Clinically extremely vulnerable receive updated guidance in line with new national restrictions

4 Nov 2020 03:16 PM

Further precautions advised on top of the tougher national measures being introduced, as cases continue to rise.

• new guidance published yesterday for the clinically extremely vulnerable on keeping safe under new national restrictions which came into force today
• group strongly advised to stay at home at all times, unless for exercise or doctors’ appointments
• range of support available, backed by over £32 million government funding for local councils

Clinically extremely vulnerable people in England yesterday received further guidance on keeping safe as the country introduces new national restrictions today, the government has announced.

The new advice details further precautions those in this group can take on top of the tougher national measures being introduced, as cases continue to rise across the country. Everyone not considered to be clinically extremely vulnerable will be expected to follow the new restrictions, such as staying at home unless shopping for food or exercising and not meeting up with people outside of the household.

The updated guidance, which clinically extremely vulnerable individuals are strongly urged to follow, includes:

• socialising: stay at home as much as possible, except to go outdoors to exercise or attend health appointments. People can exercise with those they live with or in their support bubble
• work: if people cannot work from home, they should not attend work. They may be eligible for Statutory Sick Pay, Employment and Support Allowance, Universal Credit or the Coronavirus Job Retention Scheme during this period of national measures. People in the same household who are not clinically extremely vulnerable can still attend work, in line with the new national restrictions
• school: as evidence has shown there is a very low risk of children becoming very unwell from COVID-19, most children originally on the shielded patient list no longer need to be and therefore can still attend school. If they are unsure, parents should contact their child’s usual GP or hospital clinician to check whether they should still be considered clinically extremely vulnerable. If a GP or clinician has advised that a child should remain on the shielded patient list, they are advised not to attend school. Children who live with someone who is clinically extremely vulnerable, but aren’t themselves, should still attend school
• going outside: avoid all non-essential travel – they should continue to travel to hospital and GP appointments unless told otherwise by their doctor. They are strongly advised not to go to any shops or to pharmacies

The government will also be providing over £32 million to upper tier councils in England to support the clinically extremely vulnerable over the next month. It will be used to provide support, such as access to food deliveries and signposting to local support of befriending services, to the most at risk and enable them to stay at home as much as possible over this short period.

Deputy Chief Medical Officer for England, Dr Jenny Harries yesterday said:

We have previously said that where the conditions of transmission of the infection alters significantly we would alert patients in relative regions.

With the prevalence of the virus continuing to increase across England and in places across the world, it’s right that we adjust our advice for the clinically extremely vulnerable accordingly so they can feel as safe as possible over the coming few weeks.

Our guidance for this group of individuals has always been advisory, but I would strongly urge all those who are clinically extremely vulnerable to take these extra precautions to keep themselves as safe as possible.

Individuals in this group will also be able to use an online service which will help people to request priority access to supermarket delivery slots and to inform their council they need help. NHS Volunteer Responders can also help with a regular, friendly phone call, and transport to and from medical appointments.

The clinically extremely vulnerable group includes those with reduced immune systems, for example due to organ transplants, or those with specific cancers or severe respiratory conditions, such as cystic fibrosis. The group list is updated regularly as patients’ conditions or the scientific evidence changes, so the majority will have received a letter previously from the NHS or their GP advising them of their inclusion.

Due to new evidence about groups more likely to be at risk of serious illness from COVID-19, those with chronic kidney disease (stage 5) and those undergoing dialysis, as well as adults with Down’s Syndrome, are also being added to the shielding patient list by the NHS.

Those with more general underlying health conditions or who are 70 or over may still be more vulnerable to COVID-19 than the general population, so are also advised to stay at home as much as possible, to carefully follow the rules and minimise contact with others.

The new national restrictions came into force as of yesterday and are set to be reviewed on 2 December.

Letters will be going out later this week to all those identified as clinically extremely vulnerable, providing them with further detail on the updated guidance and on how to access the support available.

Background information

How to get support if you’re clinically extremely vulnerable to coronavirus.

Those with the following conditions fall into the clinically extremely vulnerable group:

• solid organ transplant recipients
• 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 that 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
• people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
• people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell)
• people on immunosuppression therapies sufficient to significantly increase risk of infection adults with Down’s syndrome
• adults on dialysis or with chronic kidney disease (Stage 5)
• women who are pregnant with significant heart disease, congenital or acquired
• other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decision

Those in the following group count as clinically vulnerable:

• are 70 or older
• have a lung condition that’s not severe (such as asthma, COPD, emphysema or bronchitis)
• have heart disease (such as heart failure)
• have diabetes
• have chronic kidney disease
• have liver disease (such as hepatitis)
• have a condition affecting the brain or nerves (such as Parkinson’s disease, motor neurone disease, multiple sclerosis or cerebral palsy)
• have a condition that means they have a high risk of getting infections
• are taking medicine that can affect the immune system (such as low doses of steroids)
• are very obese (a BMI of 40 or above)
• are pregnant

We now have evidence to suggest that those with chronic kidney disease (stage 5) and those undergoing dialysis, as well as adults with Down’s Syndrome, are at higher risk from COVID-19 than the general population and therefore the Chief Medical Officer has advised they follow the new guidance for the clinically extremely vulnerable. We have asked the NHS to begin the process of identifying and contacting all those affected, providing them with the latest advice.