Update June 23rd: UK government (via Cheshire CCG) guidance for patients in England who are shielding

The UK Government has set out a roadmap for the clinically extremely vulnerable on the future of the shielding programme.

For now, the guidance remains the same – stay at home and only go outside to exercise or to spend time outdoors with a member of your household, or with one other person from another household if you live alone – but the guidance will change on 6 July and again on 1 August, based on clinical evidence.

Shielding and other advice to the clinically extremely vulnerable has been and remains advisory.

What are the changes? 

Recently, the UK Government advised that you can spend time outdoors, if you wish, with your own household, or if you live alone with another household. Following this, and alongside current scientific and medical advice, the UK Government is planning to relax shielding guidance in stages.

From 6 July, the guidance will change so you can meet in groups of up to six people from outside your household – outdoors with social distancing. For example, you might want to enjoy a summer BBQ outside at a friend’s house, but remember it is still important to maintain social distancing and you should not share items such as cups and plates. If you live alone (or are a lone adult with dependent children under 18), you will be able to form a support bubble with another household.

From 1 August, you will no longer need to shield, and the advice will be that you can visit shops and places of worship, but you should continue maintaining rigorous social distancing.

Why is the guidance changing now?

The roadmap has been developed in line with the latest scientific and medical advice and with the safety and welfare of those who are shielding in mind. Current statistics show that the rate of catching coronavirus in the community continues to decrease. On average less than 1 in 1,700 in our communities are estimated to have the virus, down from 1 in 500 four weeks ago.

Unless advised otherwise by your clinician, you are still in the ‘clinically extremely vulnerable’ category and should continue to follow the advice for that category, which can be found here.

We will monitor the virus continuously over coming months and if it spread too much, we may need to advise you to shield again.

If you are in receipt of Government provided food boxes and medicine deliveries, you will continue to receive this support until the end of July.

Local councils and volunteers are also providing support to people who are shielding, to enable them to stay safely in their homes. The government is funding local councils to continue to provide these services to those who need them until the end of July.

What support is available to people who are shielding until the end of July?

Essential supplies

There are a number of ways that those who are shielding can access food and other essentials:

  • Make use of thesupermarket priority delivery slots that are available for this group. When a clinically extremely vulnerable person registers online as needing support with food, their data is shared with supermarkets. This means if they make an online order with a supermarket (as both a new or existing customer), they will be eligible for a priority slot.
  • Use the many commercial options now available for accessing food, including telephone ordering, food box delivery, prepared meal delivery and other non-supermarket food delivery providers. A list has been shared with local authorities and charities.
  • A free, standardised weekly parcel of food and household essentials. If you have registered for this support onlinebefore 17 July you will continue to receive weekly food box deliveries until the end of July.
  • If you need urgent help and have no other means of support, contact your local council to find out what support services are available in their area.
  • For anyone facing financial hardship, the government has made £63 million available to local councils in England to help those who are struggling to afford food and other essentials.

NHS Volunteer Responders

Support will continue to be available through the NHS Volunteer Responder Scheme beyond the end of July.

NHS Volunteer Responders can support you with:

  • Collecting shopping, medication (if your friends and family cannot collect them for you) or other essential supplies;
  • A regular, friendly phone call which can be provided by different volunteers each time or by someone who is also shielding and will stay in contact for several weeks; and
  • Transport to medical appointment.

Please call 0808 196 3646 between 8am and 8pm to arrange support or speak to your health case professional for transport support. A carer or family member can also do this on their behalf. More information is available at www.nhsvolunteerresponders.org.uk

Health care

Any essential carers or visitors who support you with your everyday needs can continue to visit unless they have any of the symptoms of COVID-19 (a new continuous cough, a high temperature, or a loss of, or change in, their normal sense of taste or smell).

People in the clinically extremely vulnerable group should continue to access the NHS services they need during this time. This may be delivered in a different way or in a different place than they are used to, for example via an online consultation, but if they do need to go to hospital or attend another health facility for planned care, extra planning and protection will be put in place.

Mental health support

It is normal during these uncertain and unusual times to feel anxious or feel low.

Follow the advice that works for you in the guidance on how to look after your mental health and wellbeing during coronavirus (COVID-19).

The Every Mind Matters page on anxiety and NHS mental wellbeing audio guides provide further information on how to manage anxiety.

If you feel you need to talk to someone about your mental health or you are looking for more support for someone else, we would urge you to speak to a GP and seek out mental health support delivered by charities or the NHS.

Income and employment support

At this time, people who are shielding are advised not to go to work. This guidance remains advisory.

Those shielding will be eligible for Statutory Sick Pay (SSP) on the basis of their shielding status until the 31 July. SSP eligibility criteria apply

From 1 August, if clinically extremely vulnerable people are unable to work from home but need to work, they can, as long as the business is COVID safe.

The Government is asking employers to work with them to ease the transition back to a more normal way of life for their shielding employees. It is important that this group continues to take careful precautions, and employers should do all they can to enable them to work from home where this is possible, including moving them to another role if required.

Where this is not possible, those who have been shielding should be provided with the safest onsite roles that enable them to maintain social distancing.

If employers cannot provide a safe working environment, they can continue to use the Job Retention Scheme for shielded employees who have already been furloughed.

What support will be available after July? 

From 1 August, clinically extremely vulnerable people will continue to have access to priority supermarket delivery slots if you have registered online before 17 July for a priority delivery slot.

NHS Volunteer Responders will also continue to offer support to those who need it, including collecting and delivering food and medicines.

The NHS Volunteer Responders Scheme has been expanded to offer a new Check in and Chat Plus role. This new role has been designed to provide peer support and companionship to people who are shielding as they adapt to a more normal way of life.

If you are vulnerable or at risk and need help with shopping, medication or other essential supplies, please call 0808 196 3646 (8am to 8pm).

Government is committed to supporting local councils and voluntary sector organisations to respond to those who have specific support needs and requirements during the COVID-19 pandemic. Details of the support and advice available can be found here: https://www.gov.uk/find-coronavirus-support

The updated shielding guidance should not affect any social care or support you were receiving prior to the start of shielding.

Individuals should continue to contact their local council if they have any ongoing social care needs.

May 31st: Shielding Advice Updated by Public Health England

Many people with Chronic Pulmonary Aspergillosis were asked to shield themselves from exposure to the coronavirus COVID-19 in March 2020 as they were thought to be especially vulnerable to the consequences of infection by the respiratory virus.

Back in March 2020 the COVID-19 pandemic was progressing rapidly and there was some doubt about how well we might be able to contain it in the UK using a variety of social spacing measures, consequently, it was appropriate for the most vulnerable to be especially protected. We also knew relatively little about the virus and how it is transmitted, which groups might be more vulnerable to infection and severe symptoms.

More recently, by late May 2020 the pandemic in the UK is currently well under control with the number of cases in the community falling rapidly week on week, estimated at 17% between May 10 and 21st (AskZoe).

There is a real risk that extending shielding will have an overall detrimental impact on health, particularly on the mental health of those shielding, so it is important that we limit the numbers of people to those who absolutely have to, and ease up restrictions on those that have to carry on when it is deemed safe enough to do so.

The overall authority in England is Public Health England (PHE) and they released updated guidelines for people who are shielding here on 31st May 2020. 

What has changed

The government has updated its guidance for people who are shielding taking into account that COVID-19 disease levels are substantially lower now than when shielding was first introduced.

People who are shielding remain vulnerable and should continue to take precautions but can now leave their home if they wish, as long as they are able to maintain strict social distancing. If you choose to spend time outdoors, this can be with members of your own household. If you live alone, you can spend time outdoors with one person from another household. Ideally, this should be the same person each time. If you do go out, you should take extra care to minimise contact with others by keeping 2 metres apart. This guidance will be kept under regular review.

Read further information on schools and the workplace for those living in households where people are shielding. This guidance remains advisory.

 

Advice for Wales (updated but there may be some differences to PHE advice)

Advice for Scotland (not yet changed so are now different to England & Wales)

Advice for Northern Ireland (not yet changed but may change on June 8th)

COVID isolation: Mental well-being while staying at home

The UK NHS has released a list of helpful resources to assist in safeguarding your mental health during this current COVID isolation period. We have reproduced some of it here for the purpose of allowing indexing of the many sections, hopefully making access a bit quicker and easier.

Taking care of your mind as well as your body is really important while staying at home because of coronavirus (COVID-19).

You may feel bored, frustrated or lonely. You may also be low, worried or anxious, or concerned about your finances, your health or those close to you.

It’s important to remember that it is OK to feel this way and that everyone reacts differently. Remember, this situation is temporary and, for most of us, these feelings will pass. Staying at home may be difficult, but you are helping to protect yourself and others by doing it.

The tips and advice here are things you can do now to help you keep on top of your mental wellbeing and cope with how you may feel while staying at home. Make sure you get further support if you feel you need it.

The government also has wider guidance on staying at home as a result of coronavirus.

To read the complete NHS page ‘Worried about coronavirus’ click here

 

 

For a more complete resource on mental health see the NHS page ‘Every Mind Matters’.

EMM - Coronavirus - Stay at home - Find out about your rights

1. Find out about your employment and benefits rights

You may be worried about work and money while you have to stay home – these issues can have a big effect on your mental health.

If you have not already, talk with your employer about working from home, and learn about your sick pay and benefits rights. Knowing the details about what the coronavirus outbreak means for you (England and Wales only) can reduce worry and help you feel more in control.

GOV.UK: Coronavirus support

2. Plan practical things

Work out how you can get any household supplies you need. You could try asking neighbours or family friends, or find a delivery service.

Continue accessing treatment and support for any existing physical or mental health problems where possible. Let services know you are staying at home, and discuss how to continue receiving support.

If you need regular medicine, you might be able to order repeat prescriptions by phone, or online via a website or app. Contact your GP and ask if they offer this. You can also ask your pharmacy about getting your medicine delivered, or ask someone else to collect it for you.

If you support or care for others, either in your home or by visiting them regularly, think about who can help out while you are staying at home. Let your local authority (England, Scotland and Wales only) know if you provide care or support someone you do not live with. Carers UK has further advice on creating a contingency plan.

Carers UK: Coronavirus

3. Stay connected with others

Maintaining healthy relationships with people you trust is important for your mental wellbeing. Think about how you can stay in touch with friends and family while you are all staying at home – by phone, messaging, video calls or social media – whether it’s people you usually see often, or connecting with old friends.

Lots of people are finding the current situation difficult, so staying in touch could help them too.

4. Talk about your worries

It’s normal to feel a bit worried, scared or helpless about the current situation. Remember: it is OK to share your concerns with others you trust – and doing so may help them too.

If you cannot speak to someone you know or if doing so has not helped, there are plenty of helplines you can try instead.

NHS – recommended helplines

5. Look after your body

Our physical health has a big impact on how we feel. At times like these, it can be easy to fall into unhealthy patterns of behaviour that end up making you feel worse.

Try to eat healthy, well-balanced meals, drink enough water and exercise regularly. Avoid smoking or drugs, and try not to drink too much alcohol.

You can leave your house, alone or with members of your household, for 1 form of exercise a day – like a walk, run or bike ride. But make you keep a safe 2-metre distance from others. Or you could try one of our easy 10-minute home workouts.

Try a 10-minute home workout

6. Stay on top of difficult feelings

Concern about the coronavirus outbreak is perfectly normal. However, some people may experience intense anxiety that can affect their day-to-day life.

Try to focus on the things you can control, such as how you act, who you speak to and where you get information from.

It’s fine to acknowledge that some things are outside of your control, but if constant thoughts about the situation are making you feel anxious or overwhelmed, try some ideas to help manage your anxiety.

7. Do not stay glued to the news

Try to limit the time you spend watching, reading or listening to coverage of the outbreak, including on social media, and think about turning off breaking-news alerts on your phone.

You could set yourself a specific time to read updates or limit yourself to checking a couple of times a day.

Use trustworthy sources – such as GOV.UK or the NHS website – and fact-check information from the news, social media or other people.

GOV.UK: Coronavirus response

8. Carry on doing things you enjoy

If we are feeling worried, anxious, lonely or low, we may stop doing things we usually enjoy.

Make an effort to focus on your favourite hobby if it is something you can still do at home. If not, picking something new to learn at home might help.

There are lots of free tutorials and courses online, and people are coming up with inventive ways to do things, like hosting online pub quizzes and music concerts.

9. Take time to relax

This can help with difficult emotions and worries, and improve our wellbeing. Relaxation techniques can also help deal with feelings of anxiety.

10. Think about your new daily routine

Life is changing for a while and you are likely to see some disruption to your normal routine. Think about how you can adapt and create positive new routines and set yourself goals.

You might find it helpful to write a plan for your day or your week. If you are working from home, try to get up and get ready in the same way as normal, keep to the same hours you would normally work and stick to the same sleeping schedule.

You could set a new time for a daily home workout, and pick a regular time to clean, read, watch a TV programme or film, or cook.

11. Look after your sleep

Good-quality sleep makes a big difference to how we feel, so it’s important to get enough.

Try to maintain your regular sleeping pattern and stick to good sleep practices.

12. Keep your mind active

Read, write, play games, do crosswords, complete sudoku puzzles, finish jigsaws, or try drawing and painting.

Whatever it is, find something that works for you.

Coronavirus Outbreak 2020 ANNOUNCEMENT: A notice for all patients that attend the National Aspergillosis Centre, Manchester, UK, 10th April.

NAC CARES

A plea to all NAC patients

As you will be aware the NHS faces unprecedented times due to the Coronavirus pandemic. The National Aspergillosis Centre (NAC) team are extremely busy working on the frontline.

We are currently still trying to offer telephone consultations in place of face to face appointments. However, we are currently overwhelmed with the numbers of calls still required. May we politely request again that you call us to postpone all non-urgent telephone appointments.

Chronic Pulmonary Aspergillosis (CPA) Patients

Many patients have also been in contact with us regarding NHS social shielding letters and support. The National Aspergillosis Centre (NAC) has now sent letters to all NAC registered patients (and their GPs) who have a diagnosis of chronic pulmonary aspergillosis (CPA) advising that they are extremely vulnerable and should follow social shielding advice.

For further details on shielding and protecting highly vulnerable people click here.

All patients living in England will be added to the government’s list of extremely vulnerable people and can register for support at https://www.gov.uk/coronavirus-extremely-vulnerable

NOTE: There is separate advice for patients living in Scotland, Northern Ireland and Wales. For country-specific information regarding social shielding please follow these web links or contact you GP:

Allergic Bronchopulmonary Aspergillosis (ABPA) Patients

Patients with Allergic Bronchopulmonary Aspergillosis (ABPA) and Severe Asthma with Fungal Sensitisation (SAFS) requiring to shield should have been identified by the NHS database searches across the UK. These searches were based on the medication you take to control your asthma. If you have not received a letter and you believe you have severe asthma you should first contact your local respiratory consultant or GP for advice. Please note that the National Institute for Health and Care Excellence (NICE) have defined severe asthma for the purposes of COVID-19 as follows:

“asthma that requires treatment with high-dose inhaled corticosteroids (see inhaled corticosteroid doses for NICE’s asthma guideline) plus a second controller and/or systemic corticosteroids to prevent it from becoming ‘uncontrolled’, or which remains ‘uncontrolled’ despite this therapy.”

Aspergillus bronchitis and Aspergillus sinusitis Patients

Aspergillus bronchitis and Aspergillus sinusitis have not been identified as risk factors for serious complications from COVID-19. If you have one of these conditions alone, you should not follow shielding advice. Instead, you should follow social distancing guidelines.

For further guidance on social distancing click here

Coronavirus COVID-19 (SARS-CoV-2): Precautions if you have Aspergillosis (April 4th)

Coronavirus precautions

Over the last few weeks, many of us in the UK have been careful to socially distance ourselves from others in order to slow down the spread of the SARS-CoV-2 (COVID-19) viral outbreak. The requirements are as follows:

Stay at home

  • Only go outside for food, health reasons or work (but only if you cannot work from home)
  • If you go out, stay 2 metres (6ft) away from other people at all times
  • Wash your hands as soon as you get home

Do not meet others, even friends or family.

You can spread the virus even if you don’t have symptoms.

See UK Gov link for full details

These precautions are effective and appropriate for almost everyone, however, there are a few people who are more vulnerable due to age or a specific health condition and may need to take further precautions. Some, but certainly not all patients with aspergillosis will fall into that category, and in some cases will have to be individually considered by your doctor.

If you fall into the extremely vulnerable category you will be informed by a letter from UKgov, your GP, you local hospital doctor or for some (those with CPA) from the National Aspergillosis Centre. This is known as the shielding letter.

If you are extremely vulnerable

The UK government have severe asthma and severe COPD as conditions that put people at high risk from the coronavirus COVID-19 outbreak. The full document published by Public Health England(March 24th) which also contains links to a large number of other relevant documents can be accessed here. Aspergillosis refers to a range of diseases and individual cases, some of which may fall into the high-risk category but some will not. 

The main points (in addition to maintaining good handwashing, cough into tissues) 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.

All people at high risk are being informed of this by text/email/letter over the next week so that they are fully aware of what they must do to protect themselves.

In our discussions with aspergillosis patients, a few more points relating to social isolating that are not fully covered by the above document have been raised, so we will try to answer them here – if you have more questions please join our Facebook group and discuss it there.

Can I use my garden?

If you have a private garden and can maintain social distancing from neighbours and other people living in your home the answer is yes.

Deliveries: can I catch the virus?

There is a specific research paper that answers some of these questions. COVID-19 survival on a variety of surfaces was measured under one set of conditions:

 

SARS-CoV-2 is the current virus (2020 outbreak) which appears as red markers in each graph. We can see that the length of time it takes for the virus to lose half of its infectious particles (ie the half-life) is shortest for cardboard(3-4hrs) and copper (1 hr), so any virus on cardboard packaging should last the least amount of time, whereas the half-life was 6-7 hours for plastic, or roughly twice as long.

Given that someone who is infected by SARS-CoV-2 (COVID-19) can produce over a million viruses in their throat, we can see that a single cough could contain hundreds of thousands. If that number landed in cardboard it would take over 2 days for the virus to ‘die-off’, twice as long as that for plastic. Clearly it is sensible to take precautions with deliveries depending on what they are wrapped in and wipe them down with sanitiser containing more than 60% alcohol or bleach, or this US EPA document is very useful describing a large choice of disinfectants.

How easy is it to be infected if someone is coughing?

The paper above shows that the half-life of the virus under standard conditions as an aerosol ie after a cough or sneeze is similar to copper and can stay in the air for at least an hour, though the majority are thought to sink to the floor within 2-metre area in minutes. It will take 12-24 hours to die-off in air, perhaps longer under non-standard conditions (e.g. warmer temperature or higher humidity) but perhaps longer when it lands depending on the surface it lands on. This is why thorough hand washing is vital to prevent the settled virus from being passed on, and 2-metre spacing keeps us away from direct aerosols in the event of someone coughing.

Should I be cleaning my phone?

The figures given above for the survival of the virus on plastic are helpful when you realise that we all carry around a plastic screen, hold it in our hands, put it up against our faces. If any viruses land on our phones they can remain viable for over 4 days. For that reason, we should be cleaning our phones regularly, at least daily. Use alcohol-based wipes – this article gives more detail.

Disinfecting surfaces: What should I use?

Confusingly different disinfectants need to be used in different ways, and different surfaces may need different disinfectants. The best disinfectants for your hands & skin are preferably soap & running water as the soap unsticks & disables the virus and the water washed it off and dilutes the virus in your skin very efficiently – hot water with soap best of all. If you cannot access running water then hand sanitisers containing at least 60% alcohol (NOT just soap & surfactants) are effective until you can wash your hands properly.

NOTE that most wet wipes/baby wipes are designed to clean and NOT kill coronavirus.

For other surfaces, there are a range of useful disinfectants but some are no good for disinfecting surfaces covered in virus and many need to be left on the surface for longer than you think! Thankfully this document from the US Environmental Protection Agency is very informative.

Cleaning & disinfecting in a home with confirmed or suspected SARS-CoV-2

Cleaning an area that has been exposed to SARS-CoV-2 eg after someone in a house has been diagnosed as Coronavirus positive and has left

COVID-19 monitoring

Help researchers monitor the coronavirus spread using this simple App.

Myths to ignore

World Health Authority on Myths

Live Science (US-based) myths

BBC part 1

  • Garlic
  • Drink water
  • Ice cream
  • Drinkable silver (colloidal silver)

and part 2

  • Holding your breath
  • Home-made hand sanitizer
  • The virus can survive on surfaces for a month
  • Cow urine

I haven’t received a shielding letter, what do I do?

Letters are still being sent out, you may yet receive one and until then the general advice is to socially distance yourself from everyone (see above) rather than shield yourself. For people with asthma who have not received a letter Asthma UK have released some guidelines suggesting further action

For people with chronic lung disease, the British Lung Foundation have released some helpful guidelines.

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