What is a shielding letter? Do I need one?

Non-urgent advice: Source Links

NHS | Gov.uk | NHS England Shielding FAQ

Some charities and organisations have worked with the NHS to produce specific advice about coronavirus.

Asthma – Asthma UK: coronavirus (COVID-19)

Other lung conditions, such as COPD – British Lung Foundation: coronavirus and COVID-19

Joint and muscle conditions, such as arthritis – Versus Arthritis: coronavirus (COVID-19)

Heart disease – British Heart Foundation: coronavirus – what it means for you if you have heart or circulatory disease

Stroke – Stroke Association: information on coronavirus for stroke survivors

Some people with certain conditions may be at higher risk of getting a severe illness from coronavirus. Those groups of people are advised to follow shielding measures to keep themselves safe. 

We’re receiving a lot of queries regarding shielding. We’ve collated information from several of our guidelines that you might find helpful that hopefully answers the more commonly asked 

Please note that there is a large volume of text and we have tried to condense this as much as possible:

Topics covered:

  1. What is shielding?
  2. What is a shielding letter?
  3. Do I need a shielding letter? Who needs it?
  4. I have a shielding letter. What about those that live with me?
  5. I have one of the listed medical conditions that suggests I belong in the vulnerable group, but I haven’t received my letter?
  6. I HAVEN’T got one of the listed medical conditions that would suggest I belong in the vulnerable group. However, I think I should still have a shielding letter?
  7. I’m asthmatic, but it is NOT severe. Should I have a letter?
  8. I have been told that I am not considered to be at highest clinical risk, but I still want to be in the shielding group. What should I do?
  9. How to protect yourself from coronavirus

1. What is shielding?

Shielding is a way protect people who are extremely vulnerable from coming into contact with coronavirus by minimising all interaction between them and other people.

 It is intended for use in situations where the extremely vulnerable person is living in their own home, with or without additional support. This includes the extremely clinically vulnerable people living in long-term care facilities, either for the elderly or persons with special needs.

Shielding is a measure to protect people who are clinically extremely vulnerable by minimising all interaction between those who are extremely vulnerable and others. The UK Government are strongly advising people with serious underlying health conditions, which put them at very high risk of severe illness from coronavirus (COVID-19), to rigorously follow shielding measures in order to keep themselves safe.

The measures are:

  1. Strictly avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough.
  2. Do not leave your house.
  3. Do not attend any gatherings. This includes gatherings of friends and families in private spaces, for example, family homes, weddings and religious services.
  4. Do not go out for shopping, leisure or travel and, when arranging food or medication deliveries, these should be left at the door to minimise contact.
  5. Keep in touch using remote technology such as phone, internet, and social media.

Do use telephone or online services to contact your GP or other essential services.

We know that stopping these activities will be difficult. You should try to identify ways of staying in touch with others and participating in your normal activities remotely from your home. However, you must not participate in alternative activities if they involve any contact with other people.

2. What is a shielding letter?

This is a letter that you may have received a letter already if you have been identified, according to current guidelines/criteria, as belonging to the extremely vulnerable group

3. Do I need a shielding letter? Who needs it?

Current government advice are available here:

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

People falling into this extremely vulnerable group include:

  1. Solid organ transplant recipients.

  2. People with specific cancers:
    • people with cancer who are undergoing active chemotherapy
    • people with lung cancer who are undergoing radical radiotherapy
    • 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 COPD.

  4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).

  5. People on immunosuppression therapies sufficient to significantly increase risk of infection.

  6. Women who are pregnant with significant heart disease, congenital or acquired.

Shielding is for your personal protection. It is your choice to decide whether to follow the measures the government advise. Individuals who have been given a prognosis of less than 6 months to live, and some others in special circumstances, could decide not to undertake shielding. This will be a deeply personal decision.

If you have an underlying health condition listed above, you are at very high risk of severe illness as a result of coronavirus (COVID-19) requiring admission to hospital.

Shielding is a practice used to protect extremely vulnerable people from coming into contact with coronavirus.

You are strongly advised to stay at home at all times and avoid any face-to-face contact for a period of at least 12 weeks from the day you receive your letter. Please note that this period of time could change.

If you think you have developed symptoms of COVID-19 such as a new, continuous cough or fever, seek clinical advice using the NHS 111 online coronavirus service or call NHS 111. Do this as soon as you get symptoms.

If you have someone else living with you, they are not required to adopt these protective shielding measures for themselves. They should do what they can to support you in shielding and they should stringently follow guidance on social distancing, reducing their contact outside the home. If you care for but don’t actually live with someone who is extremely vulnerable, you should still stringently follow guidance on social distancing.

4. I have a shielding letter. What about those that live with me?

What should you do if you have someone else living with you?

While the rest of your household are not required to adopt these protective shielding measures for themselves, we would expect them to do what they can to support you in shielding and to stringently follow guidance on social distancing.

  1. Minimise as much as possible the time other family members spend in shared spaces such as kitchens, bathrooms and sitting areas, and keep shared spaces well ventilated.
  2. Aim to keep 2 metres (3 steps) away from people you live with and encourage them to sleep in a different bed where possible. If you can, you should use a separate bathroom from the rest of the household. Make sure you use separate towels from the other people in your house, both for drying themselves after bathing or showering and for hand-hygiene purposes.
  3. If you do share a toilet and bathroom with others, it is important that they are cleaned after use every time (for example, wiping surfaces you have come into contact with). Another tip is to consider drawing up a rota for bathing, with you using the facilities first.
  4. If you share a kitchen with others, avoid using it while they are present. If you can, you should take your meals back to your room to eat. If you have one, use a dishwasher to clean and dry the family’s used crockery and cutlery. If this is not possible, wash them using your usual washing up liquid and warm water and dry them thoroughly. If you are using your own utensils, remember to use a separate tea towel for drying these.
  5. We understand that it will be difficult for some people to separate themselves from others at home. You should do your very best to follow this guidance and everyone in your household should regularly wash their hands, avoid touching their face, and clean frequently touched surfaces.

If the rest of your household stringently follow 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 shield alongside you.

5. I have one of the listed medical conditions that suggests I belong in the vulnerable group, but I haven’t received my letter?

If you have one of the listed medical conditions above but haven’t received your letter, please contact the surgery. 

We will do our best to review your clinical information. Please be aware that it may take longer than usual due to the added demands due to the current global pandemic.

6. I haven’t got one of the listed medical conditions that would suggest I belong in the vulnerable group. However, I think I should still have a shielding letter?

Most people that are within the highest clinical risk group have already received a letter through the post. However, we are aware that central records may not capture everybody in this group. The process for identifying additional people who meet the clinical criteria but have not been identified through the initial central process is continuing.

People identified through this process will receive a letter shortly. This list is also being reviewed by GPs and hospital clinicians.
In the meantime, please continue to follow the social distancing guidance, as published on 23 March 2020.

If you think you should be considered as highest clinical risk, please contact us to tell us why you need a letter. We will do our best to review your clinical information. Please be aware that it may take longer than usual due to the added demands due to the current global pandemic.

7. I’m asthmatic, but it is not severe. Should I have a letter?

As of 06/04/20, the local guidelines informed us that:

The only asthmatic groups requiring shield are those who are taking ALL THREE OF:

  1. a steroid preventer inhaler (at any dose)
  2. another preventer medicine (e.g. you are on a combination inhaler, or take a medicine such as formoterol or salmeterol, or tiotropium as well as your steroid inhaler, or if you are taking montelukast)
  3. regular or continuous oral steroids (which means you had 4 or more prescriptions for prednisolone between July and December 2019)
  • Or you have been admitted to hospital in the last 12 months for your asthma
  • Or you have ever been admitted to an intensive care unit for your asthma.

8. I have been told that I am not considered to be at highest clinical risk, but I still want to be in the shielding group. What should I do?

If you are not considered by healthcare professionals to be at the highest risk but nevertheless wish to follow ‘shielding’ advice then this is a personal decision that you are, of course, free to make and to follow as far as possible.

However, we suggest that people who are not included in the shielding group but who are on the broader list of conditions (below) follow strict social distancing measures instead.

This is because shielding is a severe intervention which may be difficult to adhere to for such a long period of time, and the additional benefit gained from this extra measure needs to be weighed against any impact on your mental and physical wellbeing from a significant loss of social contact and needing to stay in the home for a long period of time. We do not wish to advise anybody to follow these measures unless absolutely necessary. We also cannot provide a dedicated food and medicine delivery service to those outside the shielding programme.

People who are considered in a wider vulnerable group (sometimes referred to as the ‘flu group’) but are not in the highest clinical risk registry are: 

  • aged 70 or older (regardless of medical conditions)
  • under 70 with an underlying health condition listed below (i.e. for adults this usually anyone instructed to get a flu jab as an adult each year on medical grounds):
    • chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
    • chronic heart disease, such as heart failure
    • chronic kidney disease
    • chronic liver disease, such as hepatitis
    • chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
    • diabetes problems with your spleen – for example, sickle cell disease or if you have had your spleen removed
    • a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy
    • being seriously overweight (a BMI of 40 or above)
    • those who are pregnant

9. How to protect yourself from coronavirus

People most at risk from coronavirus need to take extra steps to avoid getting it. This is known as “shielding”.

It’s recommended you follow this advice for at least 12 weeks.

Do

  • stay at home at all times – do not leave your home to buy food, collect medicine or exercise

  • stay at least 2 metres (3 steps) away from other people in your home as much as possible

  • get food and medicine delivered and left outside your door – ask friends and family to help or register at GOV.UK to get coronavirus support if you need it

  • prepare a hospital bag, including a list of the medicines you’re taking, in case you need to go into hospital

  • wash your hands with soap and water often – do this for at least 20 seconds

  • make sure anyone who comes into your home washes their hands with soap and water for 20 seconds

  • use hand sanitiser gel if soap and water are not available

  • clean objects and surfaces you touch often (like door handles, kettles and phones) using your regular cleaning products

  • clean a shared bathroom each time you use it, for example by wiping the surfaces you have touched

Don’t

  • do not have visitors in your home, including friends and family, unless they’re providing essential care


  • do not stop taking any prescription medicines without speaking to your doctor

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