Clinically extremely vulnerable receive updated advice tailored to local COVID alert levels

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  • Those considered most clinically vulnerable to receive updated guidance tailored to their local area, in line with new local COVID alert levels
  • New guidance will support them to take appropriate protective actions in their everyday lives, while retaining as much normality as possible
  • Clinically extremely vulnerable group includes those with specific health conditions, certain cancers and organ transplant recipients

Clinically extremely vulnerable people in England will receive new guidance to help them reduce their risk from coronavirus, tailored to where they live the government has announced.

The guidance will be tied into the new local COVID alert levels framework, meaning those at the highest risk of serious illness from the virus will receive specific advice depending on the level of risk in their local area, as coronavirus rates continue to rise.

With many national measures now in place that apply to everyone – for example, the rule of 6 and mandatory face coverings – the clinically extremely vulnerable group is already helped by wider protection measures not previously in place when shielding was originally introduced in March.

These additional precautions set out today, recommended by the Deputy Chief Medical Officer (DCMO) for England, will ensure an extra layer of protection specifically adapted to people’s locations and level of risk, as dictated by the local COVID alert levels.

Deputy Chief Medical Officer for England Dr Jenny Harries said:

Over the last few weeks, we’ve seen a sharp increase in the prevalence of the virus across the country and we know those who are clinically extremely vulnerable are looking for practical advice on how they can carry on their lives while the virus remains in our communities.

The new system will provide clarity on how best those in this group can keep themselves as safe as possible depending on the rates of transmission in their local area. Whilst advisory, I would urge all those affected to follow the guidance wherever they can and to continue to access health services for their medical conditions.

We will continue to monitor the evidence closely and fine-tune this approach to make sure everyone in this group is clear about the safest way to go about their daily lives, particularly over the coming winter months.

Health and Social Care Secretary Matt Hancock said:

With coronavirus rates continuing to increase, now is the time to take action and ensure we protect the most vulnerable in our society.

Today’s announcement will mean every person most at risk from serious outcomes from the virus will have specific advice targeted to local levels, which they can follow to keep themselves as safe as possible, while ensuring they can also keep as much normality in their lives as possible.

The clinically extremely vulnerable group includes those with conditions affecting the immune system, certain cancers and organ transplant recipients among others. The new advice will help this higher risk group better protect themselves from the virus, without needing to follow more restrictive shielding guidance.

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Those in exceptionally high-risk areas may still be advised to adopt formal shielding in the future, including to stay at home, not go to work or school and limit social interactions to their own household and support bubble. Those in these areas will also be updated if the decision is not to follow shielding advice. If shielding advice is reintroduced in their area, they will also be eligible for a support package – including food access support, medicines deliveries and any additional care or support required. They may also be eligible for Statutory Sick Pay or Employment and Support Allowance.

Shielding advice will not automatically be triggered by an area going into local COVID alert level very high, but will be considered as an additional intervention, agreed by ministers under advice from local public health experts and the Chief Medical Officer or DCMO. The government will write to people in these areas if they are advised to adopt formal shielding again.

The advice for the clinical extremely vulnerable, which will be in addition to the basic restrictions set out in the local COVID alert levels framework everyone must follow, includes:

  • for local COVID alert level medium: strictly observe social distancing, meet others outside where possible, limit unnecessary journeys on public transport and work from home where possible, but you can still go to work and children should still attend school. This is on top of restrictions for everyone to only meet in groups of up to 6 people
  • for local COVID alert level high: reduce the number of different people met outside, avoid travel except for essential journeys, work from home where possible and reduce the number of shopping trips made or go at quieter times of the day. You can still go to work if you cannot work from home because all workplaces should be COVID-secure, and children should still attend school. This is on top of restrictions for everyone to not meet other households indoors, unless part of a support bubble, and to only meet in groups of up to 6 people outdoors
  • for local COVID alert level very high: work from home, in general stay at home as much as possible, and avoid all but essential travel. You should also significantly reduce shopping trips, and if possible use online delivery or ask people in your household, support bubble or volunteers to collect food and medicines. People in these areas are encouraged to still go outside for exercise, and can still go to school and to work if they cannot work from home. We recognise that a small number of individuals may require additional support to follow the guidance at this alert level, and they are advised to contact their local authority if they need assistance
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It is extremely important that clinically extremely vulnerable people continue to receive the care and support they need to help them stay safe and well. Providers of social care and medical services are making every effort to ensure services remain open and as safe as possible. You should continue to seek support from the NHS for your existing health conditions. If you are told to go to hospital for a routine appointment, then the NHS has measures in place to make sure that it is safe for you to do so.

There are currently 2.2 million people identified as clinically extremely vulnerable. The Department of Health and Social Care and the NHS will write to all those identified as clinically extremely vulnerable and their doctors, outlining the changes to the guidance. Anyone advised to shield in the future will be written to individually as before.

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Dr Yvonne Doyle, Medical Director and Director of Health Protection at Public Health England (PHE), said:

People who are defined as clinically extremely vulnerable are at very high risk of severe illness from COVID-19. If you are in this group, we recommend that you follow the advice to help protect yourself at each alert level as set out in the guidance.

In addition to the rules you must follow at each alert level, you can take additional precautions. Continue to maintain strict social distancing, wash your hands regularly and try to keep the number of social interactions that you have low. The fewer social interactions you have, the lower your risk of catching COVID-19.

Background information

See the updated guidance

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
  • 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

Find out more on the local COVID alert levels framework

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