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Government to write to doctors about return of shielding measures



The Department of Health and Social Care is to write to clinically extremely vulnerable people in England and their doctors, notifying them shielding measures may be reintroduced.

The new advice will be tailored to the Government’s new Covid alert level system, the DHSC said.

People in the highest risk areas may still need to adopt formal shielding measures, but this will be based on advice from local public health experts and the chief medical officer – and will be for a limited period of time.

The DHSC and the NHS will write to the 2.2m people identified as clinically extremely vulnerable outlining the changes to the guidance.

Anyone advised to shield will be written to individually – but this will not automatically be triggered by a region moving into the highest level Covid alert.

The DHSC said today it was issuing ‘updated advice on protecting the clinically extremely vulnerable, based on the local Covid alert level in your area’.

It said: ‘This advice is less restrictive than previous shielding advice.’

But it also said for those that need to shield it was providing ‘updated shielding advice that is more targeted’.

The guidance added: ‘[Updated shielding advice] will only apply in some of the worst affected areas and only for a limited period of time. You are only advised to follow shielding advice if you receive a new written shielding notification.’

The DHSC said its guidance ‘aims to strike a better balance between providing practical steps to help keep you safe while reducing some of the potentially harmful impacts on mental and social wellbeing that were associated with previous strict shielding’.

Clinically vulnerable patients will be required to follow additional advice (see box below) to that issued to the general public to protect themselves against Covid-19.

Across all Covid alert levels students should still continue to go to school ‘unless they are one of the very small number of pupils or students under paediatric care and have been advised by their GP or clinician not to attend an education setting’, said the guidance.

For those people in the highest risk areas who are specifically told to shield, there will be further restrictions, including not attending school, only making essential journeys, not going to the shops or pharmacy and keeping two metres away from other household members.

Dr Yvonne Doyle, medical director and director of health protection at Public Health England, said: ‘People who are defined as clinically extremely vulnerable are at very high risk of severe illness from Covid-19. If you are in this group, we recommend that you follow the advice to help protect yourself at each alert level as set out in the guidance.’

She added: ‘In addition to the rules you must follow at each alert level, you can take additional precautions.

‘Continue to maintain strict social distancing, wash your hands regularly and try to keep the number of social interactions that you have low. The fewer social interactions you have, the lower your risk of catching Covid-19.’

Over the summer shielding advice was relaxed, with clinically extremely vulnerable patients told they could stop following the measures from August.

However, as some parts of the country went into local lockdowns, patients who were shielding in these regions were advised to continue for a slightly longer period.

Additional advice for the clinically extremely vulnerable

  • For Local Covid Alert Level – MEDIUM: strictly observe social distancing, meet others outside where possible, limit unnecessary journeys on public transport and work from home where possible, but you can still go to work and children should still attend school. This is on top of restrictions for everyone to only meet in groups of up to six people.
  • For Local Covid Alert Level – HIGH: reduce the number of different people met outside, avoid travel except for essential journeys, work from home where possible and reduce the number of shopping trips made or go at quieter times of the day. You can still go to work if you cannot work from home because all workplaces should be covid secure, and children should still attend school. This is on top of restrictions for everyone to not meet other households indoors, unless part of a support bubble, and to only meet in groups of up to six people outdoors.
  • For Local Covid Alert Level – VERY HIGH: work from home, in general stay at home as much as possible, and avoid all but essential travel. You should also significantly reduce shopping trips, and if possible use online delivery or ask people in your household, support bubble or volunteers to collect food and medicines. People in these areas are encouraged to still go outside for exercise, and can still go to school and to work if they cannot work from home. We recognise that a small number of individuals may require additional support to follow the guidance at this alert level, and they are advised to contact their local authority if they need assistance. 

Source: Information provided by the DHSC, based on updated guidance

READERS' COMMENTS [4]

Richard Greenway 13 October, 2020 12:27 pm

Is this really necessary? They made such a dogs breakfast of it last time -some sort of press / web announcement would be better. Of course vulnerable people in high risk areas need protection -but another clumsy mailshot?

Turn out The lights 14 October, 2020 5:41 am

I feel another NHSE follow through coming on,get out the wet wipes it’s going to be messy.There is a lot of establishment follow through with the Covid pandemic,it must be a cardinal symptom.

Kevlar Cardie 14 October, 2020 12:21 pm

And don’t forget : never eat yellow snow.

Vinci Ho 14 October, 2020 12:49 pm

The fundamental problem is the conundrum of knowing how to move forward against the dichotomy of ‘dammed you do , damned you don’t’:
(1) The daily increase of Covid 19 incidences is reminiscent of what we saw in March . The uprising curve needs to be flattened again . Undoubtedly, we have had less deaths associated with Covid 19 on daily basis . This is simply because we now have well proven treatments for severely affected , hospitalised patients( Remdesivir and carefully calculated dosages of systemic steroids appropriately used just before the onset of an overwhelming cytokine storm/ARDS) . I would argue the differences in fate between US president and our prime minister is the ‘right’ patient at the right time and right place . Life is an irony , isn’t it ?
(2) This , however , does not take away the fact that the number of patients seriously affected requiring hospital admission is reduced . NHS is potentially decimated by this influx , disregarding how many non-Covid fatalities will be recorded ultimately when we come out of this winter.
To me , unless we have developed treatment(s) which can successfully reduce the odds of patients with mild diseases moving into the serious category needing hospitalisation ( typically around day 9-10) , vaccine or no vaccine does not confer a definitive short to medium term solution . I can see why the controversy of using Hydroxychloroquine ( NOT injecting bleach into your veins!) earned so much publicity in the first wave , on hind sight .
(3) The unnatural experiences of those being shielded away in the first wave were evidently onerous , demoralising and pathological. Nobody likes it, even in countries under autocratic governments. Despite all the criticisms on the role of PCN social prescribers , I have to give credits to our PCN social prescriber (only appointed in March this year ) who worked tirelessly to help these shielded patients during the first wave up to now . Reality is shielding has become a ‘necessity’ to battle Covid 19 unless we have better alternatives.
(4) Lastly , the concept of herd immunity is reinvigorated by the recent ‘infamous’ Barrington Declaration complicated by some fake signatories. Inevitably , it will cost significant casualties before reaching the set-out objectives are reached . The concept is based on historic experiences of world pandemics in previous eras but we are supposed to be in a modern time bestowed by advanced technology and science , aren‘t we?The simple philosophical question is , however , ‘are we really any different today ?’ Well , the testing technology has certainly failed to prevent this second wave .
(5) Albeit being ‘cruel’ , I would say Covid 19 , perhaps different from previous pandemics , is somehow a call of ‘natural selection’ particularly against those older and debilitated proportion of human beings . Can we really ideally protect and shield away these vulnerable ones and let the healthy ones carry on with their lives ? Reality is , easy said than done .
The Blitz goes on ………….