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Introduction

Shielding was initially introduced between March and August when the virus was new and the Chief Medical Officer for Wales advised those most at risk to serious harm from coronavirus to stay at home to protect themselves. Since the introduction of shielding, many new safety measures have been introduced in our communities and workplaces, which have reduced the need for such restrictive advice. Asking people to shield at home for a considerable amount of time can cause harm to mental and physical health and so we will not ask people to shield again unless it is absolutely necessary. 

This new 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 shielding advice.

The Shielding Patients List is being maintained so that we can write again to this group with any updates or if the advice on shielding changes.

Frequently Asked Questions on shielding can be found here.

Who this guidance is for

This guidance is for people, including children, who are extremely vulnerable to developing serious illness if they are exposed to coronavirus because they have a particular serious underlying health condition (these are listed below).

The guidance is also for family and friends of people classified as extremely vulnerable, who want guidance on how to keep their friend/family member safe.

What has changed

We have seen an increase in cases across Wales, but this has not changed the specific advice from the Chief Medical Officer for Wales to those on the Shielding Patient List. 

A letter from the Chief Medical Officer for Wales has been sent to those on the Shielding Patient List providing the latest information and advice. Read a copy of the letter. There is an easy read version of the letter available.

If you have a learning disability and need some support understanding the letter, you can contact the Wales Learning Disability Helpline on 0808 8000 300 – it is free and is open from 9am to 5pm Monday – Friday, including bank holidays (closed on weekends).

You can also email helpline.wales@mencap.org.uk.

What do we mean by 'extremely vulnerable'?

Extremely vulnerable refers to people in Wales who have one of a very specific list of pre-existing and long-term serious health conditions.

Based on what we know so far the impact of their pre-existing, long-term health condition on their immune system puts them at high risk of serious illness if they are exposed to coronavirus.

People in the extremely vulnerable group include:

  1. Solid organ transplant recipients
  2. People with specific cancers:
    • People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
    • 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 which 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
  3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe Chronic Obstructive Pulmonary Disease (COPD)
  4. People with severe single organ disease (e.g. Liver, Cardio, Renal, Neurological).
  5. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as Severe Combined Immunodeficiency (SCID), homozygous sickle cell).
  6. People on immunosuppression therapies sufficient to significantly increase risk of infection.
  7. Adults with Down’s syndrome.
  8. Pregnant women with significant heart disease, congenital or acquired.

If you think there are clinical reasons why you should be added to the Shielding Patient List, you should discuss this with your GP or hospital clinician. They are able to add people to the shielding patient list if it is clinically appropriate to do so.

How to protect yourself

You should follow the same rules as the rest of the population in Wales as these are designed to minimise spread of the virus, but also take extra precautions by:

  • Keeping contacts to a minimum. At present most cases are being passed within families and close friends.
  • Staying 2 metres or 3 steps away from people you do not live with inside or outside (where permitted).
  • Washing your hands regularly with soap and water for 20 seconds each time, or use hand sanitiser if hand washing facilities are not available.
  • Cleaning surfaces regularly and avoid touching surfaces others have touched.
  • Planning ahead before going out. Consider what time of day you
    go out and where you are visiting e.g. avoid supermarkets
    during peak times.
  • Shopping online - you can access priority supermarket delivery slots.
  • Working from home, where you can. In a work environment review
    any risk assessment with your employer to ensure all COVID safety
    measures are being observed. Discuss start and finish times to help
    you avoid using public transport at peak times.
  • If you do need to travel, for short distances, we would encourage you to walk or cycle, as this is not only good exercise but it also means you are outside, which is generally lower risk.
  • For longer journeys, or if you cannot walk or cycle, consider what you can do to minimise the number of people you come into close contact with e.g. avoid sharing a car with another person outside your household.

Other things you could do to stay healthy

  • Eat healthily and take regular exercise.
  • Remember to take any medication your doctor has told you to take.
  • Having a flu vaccine every year is one of the best ways to protect yourself.
  • It is extremely important you have your flu vaccine this autumn. Your household contacts should also have a flu vaccine as that will help give you extra protection. GP surgeries and community pharmacies have made sure it is safe for you and your household contacts to be vaccinated.
  • It is advised you consider taking 10 micrograms of vitamin D a day to keep your bones and muscles healthy. This is because you may not be getting enough vitamin D from sunlight if you're indoors most of the day.

If you develop symptoms of coronavirus (COVID-19)

If you develop any of these symptoms, however mild, you are advised to book a test immediately.

  • a high temperature (above 37.8 °C)
  • new and continuous cough
  • loss of or change to your normal sense of smell or taste

Mental health and wellbeing

You may feel anxious or frightened and taking care of your mental and physical wellbeing is important. These are some ideas about how you can do that:

  • Noticing how you are doing and thinking about if you can do anything differently. Thinking about ways to take care of your wellbeing can help.
  • Not judging yourself when you are having a hard day. There are different ways you may be able to reassure yourself. Why not try some calming activities, such as relaxation exercises or talking to others.
  • Focusing on what you can control, like your thoughts and behaviours. This will have a big impact on how you are feeling.
  • Connecting with others. Reach out and ask for help from friends and family or from local organisations.

There are also services to support you and others you might be worried about. Talking about worries and problems can make things easier.

There are a number of helplines and information services that provide guidance and information tailored for people with particular health conditions. Further information on looking after both your physical and mental health and wellbeing is available on the Public Health Wales website. For those with specific health conditions or requirements click on the 'Charity and Support Organisation Directory’. 

ACTivate Your Life is a four session taught course that aims to teach people about stress and suffering caused by emotional issues, like worry, or chronic pain. To start go to phw.nhs.wales/activateyourlife.

SilverCloud is an online course which offers support for anxiety, depression, and much more, all based on Cognitive Behavioural Therapy (CBT). You can sign up at nhswales.silvercloudhealth.com/signup/.

CALL Mental Health Listening Line provides a confidential mental health listening and emotional support line which is open 24/7. CALL can also signpost to support in local communities and a range of online information. Call 0800132737, text “help” to 81066 or visit callhelpline.org.uk/.

Mind Active Monitoring provides six weeks guided self-help for, anxiety, depression, self-esteem, and more. To get started, talk to your GP, any other health professional, or sign up directly at: https://www.mind.org.uk/get-involved/active-monitoring-sign-up/active-monitoring-form/.

The Young Person’s Mental Health Toolkit links young people, aged 11 to 25, to websites, apps, helplines, and more to build resilience. You can access the toolkit at bit.ly/ypmhten.

If you are still struggling after several weeks and it is affecting your daily life, please contact NHS Direct Wales or call 111.

Work and Employment

Where possible you should work from home. Employers are under a duty to take all reasonable measures to minimise the spread of coronavirus, and therefore if you cannot work from home you can still go to work. Your employer should be able to explain to you the measures they have put in place to keep you safe at work.

A workplace risk assessment tool has been developed to help people working to see if they are at higher risk of developing more serious symptoms if they come into contact with coronavirus. It helps people to consider their personal risk factors for coronavirus and suggests how to stay safe. Those who were previously shielding are automatically scored 7 and placed in the Very High Risk group in the tool, which recognises the range and complexity of conditions in this category. This approach recognises that you will need a further discussion with your line manager to consider your personal risk and workplace setting, this may also need to involve Occupational Health to determine if it safe to return to work.

Your employer should help you to transition back to work safely and must take all reasonable measures to minimise exposure to coronavirus by ensuring a 2 metre distance is maintained between workers in your workplace (if you can’t work from home). The Welsh Government has already issued guidance to employers on taking measures to make the workplace safe

Employers should be mindful of the particular needs of different groups of workers or individuals.

It is breaking the law to discriminate, directly or indirectly, against anyone because of a protected characteristic such as age, sex or disability, race or ethnicity.

Employers also have particular responsibilities towards disabled workers and those who are new or expectant mothers.

You can get advice on your specific situation and your employment rights by visiting the Acas website or calling the Acas helpline, 0300 123 1100.

If you feel that you have been treated unfairly by your employer, or somebody who gives you a service, then the Equality Advisory and Support Service (EASS) offers a free advice service which you can access by calling 0808 800 0082, by text phone on 0808 800 0084 or by visiting their website: www.equalityadvisoryservice.com

If you have concerns about your health and safety at work, you can raise them with any union safety representatives, or ultimately with the organisation with responsibility for enforcement in your workplace, either the Health and Safety Executive or your local authority.

Access to Work is a publicly funded employment support programme that aims to help more disabled people start or stay in work. It can provide practical and financial support for people who have a disability or long term physical or mental health condition. Support can be provided where someone needs help or adaptations beyond reasonable adjustments.

To find out more about Access to Work:

For information on financial assistance available to you please visit Understanding Universal Credit (gov.uk)

Children and Young People

UK Chief Medical Officers have previously issued a statement saying:

  • there is clear evidence of a very low rate of severe disease in children of primary and secondary school ages compared to adults, even if they catch coronavirus 
  • there is clear evidence from many studies that the great majority of children and teenagers who catch coronavirus have mild symptoms or no symptoms at all.

Children and young people who were previously advised to shield were identified on a precautionary basis, at a stage when we had less data on the effects of coronavirus in children than we do now. Based on our better understanding of coronavirus, the great majority have now been advised they do not need to shield if this is advised again in the future, and that they should return to school.

The Welsh Government has produced operational guidance for schools and other settings on making sites safe for staff and learners. This can be found at: Operational guidance for schools and settings for the autumn term.

Doctors have been asked to review the records of children who were under 18 on 16th August 2020 to check whether they should remain on the Shielding Patients List.  A letter will be issued with the outcome of this review. In some cases doctors may need to speak with you about this and will contact you directly. Children will remain on the Shielding Patient List unless they are told they have been taken off it.

Care and Support

Carers or support workers who support you with your everyday needs can continue to visit you, unless they have signs of coronavirus.  All carers or support workers must wash their hands with soap and water for 20 seconds when they enter your home and often while they are in your home.

It is a good idea to speak to your carers about what happens if one of them becomes unwell, and consider a back-up plan. If you don’t have friends or family who can help you, there are local community groups who may be able to help. If you can’t access a local community group, you can contact your local authority for advice – contact details for each local authority are included in the letter from the Chief Medical Officer for Wales.

If you are caring for someone who is extremely vulnerable, you can find out about different sources of support that could be used and access further advice on creating a contingency plan. This is available from Carers UK.

Those living in care home settings may still be required to comply with other restrictions as a result of the care home visitors guidance available at: Visits to care homes: guidance for providers. This guidance will continue to be reviewed, to remain consistent with the wider restrictions.

Guidance on how people in supported living can see family and friends and stay safe with their support and care workers is also available.

If you are unable to go shopping yourself or receive support from friends, relatives, neighbours or volunteers, priority supermarket delivery slots are available to you online.

Many supermarkets offer food boxes you can order for delivery to your door.  Most have also introduced various e-payment methods to remove the need for access to cash if other people are shopping for you.  Find out more about alternative options.

Although our National Prescription Delivery Scheme and Royal Mail Service ended on 30 September, following the pause in shielding arrangements on 16 August community pharmacies continue to prioritise medicines delivery slots for those who have the greatest need. If you have someone who can pick up your medicines please ask them to do so.  If you no longer need them to be delivered please contact your pharmacy to inform them.

There is also a service available if you, or someone you know, is affected by Coronavirus (COVID-19) and needs additional support. This will help you to find information for a wide range of matters, from paying bills to finding somewhere to live.

If you need support from a volunteer or voluntary organisations your local County Voluntary Council will be able to put you in touch with organisations that might be able to help.

Hospital and GP appointments

GP appointments continue to be available, though initially they may be provided by phone, email or online. If you need to be seen in person, your GP practice will contact you to let you know what you should do. It is very important you continue to attend appointments and seek help for urgent medical issues.

Your hospital or clinic will contact you if any changes need to be made to your care or treatment. Please phone your hospital or clinic if you have any questions about your appointment.