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Who this guidance is for

This guidance is for people, including a small number of children, 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 in the context of the prevalence of the virus across Wales 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

As cases of the virus have reduced significantly across Wales the Chief Medical Officer has reviewed the advice to people who are clinically extremely vulnerable and recommended the advice to follow shielding measures, that had been in place since 22 December 2020, should be paused. This means, from 1 April, you can:

  • 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 following shielding measures can return to school when appropriate for their year group

We know there are associated harms when asking people to follow shielding measures and we must therefore only have this advice in place for as long as is absolutely necessary.

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 has been sent confirming this latest information and advice. The information in the letter is also available in an easy read format.

What if COVID-19 cases rise again in Wales in the future?

Although the advice to follow shielding measures will be paused after 31 March, we do need to be prepared to reinstate the advice in the future if needed.

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

How to protect yourself

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

  • Keep contacts to a minimum
  • 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
  • Ensure any enclosed areas are well ventilated.

COVID-19 Vaccine

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

If you have recently been added to the Shielding Patient List you will be prioritised for vaccination. Please allow approximately a week from the date of your letter to be invited, while systems are updated.

We are still learning about the protection the vaccine offers, particularly with new strains of the virus and so the public is advised to continue to follow social distancing and hand and surface hygiene advice strictly, even after vaccination.

The people you live with should continue to follow the public health rules and guidance as long as they are in place, including if you have received the vaccine and also if they have received the vaccine.  

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. This service is still being trialled, therefore 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 by ensuring a 2m distance is maintained between workers in your workplace (if you can’t work from home).

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. 

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 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.

As you are being advised not to attend your workplace, you may be eligible for Statutory Sick Pay (SSP). The letters sent to those on the shielding patient list can be used as evidence for the purposes of claiming SSP.

Members of your household who are not clinically extremely vulnerable should continue to attend work if they are unable to work from home.

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 last summer adopted by the Chief Medical Officer. Doctors have since been reviewing all children and young people who were initially identified as clinically extremely vulnerable to confirm whether they are still thought to be at highest risk.

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.

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.

If you are the sole or primary carer (unpaid) for a person designated clinically extremely vulnerable you are now eligible for a vaccine. Get a COVID-19 vaccine as an unpaid carer.

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

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.

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 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 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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