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Who this guidance is for

This guidance is for adults who are clinically 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 under What we mean by Clinically Extremely Vulnerable).

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.

Context

Shielding was initially introduced between March and August 2020 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. This guidance is updated regularly to support the clinically extremely vulnerable to protect themselves and minimise risk.

The advice is continuously reviewed and we write directly to people on the Shielding Patient List with advice on how to keep safe whenever there is a significant change.

What has changed

We now know a lot more about the effects of the virus than we did at the beginning of the pandemic. Evidence shows that children and young people are very unlikely to become seriously unwell if they get COVID 19, even if they have other health conditions.

As a result the four UK CMOs have recommended that those in this age group are no longer considered clinically extremely vulnerable, and are to be removed from the shielding patient list. All children and young people on the shielding patient list will receive a letter from the Chief Medical Officer with more information about this.

The only exception is those young people who will be 18 years of age before 31 December 2021. These young people will be retained on the shielding patient list as they will shortly be adults.

For all adults on the shielding patient list, shielding advice was paused on 1 April 2021. If you require additional care and support to help you stay safe and well, there is further advice below.

People on the shielding patient list must still follow the same rules as the rest of the population in Wales, but are also advised to take extra precautions to keep themselves safe from coronavirus.

A letter from the Chief Medical Officer for Wales was recently sent confirming the latest information and advice. The information in the letter is also available in an easy read format.

What if COVID-19 admissions to hospital and deaths rise again in Wales in the future?

Whilst we have seen an increase in the numbers of cases in Wales, this has not resulted in the same rise in people becoming very sick and needing to go to hospital or dying as we saw in the first and second wave. This is largely due to the success of the vaccination programme. Vaccines are very successful in protecting people from getting very sick in most cases. As the risk of becoming very sick is lower, it is not necessary to advise everyone on the shielding patient list to follow shielding measures at this time. Based on current evidence, it is not expected that there will be a need to reintroduce these measures again in the future.

How to protect yourself

Sticking to the basics remains the best way to protect yourself:

  • Keep contacts to a minimum
  • Meet others outside where possible
  • Ensure any enclosed areas are well ventilated.
  • Wash your hands regularly with soap and water for 20 seconds, or use hand sanitiser if hand washing facilities are not available
  • Stay two metres or three steps away from people you do not live with.
  • Avoid touching your face and wear a face covering where required.
  • Clean surfaces regularly and avoid touching surfaces others have touched

Further advice on how to protect yourself can be found in the ‘Socialising inside and outside the home’ section.

COVID-19 Vaccine

Everyone on the Shielding Patient List (16 years and over) has been invited to receive the COVID-19 vaccine.

Although the vast majority of the population, including the clinically extremely vulnerable, will be well protected by the vaccine, no vaccine is 100% effective and there is emerging evidence that suggests that some immunocompromised and immunosuppressed individuals may not respond as well to COVID-19 vaccines as others. However, all COVID-19 vaccines should offer some degree of protection. Therefore, it is really important that you have both your first and second dose of the coronavirus vaccine. A recent study from Public Health England, which looked at more than 1 million people in at-risk groups, found that people who are immunosuppressed are significantly better protected from symptomatic infection following the second dose of a COVID-19 vaccine.

We are continuing to work to better understand who is less well protected by the COVID-19 vaccines, and there are various studies underway that are looking at this issue.

The vaccine programme is still open and available for all eligible adults in Wales and it is never too late to arrange an appointment. Find out who to contact

Some people on the Shielding Patient List have been advised against having the vaccine by their own doctor. If you have received personal advice, you should follow the advice of your own doctor.

SMS (text) and Email Alerts

If you are on the Shielding Patient List and have been receiving letters, you can register for email or text alerts.You will receive an alert when the guidance to people on the Shielding Patient List changes significantly or when a related announcement is made. You will continue to receive any letters we send by post.

If you have followed the sign up process, please give us 10 days to acknowledge your request. If you do not hear from us by the 11th day there may be an issue with the details you have submitted. Please ensure you use a valid email address and/or telephone number and that the name, post code and Unique Reference Number match the details on your letter.

If you have already signed up and have any changes to make to your telephone or email address, please re-subscribe at the same link as above with your new details.

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 and follow the self-isolation guidance.

  • 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

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. Use technology and phone calls to stay in contact.

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 (on Public Health Wales) is a four session taught course that aims to teach people about stress and suffering caused by emotional issues, like worry, or chronic pain.

SilverCloud (on silvercloud.com) is an online course which offers support for anxiety, depression, and much more, all based on Cognitive Behavioural Therapy (CBT). 

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 the CALL website.

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 Active Monitoring Wales.

The Young Person’s Mental Health Toolkit links young people, aged 11 to 25, to websites, apps, helplines, and more to build resilience.

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

Work and employment

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

When planning a return to work, it is advisable to talk with your employer as early as possible about how employees are being kept safe.

Your employer should help you to transition back to work safely and must take all reasonable measures to minimise exposure to coronavirus.

You should complete a Risk Assessment with your employer to help consider your personal risk factors for Coronavirus (COVID-19). This tool helps you consider your personal risk factors for COVID-19 and suggests how to stay safe. 

Since shielding advice has been paused people who were shielding will no longer be eligible for Statutory Sick Pay (SSP) on the basis of being advised to follow shielding measures. However, if your doctor has advised that you should not return to work due to your health condition they will need to provide you with a fit note for the purposes of claiming SSP.

In certain circumstances your employer may still be able to furlough you under the Coronavirus Job Retention Scheme (on GOV.UK), which has been extended until the end of September 2021. You should have a conversation with your employer about whether this is possible.

You can get specific advice on any issues and also on 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 Equality Advisory and Support Service.

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 (on GOV.UK).

Children and young people

As our knowledge of COVID-19 has grown, we now know that very few children and young people are at highest risk of severe illness due to the virus. The Royal College of Paediatrics and Child Health (RCPCH) issued guidance on this in summer 2020 adopted by the 4 UK Chief Medical Officers.

Chief Medical Officers have continued to monitor the impact of COVID 19 on children and young people.  It is particularly important that we do not ask children and young people to shield when this is not necessary. This is because of the damage that isolation can cause, including the inability to meet with friends and family and not being able to attend school. Even when the advice to shield is paused, being described as ‘clinically extremely vulnerable’ can be very worrying.

Following a comprehensive review of evidence and studies commissioned by the UK Government with regard to susceptibility to Covid-19 infection, it was found that children and young people, including those originally considered to be clinically extremely vulnerable to the disease, are at very low risk of becoming seriously unwell or dying from infection with the virus.

As a result, the 4 UK Chief Medical Officers have indicated that children and young people are no longer considered clinically extremely vulnerable, and should be removed from the shielding patient list. A letter will be sent to all children and young people with more information about this decision.

Whilst all children and young people are being removed from the shielding patient list, there remains a small number in this group who may have been advised by their own specialists to isolate or reduce their social contact because of their medical condition or treatment. Where this is the case, children and young people are advised to continue to follow the advice of their own clinician.

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. Where possible the area of your home they are using should be kept well ventilated.

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.

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. This guidance will continue to be reviewed, to remain consistent with the wider restrictions.

If you do not have enough money to pay your bills, it is important to seek help and to do this as early as possible. Call Citizen’s Advice free on 03444 77 20 20 or visit the Citizens Advice website: www.citizensadvice.org.uk

Shopping and Medicines

You can go to the shops yourself, however if you do not feel comfortable doing so you should ask friends, relatives, neighbours or volunteers to go shopping for you.

Priority supermarket delivery slots are available to you online at the present time.  However, supermarkets now have much more capacity for deliveries so there is less need to have separate arrangements. These arrangements have already ended in some other areas of the UK.

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 on alternative options.

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.

Travel

If you need to use public transport, you must wear a face covering unless you are exempt. Consider travelling outside peak hours to reduce the number of people with whom you come into contact.

If you do travel, walk or cycle if you can. For longer journeys, or if you are unable to walk or cycle, try to minimise the number of people you come into close contact with and try to sit in a well ventilated area if possible.

Try to avoid car sharing with people from outside your household or extended household or where this is unavoidable, keep windows open for ventilation. Ensure that you use a face covering when using taxis.

Socialising inside and outside the home

You should follow the guidance on socialising inside and outside of the home with your friends and family according to the current alert level. You should also continue to consider the risks of close contact with others as the risk of catching or passing on COVID-19 is generally higher:

  • in crowded spaces, where there are more people who might be infectious; and
  • in enclosed indoor spaces where there is limited fresh air

You may wish to think particularly carefully about taking precautions when meeting others you do not usually meet with in order to reduce the risk of catching or spreading COVID-19. For example, you could:

  • meet outside if possible. The particles containing the virus that causes COVID-19 are quickly blown away which makes it less likely that they will be breathed in by another person
  • make sure the space is well ventilated if you meet inside; open windows and doors or take other action to let in plenty of fresh air.
  • wash your hands regularly and avoid touching your face.

What we mean by 'clinically extremely vulnerable'

Clinically 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 to date 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 clinically 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 list if it is clinically appropriate to do so.

There is a wider group people whose conditions mean they are at an increased risk, but are not considered clinically extremely vulnerable. If you are within this group you should be rigorous about following social distancing measures but otherwise follow the same advice as the general population.

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