The awaited new guidance for patients deemed clinically extremely vulnerable to Covid-19 has confirmed there will not be a return to full-on shielding during the second national lockdown.
As people in England are asked to stay at home for four weeks from Thursday, people on the shielding patient list are asked to take extra caution by:
- Staying at home as much as possible, except to go outdoors to exercise or attend health appointments
- Avoiding all non-essential travel – they should continue to travel to hospital and GP appointments unless told otherwise by their doctor. They are strongly advised not to go to any shops or to pharmacies
- If people cannot work from home, they should not attend work. They may be eligible for Statutory Sick Pay, Employment and Support Allowance, Universal Credit or the Coronavirus Job Retention Scheme
- ‘Most children’ who were shielding during the last lockdown should be able to attend school
People who require support, for example with shopping or accessing medicines, should contact their local council for help. The Government has allocated £32m worth of funding to councils to support clinically extremely vulnerable patients during the lockdown.
Parents of children still on the shielding list should ask their GP for advice, according to the guidance.
The document says: ‘Most children originally identified as clinically extremely vulnerable no longer need to follow this advice. Speak to your GP or specialist clinician, if you have not already done so, to understand whether your child should still be classed as clinically extremely vulnerable.’
It adds that ‘those children whose doctors have confirmed they are still clinically extremely vulnerable are advised not to attend school while this advice is in place’.
NHS England wrote to practices on Monday evening to ask GPs to review children on the shielding list as well as add adults with Down’s syndrome or chronic stage 5 kidney disease.
It also asked GPs to familiarise themselves with the new guidance for clinically extremely vulnerable patients when this became available.
The updated guidance makes no mention of the Government’s long-awaited new algorithm for calculating Covid-19 risk – which has identified those who are male, from a BAME background, over 70 and with certain health conditions such as diabetes as most at risk of death from coronavirus.
Deputy chief medical officer for England Dr Jenny Harries said: ‘With the prevalence of the virus continuing to increase across England and in places across the world, it’s right that we adjust our advice for the clinically extremely vulnerable accordingly so they can feel as safe as possible over the coming few weeks.
‘Our guidance for this group of individuals has always been advisory, but I would strongly urge all those who are clinically extremely vulnerable to take these extra precautions to keep themselves as safe as possible.’
Shielding had been paused since August, although the regional Covid risk tier system, that remains in place until tomorrow, allowed for local areas to advise shielding if deemed necessary.
Following the latest update, patients who should automatically be included on the shielding list include:
- solid organ transplant recipients
- those with specific cancers:
- people with cancer who are undergoing active chemotherapy
- people with lung cancer who are undergoing radical radiotherapy
- people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
- people having immunotherapy or other continuing antibody treatments for cancer
- people having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
- people who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppression drugs
- those with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
- those with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)
- those on immunosuppression therapies sufficient to significantly increase risk of infection
- adults with Down’s syndrome
- adults on dialysis or with chronic kidney disease (stage 5)
- women who are pregnant with significant heart disease, congenital or acquired
- other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decisions