Making decisions about shielding – based on guidance issued 22 September for England
Just over 2 million people in England were advised earlier this year that they needed to shield because they are extremely vulnerable to the COVID-19 virus. Shielding aimed to ensure that you did not come into contact with the virus and therefore would not become ill.
The number of people in the community who were infected dropped because of the lockdown. The Government advised that shielding should be paused because the chances of you meeting a person who was infectious had dropped significantly. Getting exercise and keeping connected to others is difficult while shielding. This has had a big impact on many people’s physical and mental health.
Now that the virus infection rates are going up again, people who are at higher risk from the virus may wish to take extra measures to avoid getting infected. Here are some things you should think about when making this decision:
- How high is the risk in your area?
- How high is your personal risk if you contracted the virus?
- How will you balance the risk with the cost of keeping safe?
No one can answer that question for you, but these are some of the things you might want to think about.
The risk in your area
In England, areas are classified as medium, high or very high. You must follow the general guidance relevant to the area. In addition, there is specific guidance for people who were shielding for each level of risk. This additional guidance is all advisory so you can choose not to follow the advice, or to go further.
You need to make sure you know the risk level for your area. If you travel to a different area, for instance to go shopping or to meet people, make sure you know the risk level in that area too.
You can find out the risk level through this website https://www.gov.uk/find-coronavirus-local-restrictions or through the NHS COVID-19 app.
Your personal risk
Not everyone who is clinically extremely vulnerable faces the same level of risk. Some are at such high risk that their clinicians have advised them to continue to stay indoors. On the other hand, some of those who were shielding and became ill with the virus have recovered. Your level of risk will depend on why you were included on the original shielding list, but also factors such as your age. Your arthritis may not be the reason you were included, if you have other conditions that put you at higher risk.
Many people with inflammatory or autoimmune conditions are on the shielding list because of medication they take, not because their condition itself makes them at higher risk. As we get more evidence about the effects of COVID-19 we understand more about different levels of risk.
You may feel that you understand your own level of risk. If not, and you are finding it hard to make decisions about how to stay safe, you might want to speak to your specialist doctor or nurse about this.
The cost of keeping safe
Shielding can also be harmful to your physical and mental health. If you do become ill (with COVID-19 or anything else) you are likely to do much better if you have been eating healthy food and kept up your fitness levels. Make sure you are getting enough exercise. Some people enjoy doing exercise indoors, e.g. online exercise classes. Others need to get outside for a run or walk. The advice is to go outside for exercise but do so at quieter times so that you can keep your distance from others.
Many people found strict shielding, staying indoors and away from everyone, extremely difficult and isolating. Some people enjoy connecting with others over Zoom and find it easier not to see people in person very often. Others, especially people who live alone, feel very isolated if they can’t spend time with people. Loneliness is very damaging to your health.
Be aware of how you are feeling. If you find you are becoming depressed, anxious or stressed it might mean that you need to take a little more risk for your own wellbeing, or find other ways to get support for your mental health.
What activity is safer
When deciding what activity you want to do, the risk of contracting COVID-19 is lower if you:
- Follow all the guidance for everyone about distancing, handwashing, not touching your face, very carefully.
- Stay in the open air – outdoors is safer than indoors
- Indoors is safer if it is well ventilated, not crowded, and people are wearing face coverings
- The fewer people you come into contact with the less likely you are to contract the virus. One or two close friends might be better than a big social network
- Take your own hand sanitiser and use it often.
You should keep 2 metres from everyone not in your household/bubble. You can buy badges to remind people to keep their distance, for instance from https://pleasegivemespace.uk/.
The risk of contracting COVID-19 increases the closer you are to others and the longer you spend with them. If someone walks past quickly and is very briefly closer than 2 metres the risk is extremely low. You can turn away from them as they pass so that you are not facing them. This is extremely unlikely to result in you contracting the virus, especially if you are outdoors.
If you are meeting someone, make sure you can keep 2 metres away from them and that they understand why this is important.
The virus can remain on surfaces, which is why washing your hands and not touching your face is important. If you need to touch something, don’t be afraid to take your own cutlery or carry antibac wipes and use them to clean items you need to touch, (remember that most wipes are not food safe). People should understand that some people are being extra careful.
Think about where you shop and at what time of day. Try to shop at quieter times and use shops which are managing social distancing better. You might want to reduce the number of shopping trips or use online shopping where you can. You might want to ask friends, family or volunteers to do your shopping for you. NHS Volunteer Responders is available if you want to avoid going to the shops. You can call them for free on 0808 196 3646 or through http://www.nhsvolunteerresponders.org.uk/.
If the alert level is very high
You are advised to reduce your shopping trip to the minimum and if possible shop online or get others to do it for you.
Meeting friends and family
The fewer different people you meet up with the smaller your risk. This is not just about the size of a group but also about the total number of people you meet. At all risk levels, people who were shielding are advised to keep the number of people they meet low.
If the alert level is very high
You are advised to continue to go out for exercise, but to stay at home as much as possible. You may also want to distance from people in your household if you can.
Walking and cycling reduce the chances of you being close to someone with the virus.
Using a car will bring you into contact with fewer people than public transport but you should not share a car with people outside your household/bubble.
If you need to use public transport, choose quieter times. Like everyone else you must wear a mask unless you are exempt or a young child. You are advised to keep public transport use to a minimum.
If the alert level is very high
You should try to avoid using public transport and travel as little as possible.
The advice for everyone is to work from home if you can. The guidance for people who were shielding is that, unless they receive a letter saying they are advised to shield, then they can go to work if they are not able to work from home.
Depending on your workplace and your role, this can be very stressful. Your employer is required to take steps to reduce your risk of exposure to COVID-19 in the workplace. You can read more about this here https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19
You should explain to your employer that you are extremely vulnerable to the virus and discuss what else could be done to keep you safe, such as changing role or traveling in at less busy times. Your employer should give you the safest role possible. You could also talk to your workplace Occupational Health if there is one. If you still have concerns about your health and safety at work you can raise them with your workplace union, the Health and Safety Executive or your local authority.
The Access to Work scheme may be able to fund extra travel costs if you can’t use public transport to get to work. They may also fund other support such as costs of working from home or extra PPE. https://www.gov.uk/government/publications/access-to-work-factsheet/access-to-work-factsheet-for-customers#claiming-access-to-work-during-the-coronavirus-covid-19-outbreak
The higher the alert level in the area you work the more important it is for your employer to enable you to be very careful when at work. This means you may need to be aware of the alert level in the area where you work as well as where you live. If they are different then you need to follow whichever is higher.
If you receive a letter advising you to shield you may be entitled to Statutory Sick Pay or Employment Support Allowance.
Many employers are being very supportive of people who are vulnerable to the virus. However, we know that some are less supportive. If you feel, after talking to your employer, that it may not be safe for you to continue in work it is important that you check your understanding of the level of risk you face. You can also get advice from ACASS, your trade union, Citizens Advice or a Law Centre. Many people who are shielding because of inflammatory or autoimmune medication are at a much lower level of risk than others on the shielding list.
Children and young people
The risks for children are now known to be much lower than for adults. Most children who were initially advised to shield were later advised that they did not need to do so. If you are unsure about your child’s risk, talk to their healthcare team. If you are told that your child is still extremely vulnerable, the same principles apply – understanding the risk of the virus as well as the risks of missing out on the benefits of socialising and activity from staying at home. Children and young people need to understand the importance of exercise in order to maintain good physical and mental health, but they also need to understand how to manage this appropriately. This will depend on the factors outlined above as well as the age of your child. It will be an individual decision for parents, involving a young person appropriately depending on their age. Think about how to explain social distancing to help your child comply for their own health needs and those of their families and friends.
CCAA has additional advice and some support resources for children living with arthritis, which you can access here: https://www.ccaa.org.uk/coronavirus-support-resources/
All pupils and students should continue to attend education settings at all local COVID alert levels unless they are one of the very small number of pupils or students under paediatric or other specialist care and have been advised by their GP or clinician not to attend an education setting.
The vast majority of schools and colleges are working very hard to follow national guidance to ensure COVID safety is maintained appropriately. If you have any concerns about your school not being safe enough for your child you should contact them immediately and discuss your concerns.
Guidance for people clinically extremely vulnerable
28 October 2020