What is ‘shielding’ and who needs to do it?

4th Jun 2020

People deemed most at risk of becoming seriously ill from the new coronavirus have been advised to “shield” by the government, meaning they should not leave their homes and should minimise all face-to-face contact until at least the end of June. 

However, there has been some confusion about who exactly is required to shield and what this means in practice. New guidance that applies from 1 June permits people who are shielding to go outside in certain situations. Our readers have asked us to  explain this.

Leaving your home 

From 1 June, clinically extremely vulnerable people who have been shielding themselves are allowed to go outside with other members of their household. Those who live alone can meet one person from another household, and ideally the same person every time. 

Everyone—whether clinically extremely vulnerable or not—should continue to follow social distancing guidelines such as keeping two metres away from people you do not live with. Do not meet with anyone who has Covid-19 symptoms, no matter how mild.

People who have been shielding are still at risk from Covid-19, and advised to only leave the house once a day. They should not go to work or shops, and should avoid crowded places. 

If people who are shielding choose to leave their house, they are advised to try and go outside when fewer people are around, such as early in the morning. Currently, clinically extremely vulnerable people are advised to continue shielding until 30 June.

Shielding and social distancing aren’t the same  

There are two levels of higher risk—the “clinically vulnerable” which includes, among others, all over 70s, and the “clinically extremely vulnerable” who are people with certain conditions who have been contacted by the NHS.

The clinically extremely vulnerable group has been told to shield, while the clinically vulnerable group hasn’t.  

But the difference between the groups hasn’t always been communicated well. 

Matt Hancock vs The Sunday Times       

This confusion was made apparent on 3 May, by the response that the health secretary, Matt Hancock, gave to the front page story in The Sunday Times.

The story said, correctly, that all those aged 70 and over, regardless of health conditions, have been classified as “clinically vulnerable.”

But it then incorrectly said that the “clinically vulnerable” have been asked to stay inside for at least 12 weeks, when this is actually the shielding advice given to the “clinically extremely vulnerable.” The piece has since been corrected.

Responding on Twitter, Mr Hancock described the story as “factually wrong and misleading” but made a mistake in his attempt to correct the article. 

He said correctly that over 70s have not been asked to stay in lockdown for 12 weeks, but then incorrectly said that over 70s are not “clinically vulnerable” which they are. 

The government advice on social distancing at the time, said people aged 70 or older are classed as clinically vulnerable, regardless of any medical conditions. It said these people are at higher risk of severe illness and “should take particular care to minimise contact with others outside your household.” 

This is still the advice as of 4 June. 

The NHS also lists people aged 70 or over as being clinically vulnerable, recommending they only leave home if it is essential. 

Mr Hancock  may have meant that over 70s are not classed automatically as “clinically extremely vulnerable.” He said: “The clinically vulnerable, who are advised to stay in lockdown for 12 weeks, emphatically DO NOT include all over 70s. I’ve asked for an urgent correction.”

But what do these two labels mean in practice? 

Shielding for the clinically extremely vulnerable    

Clinically extremely vulnerable people should have received a letter from the NHS or been told by their GP that they are in this group. If you have not received a letter but think you should have, you should discuss this with your GP. Your doctor may have given your extra advice on what to do, that is not covered in the guidance, which you should follow.

People in this group include

  • People who have specific cancers, 
  • People who have severe respiratory conditions or rare diseases that significantly increase the risk of infections, 
  • People who have received a solid organ transplant 
  • People who are receiving immunosuppression therapies that could significantly increase their risk of infection
  • Women who are pregnant and have significant heart disease
  • People with other conditions who have been told by a GP or hospital clinician that they are clinically extremely vulnerable. 

These are the people who have been told to shield. This means strictly avoiding contact with anyone displaying any Covid-19 symptoms, such as a high temperature or new and continuous cough. The current advice is for people in this group to shield until the end of June. 

This goes beyond the universal social distancing guidelines which apply to the public. 

Clinically extremely vulnerable people have been advised to wash their hands more often, and to avoid touching their eyes, nose and mouth with unwashed hands, and to frequently clean and disinfect frequently touched objects and surfaces in the home.

If you are in this group you should arrange for any food or medicines to be collected by someone you know or delivered, rather than going out yourself. Essential carers or visitors who support you with everyday needs can continue to visit unless they show any symptoms, and should ensure they wash their hands on arrival at your house and often while they are there. You should discuss with your GP or specialist whether any scheduled hospital or medical appointments are absolutely essential to attend. 

If you live with other people you should minimise the time you spend with them in shared spaces such as kitchens, bathrooms and sitting areas, and keep these spaces well ventilated. If possible you should use a separate bathroom, but if this isn’t possible then all surfaces should be cleaned after use and you should ensure you use separate towels from them after bathing and to dry your hands. The government suggests drawing up a rota for bathing, with the clinically extremely vulnerable family member using the facilities first. 

Government advice also recommends avoiding using the kitchen when others are present, and taking your meals back to your room to eat, sleeping alone and keeping two metres (or three steps) away from people you live with if possible. 

If you live with someone who is shielding, you do not need to shield as well but you should follow the guidance on social distancing carefully. If you are an unpaid carer for someone who is clinically extremely vulnerable, you should ensure you only provide essential care and follow advice on good hygiene, and do not visit or provide care if you are unwell. 

No work should be carried out in a household where someone has been advised to shield, unless there is a direct risk to safety such as emergency plumbing or repairs, or to provide emergency childcare.

If you are clinically extremely vulnerable and you develop symptoms of Covid-19, such as a new continuous cough, a fever or a loss of taste or smell, you must arrange to have a test by booking one online or calling NHS 119. You should do this as soon as you get symptoms. If you are seriously ill call 999 and explain that you are clinically extremely vulnerable to coronavirus. 

The government also recommends preparing a hospital bag in case you need to go into hospital for treatment for Covid-19. This should include details for your emergency contact, a list of medication you take, things you need to stay overnight, any information on planned care appointments and details of your advanced care plan, if you have one.

Clinically extremely vulnerable people who have received a letter from the NHS can register online for extra support, such as getting groceries delivered to their home. You can also call 0800 028 8327.

Strict social distancing for the clinically vulnerable

‘Clinically vulnerable’ describes the wider group of people who have been identified as being more at risk from the new coronavirus but not so severely that they need to shield themselves. 

The government doesn’t actually recommend that clinically vulnerable people follow any rules that differ from the universal social distancing guidance. 

But these people are being told to follow that guidance carefully, and to take particular care to minimise contact with others outside of their household. 

As discussed above, this group includes anyone aged 70 or older regardless of their medical conditions. 

It also includes anyone who is under 70 but has health conditions including chronic mild to moderate respiratory disease, chronic heart, kidney or liver disease, chronic neurological conditions, diabetes or a weakened immune system because of conditions such as HIV and AIDS or medicines like steroid tablets. 

This group also includes pregnant women and anyone classed as seriously overweight, with a body mass index of 40 or above.

Update 4 June 2020

This article was updated to include new government guidance on shielding.