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Background and scope of guidance

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).

It is also for their families, friends and carers.

The guidance is for use by people who are shielding in their own home, or are in long-term care facilities.

We are strongly advising people with serious underlying health conditions, which put them at high risk of serious illness from coronavirus (COVID-19), to follow “shielding” measures to keep them safe. We will describe these measures in detail later.

“Shielding” means protecting those people who are extremely vulnerable to the serious complications of coronavirus because they have a particular existing health condition. 

The advice for those shielding to stay at home at all times has changed. This is because there are fewer people with coronavirus and so the risk of catching coronavirus has reduced. The risk of catching coronavirus when outside is low providing social distancing and good hygiene is strictly followed.

Those who have been shielding at home are now able to leave home to exercise or meet outside with people from another household. You should strictly follow social distancing (2 metres or 3 steps away from another person) and you should practice good hygiene (frequent hand washing for 20 seconds or using a hand sanitiser and avoiding touching things touched by others).

People should follow this advice until at least 16 August 2020. A letter is being sent to everyone in Wales who is shielding to tell them this and what to do next. The Chief Medical Officer will write again to those who are shielding advising what to do after 16 August 2020. Local authorities have been working closely with the Welsh Council for Voluntary Action (WCVA) to ensure all the arrangements to make sure support is available locally for people who are shielding.

What do we mean by 'extremely vulnerable'?

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

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.

We are asking this group of people to take a series of special measures, called "shielding", to protect themselves from getting ill.

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.

Shielding is for your protection. We strongly advise you to follow this guidance but it is your decision to make. This will be a deeply personal decision and we would advise you to speak to your family and friends about this, and with your healthcare professionals, if necessary.

You will receive a letter from the Welsh Government setting out the advice and sources of help and support in your local community. If you are employed, this is also proof that you will not be able to go to work while you are shielding and can be shared with your employer. If you are able to, you can work from home, if your job allows it. You will not need to get a fit note from your GP.

If you need help from the welfare system visit Universal Credit on GOV.UK.

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. 

We understand this is an anxious time and people considered extremely vulnerable will understandably have questions and concerns. Plans are being put into place to make sure you have a wide range of help and support.

How do I know if I’m in the extremely vulnerable group of people?

Everyone in the extremely vulnerable category will receive a letter from the Chief Medical Officer for Wales Dr Frank Atherton, setting out the steps you should take to protect your health. These are known as “shielding” measures.

The NHS has worked very hard on this list to check it contains the names of those people who are in the extremely vulnerable category.

GPs and hospital doctors have also been provided with a list of the people who have been sent letters to check against their patient lists. They can contact any additional high-risk people who may not have been identified to ensure they also receive the advice in the letters from the Chief Medical Officer.

What you need to know

If you have an underlying health condition listed above, you are at high risk of serious illness requiring hospital treatment if you catch coronavirus (COVID-19).

Shielding is used to protect people who are considered to be extremely vulnerable from being exposed to the virus. 

The advice for those shielding to stay at home at all times has changed. This is because there are fewer people with coronavirus and so the risk of catching coronavirus has reduced. The risk of catching coronavirus when outside is lower than inside providing social distancing and good hygiene is strictly followed. Those who have been shielding at home are now able to leave home to exercise or meet outside with people from another household following the guidance below.

You are strongly advised to only leave home to exercise outdoors or to meet outside with people from another household until at least 16 August 2020. You should strictly follow social distancing (2 metres or 3 steps away from another person) and you should practice good hygiene (frequent hand washing hands for at least 20 seconds or using a hand sanitiser and avoiding touching things touched by others). You should try to exercise outdoors at times when fewer other people are around to help further limit any risk.

Visits from carers or healthcare workers, who would normally come and help with your daily needs or social care, will be able to carry on as normal. But carers and care workers must stay away if they have any of the symptoms of coronavirus:

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

You may find this guidance on home care provision useful: COVID-19: guidance on home care provision on GOV.UK

Everyone coming into your home must wash their hands with soap and warm water for at least 20 seconds on arrival to your house, and frequently while they are in your home.

It will be a good idea to write a list of people – friends, family or a support network in your local community – who can help with your care if your main carer becomes unwell. You can also contact your local authority for advice and support (contact details are available in the letter).

If you think you have developed symptoms of COVID-19, seek clinical advice using the online coronavirus service or, if you do not have access to the internet, call 111. Do this as soon as you get symptoms.

If you live with someone, they do not need to practice the shielding measures but they do need to take extra steps to help protect you – it is very important they follow the current guidance about social distancing.

If you are caring for someone who is extremely vulnerable, you must follow the guidance on social distancing.

What do I do if I have been told to take “shielding” measures?

If you have an underlying health condition listed above, you are at high risk of serious illness requiring hospital treatment if you catch coronavirus (COVID-19).

Shielding will help to protect people who are extremely vulnerable people by reducing their contact with other people, and the risk of being exposed to coronavirus.

In practice, it means people who are extremely vulnerable should only leave home to exercise outdoors or to meet outside with people from another household. Inside their homes, if they live with others, they should continue to practice social distancing with other members of their household.

You are strongly advised to following this advice until at least 16 August 2020. The Chief Medical Officer will write again to those who are shielding advising what to do after 16 August 2020.

The actions are:

  1. Avoid any contact with anyone showing symptoms of coronavirus (these include a high temperature (above 37.8 °C) or new and continuous cough or loss of or change to your normal sense of smell or taste)
  2. Only leave home to exercise outdoors or to meet outside with people from another household but strictly follow social distancing (stay 2 metres or 3 steps away from other people) and practice good hygiene.
  3. Stay away from gatherings of large numbers of people, including weddings, other celebrations and religious services;
  4. Arrange for food and medication to be delivered to your home
  5. Keep in touch with other people using remote technology such as the phone, internet, and social media
  6. Use phone or online services to contact your GP or other essential services
  7. Regularly wash your hands with soap and warm water for 20 seconds, and make sure all carers or support workers who visit your home do the same.

We know shielding will be difficult. 

You should try to find ways of staying in touch with friends and family and taking part in your normal activities over the phone or the internet.

This advice will be in place until at least 16 August 2020. A letter is being sent to everyone in Wales who is shielding to tell them this and what to do next. The Chief Medical Officer will write again to those who are shielding advising what to do after 16 August 2020.

What should you do if you live with someone?

The rest of your household will not need to undertake these protective shielding measures if they do not have a serious underlying health condition (as listed earlier). But they will be there to support you, and they must follow guidance on social distancing.

  • Minimise the time you spend with others in shared spaces such as the kitchen, bathroom and sitting area, and keep the rooms you share well ventilated.
  • Aim to keep 2 metres (3 steps) away from others, and sleep in a separate bed where possible.
  • Use separate towels and bathrooms. If you share a bathroom, clean it after every use. Consider creating a rota for bathing, with you using the facilities first.
  • Avoid using the kitchen at the same time as others, and eat your meals in separate rooms. Ensure all kitchenware is cleaned thoroughly.

We know it will be difficult for some people to lead separate lives. Please follow this guidance and everyone must regularly wash their hands with soap and water for 20 seconds, avoid touching their face, and clean frequently touched surfaces.

If the rest of your household follows the advice on social distancing and minimise the risk of spreading the virus within the home by following the advice above, there is no need for them to also follow the shielding measure alongside you.

Good hygiene

Here are some simple guidelines to follow to help prevent the spread of airway and chest infections, including:

  • Wash your hands more often - with soap and water for at least 20 seconds, or use a hand sanitiser. Do this after you blow your nose, sneeze or cough, and before after you eat or handle food.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact with people who have symptoms
  • 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.

What should you do if you develop possible symptoms of coronavirus (COVID-19)?

If you develop any of the symptoms of COVID-19:

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

seek clinical advice using the online coronavirus service or, if you do not have access to the internet, call 111.

In an emergency, call 999 if you are seriously ill. Do not visit the GP, pharmacy, urgent care centre, or a hospital.

To help the NHS provide you with the best care if you need to go to hospital as a result of catching coronavirus, please prepare a single hospital bag. This should include your emergency contact, a list of the medications you take (including dose and frequency), any information on your planned care appointments and things you would need for an overnight stay (snacks, pyjamas, toothbrush, your medication etc). If you have an advanced care plan, please include that.

Ongoing support from health and social care

If you receive support from health and social care organisations, for example, if you have care provided by your local authority, this will continue as normal. Your health or social care provider will be asked to take additional precautions to make sure you are protected. The advice for formal carers is included in the home care provision guidance on GOV.UK.

Food

If you cannot order food shopping on the internet and do not have any support from family, friends, neighbours or support groups close by who can help you while you are shielding, you will be able to request a free weekly food box delivery. Each food box will contain enough food for one person shielding for a week – if two people in a household are shielding, you will be able to request two boxes.

To request a free weekly food box, please call the special number for your local authority, which is contained in the letter you received from the Chief Medical Officer.

The food box will be delivered directly to your home. Local authorities also have arrangements in place to help people who are in immediate need – before the deliveries begin.

The box will contain essential foods in packages and tins but only limited fresh produce. We are not able at the moment to meet people’s dietary needs including allergies. All the contents will be labelled so will need to be checked very carefully. We are looking to see if we can meet people’s dietary needs, including allergies, in the future, and hope to improve the variety.

A box will provide food and essentials for one person for one week. If there are two eligible people in the house, there will be two boxes.

Major supermarkets now have the details of all those who have received a shielding letter to enable them to prioritise internet orders for those who are shielding.

Medicines

If your prescription is not currently collected or delivered, you can arrange this by:

  • asking someone to pick up your prescription from the local pharmacy, (this is the best option, if possible)
  • contact your pharmacy to ask them for advice on how to get your medicines

Volunteers may support pharmacies to ensure medicines can be delivered to people’s homes – all volunteers will have been ID checked, and will have received training in infection prevention control and medicine delivery.

You may also need to arrange any specialist medication prescribed to you by your hospital care team to be collected or delivered to you.

What should you do if you have hospital and GP appointments during this period?

We are advising everyone to access appointments over the phone or internet, wherever possible. However, if you have a scheduled hospital or other medical appointment, talk to your GP or doctor to ensure you continue to receive the care you need. It is possible that your hospital may need to cancel or postpone some clinics and appointments.

What is the advice for visitors, including those who are providing care for you?

You should contact regular visitors to your home, such as friends and family to let them know that you are shielding and they should not come into your home during this time, unless they are providing essential care for you. Essential care includes things like help with washing, dressing, or feeding.

If you receive regular health or social care from an organisation, either through your local authority or paid for by yourself, inform your care providers that you are shielding, and agree a plan for continuing your care.

If you receive essential care from friends or family members, speak to your carers about extra precautions they can take to keep you safe.

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.

What is the 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.

How to look after your mental wellbeing

Shielding and distancing can be both boring and frustrating. You may find your mood and feelings are affected and you may feel low, worried, or have problems sleeping, and you might miss being outside and among other people. This is one of the reasons why we are now advising that those who are shielding can leave their home to exercise or meet outside with people from another household providing they strictly socially distance and practice good hygiene.

At times like these, it can be easy to fall into unhealthy patterns of behaviour which in turn can make you feel worse. There are simple things you can do that may help to stay mentally, and physically, active during this time, such as:

  • Spend time doing things you enjoy – this might include exercising outside, reading, cooking, other indoor hobbies or listening to/watching favourite radio or TV programmes.
  • Try to eat healthy, well-balanced meals, drink enough water, exercise regularly, and try to avoid smoking, alcohol and recreational drugs.

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

Constantly watching the news can make you feel more worried. If you think it is affecting you, try to limit the time you spend watching, reading, or listening to media coverage of the outbreak. It may help to only check the news at set times or limiting this to a couple of times a day. 

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.

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

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.

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

What steps can you take to stay connected with family and friends during this time?

Draw on support from friends, family and other support networks. Try to stay in touch with those around you over the phone, by post, or online.

Let people know how you would like to stay in touch and build that into your routine. This is also important in looking after your mental wellbeing and you may find it helpful to talk to them about how you are feeling, if you want to.

Remember, it is ok to share your concerns with others you trust, and in doing so you may end up providing support to them too. You may also want to contact the C.A.L.L. helpline on 0800 132 737, or by texting ‘help’ to 81066. Alternatively visit the C.A.L.L. website.

What is the advice for people living in long-term care facilities, either for the elderly or persons with special needs?

This advice also applies to extremely vulnerable people living in long-term care facilities.

Care providers should carefully discuss this advice with the families, carers and specialist doctors looking after residents to ensure this guidance is strictly followed.

What is the advice for parents and schools with extremely vulnerable children?

The advice also applies to extremely vulnerable children in mainstream and special schools.

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