Most of England goes into Tier 4 COVID restrictions on Thursday 31st December

Most of South-Eastern England has been under Tier 4 COVID restrictions for the last week, but most of the rest of England will go under Tier 4 restrictions on Thursday 31st December.

Tier 4 means don’t leave home unless for essential reasons such as to go to work that cannot be done from home. For many of our NAC patients (all CPA, some ABPA) the following applies:

Full details for England


Guidance is slightly different in the rest of the UK

Northern Ireland

COVID-19 UK Government Re-introduce Shielding for the Highly Vulnerable in Tier 4

இங்கிலாந்து அரசு உள்ளது re-introduced shielding for all highly vulnerable people who are living in tier 4 areas.

All people with Chronic Pulmonary Aspergillosis (CPA) are classed as highly vulnerable, some people with Allergic Bronchopulmonary Aspergillosis (ABPA) are classed as highly vulnerable – ABPA patients should seek advice on this from their local respiratory service or GP rather than the National Aspergillosis Centre in Manchester.

For full details please read the instructions on the website


As many of us will have immediate concerns about the Christmas period, we reproduce the advice given at the above link hear for ease of access:

Advice during the Christmas period

We recognise that many people may want to be with their friends and family over the festive period, particularly after a very difficult year. As a result, the Government is changing some restrictions on social contact in Tiers 1, 2 and 3, allowing you to form a ‘Christmas bubble’ in which you can spend time indoors and outdoors, including in your home, with people from up to 3 households including your own.

This will only apply on 25 December. More information about the rules on Christmas bubbles is available.

You may not form a Christmas bubble if you live in a Tier 4 area. You are still allowed to meet with your support bubble.

In Tiers 1, 2 and 3, you can choose to be part of a Christmas bubble if you are clinically extremely vulnerable, but it does involve greater risks for you as you will be increasing the number of people you have contact with. The safest approach is not to form a Christmas bubble. You will continue to minimise your risk of infection if you limit social contact with people that you do not live with, even at Christmas. It is important that you and the other people in your Christmas bubble consider these risks carefully before agreeing to form a bubble. Forming a Christmas bubble is a personal choice and should be balanced against the increased risk of infection. You should also be aware that there is a new variant of the virus circulating currently, which may mean transmission of infection is more likely.

If you do decide to form a Christmas bubble it is advised that you maintain social distance from those you don’t normally live with at all times, avoiding physical contact. Everyone should wash their hands regularly and it is important to keep the space where you spend time with those you don’t normally live with well ventilated and to clean touch points regularly, such as door handles and surfaces. You may want to think about who you sit next to, including during meals, and also consider wearing a face-covering indoors where social distancing may be difficult as well as encouraging others to do the same.

If you don’t feel comfortable spending time with other people indoors, think of other ways that you can safely spend time together, for example on walks outdoors or supported by technology, and how you can make that time feel different and special. Going outdoors carefully for exercise is also encouraged. It is important that you do not feel pressured to celebrate Christmas in an environment that makes you anxious.

There may be a lot of expectation and pressure around celebrating Christmas together, but you should feel comfortable to do what is right for you over this period. To do that, it is important that the other people in your Christmas bubble understand your needs and increased risk. They can help by being extra vigilant in the days before you get together, reducing any unnecessary contact with people, especially as some people with the virus have no symptoms.

Before and after 25 December, you should follow the guidance that was in place before Christmas, in line with the restrictions for your local area.

COVID Vaccine for Aspergillosis Patients

The UK NHS is now rolling out the Pfizer/BioNTech vaccine (approval documentation). As there is a limited supply of the vaccine, a limited capacity to deliver it and 65 million people to be vaccinated, a priority list has been drawn up by the  Joint Committee on Vaccination and Immunisation (JCVI).

People will be offered this vaccine according to their vulnerability to infection by COVID, or the risk that they will transmit the virus to a vulnerable person, so top priority is going to the eldest and those who care for them.

Once all of those over age 75 (approximately 5 million people) have been vaccinated then the extremely highly vulnerable will be vaccinated (i.e. on the grounds of their health condition. These are likely to be those who have had a letter from their doctor or this year informing them that they are highly vulnerable, which includes chronic pulmonary aspergillosis, but not all allergic bronchopulmonary aspergillosis).

The UK has ordered enough vaccine for 20 million people so we have enough to vaccinate all of the most highly vulnerable people (defined as all those over age 50, plus all the with high vulnerability), however, the UK government has said that it will take until April 2021 to vaccinate all of these most vulnerable people.

NOTE there have been two cases of people who appear to have had an allergic reaction to the Pfizer/BioNTech vaccine in the first few days of the vaccination program. As planned these episodes have been very quickly reported to the regulatory authorities responsible for closely monitoring all health outcomes (UK Medicines and Healthcare products Regulatory Agency (MHRA)) and precautionary advice has been issued to everyone administering the vaccine.


For further details please see the following for your part of the UK

England advice

Welsh advice

Scottish advice

NI advice

COVID Precautions for the extremely vulnerable: Winter 2020

UK government has today announced its strategy to protect UK citizens from COVID-19 infection and to try to reduce virus transmission rates.

Part of these new guidelines refers to the extremely vulnerable eg people who have received the most recent letter or email from advising them that they are clinical extremely vulnerable. If you didn’t receive a letter and are still concerned you should contact your doctor.

75. Under recent national measures, the clinically extremely vulnerable have been advised
to take extra precautions and stay at home as much as possible. Local Authorities
have been working to ensure the right support is available for those that need it.

76. As the national restrictions end, the guidance to the clinically extremely vulnerable
not to go to work or school will also end. The Government will reintroduce the specific
advice for clinically extremely vulnerable people on how they can protect themselves
at each tier. The Government will constantly monitor the latest evidence and the
evolving situation in local areas to keep the advice for clinically extremely vulnerable
people up to date. Support will be available for those who need it, either through
Local Authorities in tier 3 areas or NHS Volunteer Responders. Supermarket priority
delivery slots will also continue for those who have already registered. The
Government has also made free influenza vaccinations available to the household
contacts of those on the Shielded Patients List.

77. A better understanding of the factors contributing to clinical risk has informed the
clinical advice from Medical Officers that most children can be removed from the
Shielded Patient List, following a clinician-parent conversation. It has also led to the
addition of those with Chronic Kidney Disease Stage 5 and of adults with Down’s
Syndrome to the Shielded Patients List, ensuring that they are provided with the best
advice on protecting themselves.

Read the full 2020 COVID-19 Winter Plan here

NHS: COVID-19. What if I’ve already got respiratory condition?

The NHS has published a set of guidelines for people who have a pre-existing respiratory condition and then get a COVID-19 infection. We reproduce some of the guidelines here but to read the full article click here.

We know that people with existing breathing conditions may have some additional concerns about catching the coronavirus. You are at no more risk of catching the virus than anyone else but if you do then you could become more ill. As COVID affects the lungs, it may be more difficult for you to judge what is causing symptoms.

Washing your hands on a regular basis (especially after visiting the toilet and before eating) and social distancing will reduce your risk of exposure to the virus and it is important you do this.

Should I take my medication as usual?

It is important that you continue taking the medication that has been prescribed for you. Otherwise, this could have an effect on your overall condition and possibly make you feel worse. If you have any concerns or queries about your medication please speak to your local pharmacist or your General Practitioner (GP). Your local surgery or pharmacist can organise a delivery for you.

It is very important that you clean your spacer and inhaler, and any masks/mouthpieces at least weekly.

If you do need to be admitted to hospital, please remember to bring your inhalers, and an up to date list of your medication with you.


What should I do if I feel unwell?

Early treatment for a flare-up (exacerbation) of your lung condition may avoid needing to go to hospital, and you may be able to be treated at home.

You should call your doctor who can assess your symptoms and likelihood of COVID. They can prescribe treatment for you.

If you have a community respiratory nurse they can offer further advice and support.

If you are unsure or outside doctors’ hours you can call 111 for advice or 999 if your breathing problem is very severe.


Does it matter if I smoke?

The chemicals and particles in cigarette smoke will irritate and damage your lungs if you do not stop. It is never too late to stop. Help and support is available, and you are four times more likely to stop with help from a stop smoking advisor.


What can I do if I feel breathless?

If you have a ‘rescue’ inhaler you can take that as prescribed.

Using a handheld fan (not in a public place) moved slowly cheek to cheek can be helpful.

Try to slow your breathing (e.g. breathe in and count to four; breathe out slowly and count to seven).

If you have swollen feet and ankles you may have extra fluid in your body so you will should talk to your doctor about this.


What about routine hospital appointments?

Many hospitals have had to make a difficult decision to postpone many of the non-urgent hospital appointments and planned procedures due to the COVID outbreak. These decisions have been in line with national guidance, you will be offered another appointment when it is safe to do so.

Patients should be contacted by their local hospital teams to see how their appointment has been affected.

Some of the appointments may go ahead and some will be offered either face to face (urgent appointments or via the telephone (virtually).

If you are unsure what has happened to your appointment then please contact your local hospital switchboard or ring the number on the appointment letter.

However, it is important to remember that you should not attend if you have any symptoms of COVID, or have suffered with sickness or diarrhoea in the last 48 hours.


How do I know if I’m on the shielding list?

Please follow the link to the Government guidelines on shielding:


For other useful information about respiratory conditions and COVID please see some useful links below: (British Lung Foundation)

1 2 3 12