GAtherton

15th May 2020: Shielding advice to continue until the end of June.

The original shielding letters and advice that have been sent out to people who are highly vulnerable to COVID-19 (coronavirus) infection stated that all recipients of the letter should completely isolate themselves from physical contact, not go outside of their homes for 12 weeks.

This advice was sent to all patients of the National Aspergillosis Centre (NAC) who have chronic pulmonary aspergillosis (CPA).

Patients who have allergic bronchopulmonary aspergillosis (ABPA), severe asthma and forms of aspergillosis other than CPA were informed of their vulnerability status by their local respiratory clinic or GP. Some will have been told to shield, others not but all shielding advice was to remain in place for 12 weeks from the day of receipt of the letter.

That advice for people shielding has now been amended to say that all shielding people should continue shielding until the end of June 2020.

Latest shielding advice (UK).

Latest advice from Welsh government

Latest advice from Scottish government

Latest advice from Northern Ireland

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by GAtherton

May 11th 2020: UK Government updated advice for vulnerable people during the COVID-19 epidemic

General population

Now that an overwhelming peak of COVID-19 cases has been avoided in the UK, at least for the time being UK government has advised the UK general population that:

• People and employers should stay safe in public spaces and workplaces by following “Covid-19 secure” guidelines. This should enable more people to go back to work, where they cannot work from home, and encourage more vulnerable children and the children of critical workers to go to school or childcare as already permitted
• You should stay safe when you leave home: washing your hands regularly, maintaining social distancing, and ensuring you do not gather in groups of more than two, except with members of your household or for other specific exceptions set out in law
• You must continue to stay home except for a limited set of reasons but - in line with scientific advice - can take part in more outdoor activities from Wednesday 13 May

See the full document for details

A large group of people, assessed as particularly vulnerable must take further action and observe the following additional guidelines:

There are two classes of people referred to as vulnerable. These are the 'vulnerable' and the 'highly vulnerable'. There are new instructions for both groups (HM Gov update 11th May 2020)

Vulnerable people

Clinically vulnerable people are those who are:

• aged 70 or older (regardless of medical conditions)
• under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab as an adult each year on medical grounds):
• chronic (long-term) mild to moderate 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), or cerebral palsy
• diabetes
• a weakened immune system as the result of certain conditions, treatments like chemotherapy, or medicines such as steroid tablets
• being seriously overweight (a body mass index (BMI) of 40 or above)
• pregnant women

In addition, there may be people who do not fit in any of the categories listed above, but who have been advised that they are clinically vulnerable by their GP or other health professional.

All people who fall into this category must stay at home as much as possible, and take particular care to avoid contact with others outside of their household if they go out.

 

Highly vulnerable people

This is the group who have received a 'Shielding letter' or other instruction from a medical authority such as their GP. Their updated instructions do not seem to have been substantially changed and can be found here. This group of people need to stay at home, do not go out, keep shielding. The Government is currently advising people to shield until the end of June and is regularly monitoring this position.

FAQ's

What you can and can't do

Shielding

Does easing restrictions apply to healthy 70 year olds and over? (see section 2)

How long will shielding be in place? (see section 2.2)

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by GAtherton

April 17th: Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19

[toc]
HM governments latest update for people who may be extremely vulnerable. You can find the full guidelines here.

In particular NOTE: guidelines on registering as a highly vulnerable patient.

Background and scope of guidance

This guidance is for people who are clinically extremely vulnerable, including children. It’s also for their family, friends and carers.

People who are clinically extremely vulnerable should have received a letter telling them they’re in this group or been told by their GP.

It’s for situations where a clinically extremely vulnerable person is living at home, with or without additional support. This includes clinically extremely vulnerable people living in long-term care facilities for the elderly or people with special needs.

If you have been told that you’re clinically extremely vulnerable, you should:

• follow the advice in this guidance
• register online even if you do not need additional support now

Who is ‘clinically extremely vulnerable’?

Expert doctors in England have identified specific medical conditions that, based on what we know about the virus so far, place someone at greatest risk of severe illness from COVID-19.

Clinically extremely vulnerable people may include the following people. Disease severity, history or treatment levels will also affect who is in the group.

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 chronic obstructive pulmonary (COPD).
4. 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).
5. People on immunosuppression therapies sufficient to significantly increase risk of infection.
6. Women who are pregnant with significant heart disease, congenital or acquired.

People who fall in this group should have been contacted to tell them they are clinically extremely vulnerable.

If you’re still concerned, you should discuss your concerns with your GP or hospital clinician.

Staying at home and shielding

You’re strongly advised to stay at home at all times and avoid any face-to-face contact if you’re clinically extremely vulnerable to protect yourself.

This is called ‘shielding’.

Shielding means:

1. Do not leave your house.
2. Do not attend any gatherings. This includes gatherings of friends and families in private spaces, for example, family homes, weddings and religious services.
3. Strictly avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough.

The Government is currently advising people to shield until the end of June and is regularly monitoring this position.

Handwashing and respiratory hygiene

There are general principles you should follow to help prevent the spread of airway and chest infections caused by respiratory viruses, including:

• wash your hands more often with soap and water for at least 20 seconds or use a hand sanitiser. Do this after you blow your nose, sneeze or cough, and after you eat or handle food
• avoid touching your eyes, nose, and mouth with unwashed hands
• avoid close contact with people who have symptoms
• cover your cough or sneeze with a tissue, then throw the tissue in a bin
• clean and disinfect frequently touched objects and surfaces in the home

Note

Register for support

 

Everyone who has received a letter advising that they are clinically extremely vulnerable should register online if you need any extra support, for example, essential groceries delivered to your home.

Please register even if:

• you do not need support now
• you’ve received your letter from the NHS

Letters to clinically extremely vulnerable people

The NHS in England has contacted clinically extremely vulnerable people with the conditions listed above to provide further advice.

If you have not received a letter or you have not been contacted by your GP but you’re still concerned, you should discuss your concerns with your GP or hospital clinician.

Help with food and medicines if you’re shielding

Ask family, friends and neighbours to support you and use online services.

If you cannot get the help you need, the government can help by delivering essential groceries and support. It may take time for support offered through this service to arrive. If you have not received a letter from the NHS then you may not be able to receive the support offered through this service. If you need urgent food or care, please contact your local council.

Getting your prescriptions

Prescriptions will continue to cover the same length of time as usual.

If you do not currently have your prescriptions collected or delivered, you can arrange this by:

1. Asking someone who can pick up your prescription from the local pharmacy (this is the best option, if possible).
2. Contacting your pharmacy to ask them to help you find a volunteer (who will have been ID checked) or deliver it to you.

You may also need to arrange for collection or delivery of hospital specialist medication that is prescribed to you by your hospital care team.

If you receive support from health and social care organisations, for example, if you have care provided for you through the local authority or health care system, this will continue as normal.

Your health or social care provider will be asked to take additional precautions to make sure that you are protected. The advice for formal carers is included in the home care provision.

Visits from essential carers

Any essential carers or visitors who support you with your everyday needs can continue to visit unless they have any of the symptoms of coronavirus. Everyone coming to your home should wash their hands with soap and water for at least 20 seconds on arrival to your house and often while they are there.

If your main carer becomes unwell

Speak to your carers about back-up plans for your care in case your main carer is unwell and needs to self-isolate.

You should have an alternative list of people who can help you with your care if your main carer becomes unwell. You can also contact your local council for advice on how to access care.

Living with other people

The rest of your household do not need to start shielding themselves, but they should do what they can to support you in shielding and to carefully follow guidance on social distancing.

At home you should:

1. Minimise the time other people living with you spend in shared spaces such as kitchens, bathrooms and sitting areas, and keep shared spaces well ventilated.
2. 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, use a separate bathroom from the rest of the household. 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 share a toilet and bathroom with others, it’s important that they are cleaned every time after use (for example, wiping surfaces you have come into contact with). 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’re present. If you can, 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. Everyone in your household should regularly wash their hands, avoid touching their face, and clean frequently touched surfaces.

If the rest of your household are able to follow this guidance, there is no need for them to take the full protective measures to keep you safe.

If you do not want to be shielded

Shielding is for your personal protection. It’s your choice to decide whether to follow the measures we advise.

For example, if you have a terminal illness, or have been given a prognosis of less than 6 months to live, or have some other special circumstances, you may decide not to undertake shielding.

This will be a deeply personal decision. We advise calling your GP or specialist to discuss this.

Symptoms of coronavirus (COVID-19)

The most common symptoms of coronavirus (COVID-19) are recent onset of one or both of the following:

• new continuous cough
• high temperature (above 37.8°C)

If you develop symptoms

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.

In an emergency, call 999 if you’re seriously ill. Do this as soon as you get symptoms.

Do not visit the GP, pharmacy, urgent care centre or a hospital.

Prepare a single hospital bag. This will help the NHS provide you with the best care if you need to go to hospital as a result of catching coronavirus. Your bag should include:

• your emergency contact
• a list of the medications you take (including dose and frequency)
• any information on your planned care appointments
• things you would need for an overnight stay (for example, snacks, pyjamas, toothbrush, medication)
• your advanced care plan (only if you have one)

Hospital and GP appointments if you’re shielding

Everyone should access medical assistance online or by phone wherever possible.

However, if you have a scheduled hospital or other medical appointment during this period, talk to your GP or specialist to ensure you continue to receive the care you need and determine which of these appointments are absolutely essential.

Your hospital may need to cancel or postpone some clinics and appointments. You should contact your hospital or clinic to confirm appointments.

Looking after your mental wellbeing

Social isolation, reduction in physical activity, unpredictability and changes in routine can all contribute to increasing stress.

Many people, including those without existing mental health needs, may feel anxious. For example, how it could affect support with daily living, ongoing care arrangements with health providers, support with medication and changes in their daily routines.

If you’re receiving services for your mental health, learning disability or autism and are worried about the impact of isolation, please contact your key worker or care coordinator or provider to review your care plan. If you have additional needs, please contact your key worker or care coordinator to develop a safety or crisis plan.

Understandably, you may find that shielding and distancing can be boring or frustrating. You may find your mood and feelings are affected and you may feel low, worried or have problems sleeping and you might miss being outside with other people.

At times like these, it can be easy to fall into unhealthy patterns of behaviour which in turn can make you feel worse.

Constantly watching the news can make you feel more worried. If you think it is affecting you, try to limit the time you spend watching, reading, or listening to media coverage of the outbreak. It may help to only check the news at set times or limit this to a couple of times a day.

Try to focus on the things you can control, such as your behaviour, who you speak to and who you get information from. Every Mind Matters provides simple tips and advice to start taking better care of your mental health.

If you’re struggling with your mental health, please see the NHS mental health and wellbeing advice website for self-assessment, audio guides and tools that you can use.

If you’re still struggling after several weeks and it’s affecting your daily life, please contact NHS 111 online. If you have no internet access, you should call NHS 111.

Staying mentally and physically active

There are simple things you can do that may help, to stay mentally and physically active during this time such as:

• look for ideas of exercises you can do at home on the NHS website
• spend time doing things you enjoy such as reading, cooking, other indoor hobbies or listening to favourite radio programmes or watching TV
• try to eat healthy, well-balanced meals, drink enough water, exercise regularly, and try to avoid smoking, alcohol and drugs
• try spending time with the windows open to let in the fresh air, arranging space to sit and see a nice view (if possible) and get some natural sunlight, or get out into any private space, keeping at least 2 metres away from your neighbours and household members if you are sitting on your doorstep

Staying connected with family and friends

Use support you might have through your friends, family and other networks during this time. Try to stay in touch with those around you over the phone, by post or online.

Let people know how you would like to stay in touch and build that into your routine. This is also important in looking after your mental wellbeing and you may find it helpful to talk to them about how you are feeling if you want to.

Remember, it is OK to share your concerns with others you trust and in doing so you may end up providing support to them, too. Or you might want to try an NHS recommended helpline.

Unpaid carers who provide care for someone who is clinically extremely vulnerable

If you’re caring for someone who is clinically extremely vulnerable, there are some simple steps that you can take to protect them and to reduce their risk.

Ensure you follow advice on good hygiene:

• only provide care that is essential
• wash your hands when you arrive and often, using soap and water for at least 20 seconds or use hand sanitiser
• cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
• put used tissues in the bin immediately and wash your hands afterwards
• do not visit or provide care if you are unwell and make alternative arrangements for their care
• provide information on who they should call if they feel unwell, how to use NHS 111 online coronavirus service and leave the number for NHS 111 prominently displayed
• find out about different sources of support that could be used and accessing further advice on creating a contingency plan is available from Carers UK
• look after your own wellbeing and physical health during this time. See further information from Every Mind Matters

More information on providing unpaid care is available.

People living in long-term care facilities, for the elderly or people with special needs

This guidance also applies to clinically extremely vulnerable people living in long-term care facilities. Care providers should carefully discuss this advice with the families, carers and specialist doctors caring for such people to ensure this guidance is strictly adhered to.

Parents and schools with clinically extremely vulnerable children

This guidance also applies to clinically extremely vulnerable children in mainstream and special schools. If you live with a child who is clinically extremely vulnerable you should try to follow the advice on living with other people, you should continue to have physical contact to provide essential care.

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by GAtherton

NICE Guidance for Respiratory Patients with regard to COVID-19

The National Institute for Health and Clinical Excellence (NICE) guides the UK NHS and its clinicians as well a social care professionals when good, balanced and well-researched opinions are needed for a new situation, or an update is needed for an existing medical condition. Consequently NICE has brought out a series of guidelines for SARS-CoV-2 (COVID-19) coronavirus infections as the epidemic has developed and doctors may refer to those guidelines for the best way to treat their infected patients who also have a respiratory disease.

NICE can also respond to specific questions from clinicians and some questions relate to people with respiratory disease. We know that some steroid medication can leave patients slightly more vulnerable to some types of infection, so the question was posed "is it better to stop taking steroid medication to help prevent a COVID-19 infection or shall we advise patients to continue taking steroid medication to control their symptoms".

1. The first set of guidelines were designed for doctors treating patients with asthma and importantly defines exactly what they mean by severe asthma which is
   

   "severe asthma is defined by the European Respiratory Society and American Thoracic Society as asthma that requires treatment with high-dose inhaled corticosteroids plus a second controller, and/or systemic corticosteroids to prevent it from becoming or remaining 'uncontrolled' despite this therapy"
   

   As you might expect much of the document is quite technical, but it is clear that severe asthma patients who get a COVID-19 infection are to continue to use their normal medication including corticosteroid just as they did before infection.

2. The second set of relevant guidelines refers to people who have Chronic Obstructive Pulmonary Disease (COPD).
   

   "The new guidance on community-based care of patients with COPD says all patients, including those with suspected or confirmed COVID-19, should continue taking their regular inhaled and oral medicines in line with their individualised self-management plan".

NICE says there is no evidence that treatment with inhaled corticosteroids for COPD increases the risk associated with COVID-19, so patients established on these drugs should continue to use them, and delay any planned trials of withdrawal. Patients on long-term oral corticosteroids should also be told to continue taking them at the prescribed dose.

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by GAtherton