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Extremely vulnerable patients

On 31 October the Government announced new national restrictions to help control the spread of infection which will apply from 5 November 2020.  A letter will be sent from the Department of Health and Social Care to all patients identified as clinically extremely vulnerable with guidance regarding shielding and how to access advice and support.

This guidance is for people who are clinically extremely vulnerable, including children. It’s also for their family, friends and carers.

People who are clinically extremely vulnerable should have received a letter telling them they’re in this group or been told by their GP.  If you have not received a letter and think you should be included in this category, please arrange a telephone review with your GP to discuss.

Definition of clinically extremely vulnerable groups

People who are defined as clinically extremely vulnerable are at very high risk of severe illness from COVID-19. There are 2 ways you may be identified as clinically extremely vulnerable:

  1. You have one or more of the conditions listed below, or
  2. Your hospital clinician or GP has added you to the Shielded patients list because, based on their clinical judgement, they deem you to be at higher risk of serious illness if you catch the virus.

If you do not fall into either of these categories and have not been informed that you are on the Shielded patients list, follow the new national restrictions from 5 November.

If you think there are good clinical reasons why you should be added to the Shielded Patient List, discuss your concerns with your GP or hospital clinician.

Adults with the following conditions are automatically deemed clinically extremely vulnerable:

  • solid organ transplant recipients
  • those 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
  • those with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
  • those with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)
  • those on immunosuppression therapies sufficient to significantly increase risk of infection
  • adults with Down’s syndrome
  • adults on dialysis or with chronic kidney disease (stage 5)
  • 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 decisions

If you have been told that you’re clinically extremely vulnerable, you should:

  • follow the advice in this guidance (link below)

Advice regarding shielding can be found here: 

https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19#cev

Certain patients, typically those who are offered an Influenza Vaccine annually, are at High Risk and should practice social distancing which is different from shielding.  Further guidance on social distancing is available at:

https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults

Government guidance is regularly updated.  All guidance in relation to Covid-19 can be accessed at: https://www.gov.uk/coronavirus-taxon

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