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Introduction

People considered as ‘extremely vulnerable’ were advised by the Chief Medical Officer for Wales to take extra precautions during the peak of the pandemic in Wales i.e. ‘shielding’.

Shielding was first introduced at the start of the pandemic in March.

What has changed

Those who have previously followed shielding advice no longer need to do so. You can now follow the same rules as the rest of the population in Wales. This means:

  • You no longer need to stay 2 metres or 3 steps away from people you live with or who are part of your extended household (where permitted)
  • You can now go to work, if you cannot work from home, as long as the business is COVID secure (has taken reasonable measures to minimise risk to employees)
  • Children who have been shielding can attend school when school
  • You can now go out for any reason, including going to shops to buy food but you should stay 2 metres or 3 steps from other people.

As part of the support arrangements food boxes will end, but priority supermarket slots will continue to be available and medicine deliveries will be available via the National Volunteer Prescription Delivery Scheme until the end of September.

A letter from the Chief Medical Officer for Wales has been sent providing the latest information and advice. View a copy of the letter.

Who is this guidance for?

This guidance is for people, including children, who are at high risk of developing serious illness if they are exposed to coronavirus (COVID-19) because they have a particular serious underlying health condition (these are listed below).

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 this 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. Pregnant women with significant heart disease, congenital or acquired.
  8. Children up to the age of 18 with significant heart disease, congenital or acquired.

If you believe you fall into one of the categories of extremely vulnerable people listed above and you have not received a letter, you should discuss your concerns with your GP or hospital doctor. 

Things you should be doing to stay safe

  • Do keep 2 metres or three steps away from other people outside your home or extended household (where permitted).
  • Do follow the latest government advice on face coverings
  • Do regularly wash your hands with soap and water for 20 seconds.
  • Do plan ahead. Think about the availability of places to rest when going for a walk, or toilet facilities when further away from home. Take hand sanitiser in case hand washing facilities are not available.
  • Do work from home if you can or return to your workplace if it is COVID secure (has taken reasonable measures to minimise risk to employees).
  • Do contact your local supermarket for priority online shopping if you do not feel ready to do your own food shopping yet. If you do go to a supermarket, choose quieter times of the day.
  • Do use telephone or online services to contact your GP, pharmacy or other day-to-day services.
  • Do contact your local council if you have no one who can help you. The number is at the end of this letter.

Things you should not be doing to stay safe

  • Do not get close to anyone who is showing signs of coronavirus. These could be any or all of the following: high temperature (above 37.8 °C), a new and continuous cough, a loss of taste or smell.
  • Do not take unnecessary risks, such as attending large gatherings indoors where physical distancing is not possible.
  • Do not go to your GP or hospital without phoning first. If you need to contact the NHS you should let them know you have been shielding.

What we will do if COVID-19 cases rise in Wales

We will keep a record of everyone on the shielding patients list should we need to ask anyone to shield again in future.

If the Chief Medical Officer for Wales’ advice changes for your area we will communicate with the public via local radio and television and if shielding is necessary he will write to you again. 

Going forward we want to have a better understanding of each individual’s personal risk. We are currently working together with the other UK nations to develop a tool that will allow doctors to assess an individual’s risk and what actions they should take to help lower the risk.

Work and employment

As shielding advice has been paused people who have been shielding will no longer be eligible for Statutory Sick Pay (SSP) on the basis of being advised to shield.

You should continue to work from home if possible, however you can return to work if your workplace is COVID Secure.

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 2m 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.

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 responsibility for enforcement in your workplace, either the Health and Safety Executive or your local authority.

If you are self-employed support is available through the Self-employment Income Support Scheme.

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. Call the Access to Work helpline on 0800 121 7479.

For information on financial assistance available to you please visit Understanding Universal Credit on GOV.UK.

Children and young people

In the same way as adults, children and young people no longer need to shield which means they can go back to school or college/university.

There is also strong evidence that suggests many children and young people do not need to shield at any time because, in general, children and young people have a much lower risk of severe illness from COVID-19.

There are around 5,000 children and young people on the Shielded Patients List in Wales.

We expect that the majority of children will be removed from this list. This means they would not be asked to shield again in the future. We expect that only those on certain treatments, such as for cancer care or those at risk of severe infection due to an immunodeficiency will stay on this shielding list and so may be advised to shield again in the future.

Your child’s paediatrician or GP will notify you whether your child should remain on the Shielding Patients List.

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

Support

Food box deliveries ended when shielding paused, however if you still need support and you do not have friends, family or neighbours to help you, you should contact your local council.

Many supermarkets also 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.  You can find out more on alternative options here.

The National Volunteer Prescription Delivery Scheme will be available until the end of September.  

We are asking community pharmacies to ensure that they prioritise medicines delivery slots for those who have the greatest need. If you have someone who can pick up your medicines or 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.

Hospital and GP appointments

Wherever possible, GP appointments will continue to 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. 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.  

It is recommended that you should wear a face mask when you need to visit your GP surgery or hospital.  If you do not have one, you can ask for one to be provided to you on arrival.

Advice for visitors, including those who are providing care for you

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.

Advice for informal carers who provide care for someone who is extremely vulnerable

If you are caring for someone who is extremely vulnerable, there are some simple steps that you can take to protect them and reduce their risk of being exposed to coronavirus:

  • Only care that is essential should be provided.
  • Wash your hands on arrival at their home and often whilst there, using soap and water for at least 20 seconds, or use hand sanitiser.
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze.
  • Put used tissues in the bin immediately and wash your hands afterwards.
  • Do not visit or provide care if you are unwell, but make alternative arrangements for their care. 
  • Provide information on who they should call if they feel unwell, how to use the online coronavirus service, and leave the 111 number prominently displayed.
  • Find out about different sources of support that could be used and access further advice on creating a contingency plan which is available from Carers UK.
  • Look after your own well-being and physical health during this time. Further information on this is available further below.

Advice for those living in a care home setting

Those living in care home settings may still be required to comply with other restrictions as a result of the care home visitors guidance.  This guidance will continue to be reviewed, consistent with the wider lockdown restrictions.

Mental health and wellbeing

As you emerge from shielding you may feel anxious or frightened.

Taking care of your mental 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.
  • Take it one step at a time. Plan small things you can do to come out from the isolation of shielding. A short walk with a friend or a visit to a small shop to build your confidence. 
  • 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. 

If you are receiving services for your mental health, learning disability or autism and are worried about the impact of isolation, please contact your keyworker/care coordinator or provider to review your care plan. If you have additional needs please contact your key worker or care coordinator to develop a safety or crisis plan.

If you have a learning disability and need some support understanding the shielding letter you can read the easy read version or contact the Wales Learning Disability Helpline on 0808 8000 300 – it is free to phone and is open from 9am to 5pm every day including bank holidays. You can also email helpline.wales@mencap.org.uk

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. A list of organisations providing such services is available on the PHW website - click on the 'Charity and Support Organisation Directory for those with specific health conditions or requirements. 

The C.A.L.L. Helpline is a dedicated mental health helpline for Wales. It provides confidential listening and emotional support and can help you contact support in your local area, including voluntary and charitable organisations. It is available on 0800 132 737, or by texting ‘help’ to 81066. Alternatively visit the C.A.L.L. website.

Further information on looking after your mental health and wellbeing is available on the Public Health Wales website.  

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

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