Millions of people are being told to shield and stay at home at all times as England enters its third national coronavirus lockdown.
The guidance was already in place for Tier 4 areas and it could remain for months after Michael Gove admitted this shutdown – triggered by a new, more infectious variant of Covid-19 – could drag on into March.
New shielding letters are to be sent to those deemed clinically extremely vulnerable.
The latest Government guidance, yet to be updated following Monday night’s lockdown announcement, says people who are extremely vulnerable should only go out for medical appointments, exercise or another essential reason.
The group includes those with reduced immune systems, specific cancers or severe respiratory conditions such as cystic fibrosis or severe asthma, adults with Down’s syndrome, and pregnant women with significant heart disease.
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Those who are clinically vulnerable are being told they should not go out to the shops, pharmacies or work, even if they are unable to work from home.
They should avoid all non-essential travel.
It is not known how long the guidance will be in place.
This is similar to the advice in November.
The measures mark a slight relaxation from last spring, when shielding patients were told to stay at home at all times and medical appointments were advised to be done at home.
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Who is considered extremely vulnerable?
The clinically extremely vulnerable group includes people whose immune systems are suppressed or who suffer specific conditions.
The conditions include specific cancers or severe respiratory conditions, such as cystic fibrosis.
There are two ways people may be identified as clinically extremely vulnerable – they fall into the list below, or their GP has added them to the shielded patient list.
Those with the following conditions fall into the clinically extremely vulnerable group:
– Solid organ transplant recipients.
– People with cancer who are undergoing active chemotherapy.
– Lung cancer patients 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.
– Those 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.
– Those who have had bone marrow or stem cell transplants in the last six months or who are still taking immunosuppression drugs.
– Patients 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.
– Problems with your spleen, for example splenectomy (having your spleen removed)
– 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 decisions.
People included on the list will receive a specific identifying letter.
What does the guidance say?
Stay at home as much as possible, except to go outdoors to exercise or attend health appointments.
Try to keep all contact with others outside of your household to a minimum, and avoid busy areas.
You can still remain in your support bubble and receive informal care at home from people within your support bubble.
As well, you can still receive care at home from professional social care and medical professionals.
But you cannot meet with friends and family you do not live with unless they are part of your support bubble, according to the guidance.
Try to stay two metres away from other people within your household.
Avoid all non-essential travel, but continue to travel to hospital and GP appointments as required unless told otherwise by their doctor.
Those who are extremely vulnerable are strongly advised not to go to any shops or to pharmacies, and government support is available for those who need it while they remain at home.
If people cannot work from home, they should not attend work.
People in the same household who are not clinically extremely vulnerable can still attend work, in line with the new national restrictions.
Schools in England are currently closed to all pupils except vulnerable young people and the children of key workers.
Before mass school closures, the Government’s guidance stated: “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 follow shielding advice and should not attend school, because the risk of exposure to the virus in your area may currently be very high.
“Your school or college will make appropriate arrangements for you to be able to continue your education at home.
“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.”
What kind of support is available?
The government has insisted it will make sure support is available for those who need it so they can remain at home as much as possible.
This includes food and medicines and signposting to local support or befriending services, to enable people to stay at home as much as possible over this period.
The government said: “Use online shopping if you can, or ask others to collect and deliver shopping for you.
“NHS Volunteer Responders can also help with a regular, friendly phone call, and transport to and from medical appointments.”