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Introduction

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 has been updated to support the clinically extremely vulnerable in protecting themselves from exposure to coronavirus as there are high levels of coronavirus circulating in communities across Wales and we are concerned about the transmissibility of new variants.

The Shielding Patient List has been maintained so that we can write again to this group with any updates or if the advice changes. As the new advice from 22nd December 2020 represented a change, we wrote again directly to people on the Shielding Patient List with advice on how to keep safe.

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

The advice to those who are Clinically Extremely Vulnerable has changed. You are advised that you should no longer attend work or school outside the home. We have sent a letter to everyone on the Shielding Patient List  confirming this advice. A version of the letter can be viewed here.

The information in the letter is also available in easy read.

We know long periods of isolation can be harmful for mental and physical health, therefore you can remain part of a support bubble, as long as you take care. You are encouraged to still go outside to exercise and attend medical appointments.

Everyone in Wales is currently subject to regulations in place at alert level 4 and therefore must stay at home as much as possible.

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

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

  • Keeping contacts to a minimum. Use technology to stay in contact with family, friends, neighbours or volunteers.
  • Staying 2 metres or 3 steps away from people you do not live with.
  • Washing your hands regularly with soap and water for 20 seconds each time, or use hand sanitiser if hand washing facilities are not available.
  • Avoid touching your face and wear a face covering where required
  • Keep your home well ventilated
  • Cleaning surfaces regularly and avoid touching surfaces others have touched.

You are also advised to avoid using public transport and avoid sharing a car with anyone you don’t live with or have formed a support bubble with.

Other things you could do to stay healthy

  • Eat healthily and take regular exercise, for example go for a walk outdoors at quieter times of the day
  • 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.

COVID-19 Vaccine

The Welsh Government is committed to ensuring everyone on the Shielding Patient List (16 years and over) receives their first dose of the COVID-19 vaccine by the middle of February. You will be invited to a dedicated clinic, so to help the NHS, please wait to be invited. There will be no need to apply for or ask GPs or pharmacists for the vaccination, as invitation will be automatic. Please do not call your surgery or hospital.

Even if you have had both doses of the vaccine, you should continue to follow the advice not to attend work or school outside the home until further notice, as we continue to assess the impact of vaccination among all groups.

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.  

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

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. 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 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

You are strongly advised to work from home because the risk of exposure to the virus is significant. If you cannot work from home, then you should not attend work. This is particularly the case for those whose work requires them to be in regular or sustained contact with other people, or where individuals share a poorly ventilated workspace for long periods.

You may want to speak to your employer about taking on an alternative role to enable you to work from home if possible.

If you cannot make alternative arrangements, your employer may be able to furlough you under the Coronavirus Job Retention Scheme, which has been extended until the end of April 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 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

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. Doctors have therefore 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.

If you have already discussed this with your child’s doctors and they have confirmed your child is still considered clinically extremely vulnerable, your child should not attend school.

Children and young people in the household who are not clinically extremely vulnerable should continue to attend school. Children and young people whose parents or carers are clinically extremely vulnerable should also continue to go to school.

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 your 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.

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.

Avoid going to the shops yourself. We advise you 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. Find out more about alternative options.

Although our National Prescription Delivery Scheme and Royal Mail Service ended on 30 September, 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.

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