment for coronavirus.
Antibiotics do not help, as they do not work against viruses.
Treatment aims to relieve the symptoms while your body fights the illness.
You'll need to stay in isolation away from other people until you've recovered.
Part 2. Implications for blood cancer patients
If I have blood cancer, is there anything else I need to do?
If you are at higher risk you are advised to:
- Be more meticulous about doing everything advised above.
- Limit the time you spend with other people.
The NHS should have contact by Monday 30 March 2020 if you are at particularly high risk of getting seriously ill with coronavirus to give specific advice about what to do.
If you think you fall into one of the categories of extremely vulnerable people listed bellow and you have not received a letter or been contacted by your GP, you should register here and then discuss your concerns with your GP or hospital clinician.
Your team may find ways to reduce you spending unnecessary time in the hospital too, for example by doing more telephone consultations or offering home/local blood tests.
Many of the MDS consultants have already put such plans in place. Call your Nurse to find out if this is an option for you.
If I have blood cancer, am I more at risk?
For many people, their body will be able to fight off coronavirus like other viruses and colds. However, coronavirus can have more serious effects on anyone who has a long-term health condition or a weakened immune system, including some people with cancer. This includes:
- People having chemotherapy, or who’ve had chemotherapy in the last 3 months.
- People having immunotherapy or other antibody treatments for cancer.
- People having targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors.
- People who’ve had a bone marrow or stem cell transplant in the last 6 months, or who are still taking immunosuppression drugs.
- People with some types of blood cancer which affect the immune system, such as MDS, chronic leukaemia, lymphoma or myeloma, even if no treatment is being given.
Part 3. Implications for our MDS UK local patient group meetings
MDS UK has taken the decision to postpone all of their local patient groups – as a precaution.
This is following the advice of our clinical team and some of the hospitals where our groups are due to meet.
We are sorry for the disruption this will no doubt cause – but we would rather be safe than sorry.
The sooner everyone acts to curb the potential spread of the virus, the quicker the epidemic will slow down.
We also do not want our patients to feel they are missing out on a meeting – because they are being cautious.
The local group coordinators have been informed and notifications are going out to all our members by email and letters.
Thank you for your cooperation and understanding.
We will monitor the situation and update everyone as news and advice progresses.
Please keep checking our website.
Part 4. Travel advice about coronavirus
Upcoming travel plans
The Foreign & Commonwealth Office (FCO) now advises British people against all non-essential travel worldwide. This advice takes effect immediately and applies initially for a period of 30 days.
The COVID-19 pandemic has led to unprecedented international border closures and other restrictions. All countries may restrict travel without notice.
If you now need to change or cancel your travel plans, follow these steps:
- contact your airline, travel company, cruise line or other transport and accommodation providers
- get in touch with your insurance provider
- continue to follow the NHS coronavirus guidance
The FCO was already advising against all but essential travel or all travel to some areas or countries due to risks that do not relate to COVID-19. This advice remains in place. Check FCO travel advice pages for the latest information.
Symptoms of coronavirus
The symptoms of coronavirus are:
- a cough
- a high temperature
- shortness of breath
These are also symptoms of other common conditions such as a regular cold, virus or flu. Having these symptoms does not necessarily mean you have coronavirus.
But if you are worried, you can call 111 or use 111 online to check your risk.
If you feel unwell
If you feel unwell, contact your healthcare team as usual.
Getting help in Scotland, Wales or Northern Ireland
- Scotland: call your GP surgery or call 111 if your surgery is not open
- Wales: call 111
- Northern Ireland: call 111
Check if you need medical help
NHS 111 has an online coronavirus service that can tell you if you need medical help and advise you what to do.
Use this service if:
- you think you might have coronavirus
- in the last 14 days you've been to a country or area with a high risk of coronavirus – see our coronavirus advice for travellers
- you've been in close contact with someone with coronavirus
Do not go to a GP surgery, pharmacy or hospital. Call 111 if you need to speak to someone.