Updated shielding guidance for people with blood cancers – FAQs

There have a number of changes to guidance around COVID-19 in recent days across the UK. This blog will update you on any changes.

Correct as of 27/11/2020. We will update this with further information as soon as possible. Please get in touch with us at advocacy@leukaemiacare.org.uk for further help. 

There have been a number of changes to guidance around COVID-19 in recent weeks across the UK. This blog will update you on any changes, with a focus on the advice specifically for the clinically extremely vulnerable.

1a. I live in England; what is the advice for those who are shielding during the national lockdown?

ENGLAND:

From 5th November, new national lockdown restrictions will replace the 3 tier system of local lockdowns. This means people will be required to stay at home, where possible, with specific exceptions. There are also restrictions on meeting family or friends socially indoors; that are not part of your household or support bubble. Certain businesses including non-essential retail, entertainment venues and personal care facilities will be required to close. Whilst education and childcare remain open.

It has been confirmed that the lockdown will end of the 2nd of December and be replaced with a tier system, similar to the system in place immediately prior to the lockdown on the 5th of November. We will have advice available ready for and available from the 2nd of December, with any advice available on how to protect yourself depending on the tier in which you live

You may be wondering what this means for those who are clinically extremely vulnerable to severe COVID-19; this group includes the majority of blood cancer patients who were asked to shield from March to August this year.

The latest guidance can be read 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.

Below we have answered some questions you might have about this new guidance.

Has shielding restarted again?

The government has issued additional advice to the clinically extremely vulnerable (see next question). However, we recognise that some people may require support to follow this guidance; please get in touch with our advocacy team if this is the case.

What can I do to protect myself now?

If you are concerned about your own personal risk of COVID-19 and whether recent announcements should change this; please speak to your haematologist or clinical nurse specialist for further advice. We are unable to give advice about individual risk levels.

For those who want to reduce their potential risk of exposure, the following steps may help:

  • Stay at home as much as possible, except to go outdoors for exercise or to attend medical appointments.
  • You are advised to work from home if that is not possible, you are strongly advised to not attend work during these 4 weeks. This does not apply to other people you live with, they are advised to follow the national lockdown restrictions.
  • Avoiding all but essential travel.
  • You are advised to not go out for shopping. If possible, use online delivery or ask people in your household, support bubble or volunteers to collect food and medicines

What support is in place to help me follow this guidance?

The national support schemes will not be put back in place unless shielding is reinstated. The NHS volunteers scheme continues and should contact them in the first instance if you need support in getting food, medicines or arranging transport to attend a medical appointment.

You can contact them here: https://nhsvolunteerresponders.org.uk/services.

If you are not eligible for NHS volunteer support, your local authority will be instructed to provide extra support, so contact them in the first instance. You can find out more here: https://www.gov.uk/coronavirus-local-help

You can register for additional support by entering your details here: https://www.gov.uk/coronavirus-shielding-support, including getting access to priority supermarket delivery slot, and enquiring about any other local support available to enable you to follow the new guidance.   Please note – this link is for residents in England only.

You can find information on support for Wales, Scotland and Northern Ireland on the following links:

Wales: https://gov.wales/protecting-people-defined-medical-grounds-extremely-vulnerable-coronavirus-covid-19-previously

Scotland: https://www.gov.scot/publications/covid-shielding/

Northern Ireland: https://www.nidirect.gov.uk/articles/coronavirus-covid-19-guidance-clinically-extremely-vulnerable-and-vulnerable-people

If you have any questions about ordering repeat prescriptions or booking online consultations with your healthcare professional, please read more here: https://www.nhs.uk/health-at-home/ 

What if I can’t work from home – is there financial support?

If you cannot work from home, you may be eligible for Statutory Sick Pay (SSP) or Employment Support Allowance (ESA).

The furlough scheme was reopened until December 2nd and if you are unable to work from home, you should speak to your employer and ask them to furlough you. If you need support in speaking to your employer, our welfare team can help.

Please get in touch with the advocacy team if you need further support or help with any of this.

Should my children still go to school?

For children who have been diagnosed with a blood cancer, the guidance is that children should continue to go to school unless their clinicians advise otherwise.

For people with blood cancers who are living with children who are of school age, there is no formal guidance for this group. Please get in touch with your haematologist and your child’s school if you have concerns.

How do I know if I am on the shielded list still, in case shielding is restarted?

The shielded patient list has been maintained since shielding was paused in August. It has been reviewed to see if there are patients that are no longer needing to be on the list (e.g. someone has stopped taking an immunosuppressant drug). If this applies to you, your doctor should have discussed with you before doing this.

To make sure you receive a letter in the event of shielding being reinstated, please make sure your GP surgery has your correct address and an email address if possible.

I have been diagnosed in the last 6 months; will I be told when shielding is needed?

Anyone who has become clinically extremely vulnerable, such as a receiving a new diagnosis, should have been added to the shielded patient list too. Make sure your GP has the correct contact details so you can be easily contacted.

 

 

1b. I live in England: What is this advice for the vulnerable for when the national lockdown end on the 2nd of December?

When the national lockdown ends, everyone will be asked to go back to following advice based on the level of COVID cases in their local area. This includes an end to the advice for vulnerable patients to shield that was in place from the 5th of November until the 2nd of December.  

You can read all the general advice for each tier here: https://www.gov.uk/guidance/local-restriction-tiers-what-you-need-to-know#all-tiers. In summary, Tier 1 allows up to 6 people to meet indoors, Tier 2 bans any meeting indoors and only a meeting of up to 6 outdoors, and Tier 3 bans any meeting between households except in a public outdoor space. The rules are similar, but slightly stricter than, the tier system that was in place prior to the national lockdown in November. 

There is some extra advice for the clinically extremely vulnerable, based on which tier you are in. This can be read here: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/cev-from-2-dec. We have also summarised below: 

Medium alert level (Tier 1): 

  • Strictly observe social distancing 
  • Meet others outside where possible 
  • Exercise outside if possible  
  • Limit unnecessary journeys on public transport 
  • Work from home where possible, but you can attend work if it is COVID-secure 
  • Consider shopping at quieter times of day 

High alert level: 

  • Reduce the number of different people you meet and keep this number as low as possible 
  • Avoid travel except for essential journeys 
  • Work from home where possible, but you can attend work if it is COVID secure 
  • Reduce the number of shopping trips made or go at quieter times of the day 
  • Going to work – in COVID-secure workplaces – permitted if they cannot work from home 
  • Children should still attend school 
  • Very high alert level: 
  • Work from home or talk to your employer about alternative arrangements.  
  • Stay at home as much as possible 
  • Avoid all but essential travel 
  • Avoid busy locations if exercising outdoors, but continue to take exercise  
  • Reduce shopping trips, and if possible use online delivery or ask people in your household, support bubble or volunteers to collect food and medicines. You can still register for priority slots for delivery of food. 
  • Additional support should be available from local authorities 

How do I know my tier? 

The tiers that were announced by the Health Secretary on the 26th of November will run from the 2nd of December until the 16th of December. Any changes in the tier that your local area is in will be communicated via local and national news services. There are also a few ways to find out the risk in your local area immediately: 

Can I still be furloughed if it is not safe for me to return to work?  

Yes. The advice for the clinically extremely vulnerable states that employers are able, but are not obligated, to use to the furlough scheme for vulnerable patients who cannot work at home, regardless of the tier. 

Please contact our advocacy team if you need further support with this.  

What support is in place to help me follow this guidance? 

The NHS volunteers scheme continues and should contact them in the first instance if you need support in getting food or medicines. You can contact them here: https://nhsvolunteerresponders.org.uk/services. If your area enters the very high risk area or you are not eligible for NHS volunteer support, your local authority will be instructed to provide extra support, so contact them in the first instance. 

Please get in touch with the advocacy team if you need further support. 

What if I work in an area which is a tier that is higher than the area you live? 

The guidance says that you should follow the guidance of the place with the highest tier. For example, if you live in a medium risk area but work in a high-risk area, you should follow the high risk tier advice when it comes to work.  

Should my children still go to school? 

For children who have been diagnosed with a blood cancer, the guidance continues to be that children should continue to go to school unless their clinicians advise otherwise. 

For people with blood cancers who are living with children who are of school age, there is no formal guidance for this group. Please get in touch with your haematologist and your child’s school if you have concerns.  

Will shielding be reinstated at any time during the tiered restrictions? 

The advice states that shielding is not automatically y reinstated in any tier, even in the highest tiers. However, it may be considered in some Tier 3 locations if the situation worsens whilst restrictions are in place. This will be communicated to those on the shielded list through emails and letter.  

Please make sure you keep your details up to date with your GP practice and your haematology team, as this will be where the information to contact you is taken from. 

 

2. I live in Scotland, what is the status of shielding?

SCOTLAND

In Scotland, an announcement on the 22nd of October by the First Minister set out a new 5 level system (risk level 0 to 4) that indicates the concern about the spread of COVID-19 in individual areas. This will come into place on the 2nd of November, and each level comes with specific restrictions for both the general public and the clinically extremely vulnerable group. You can read more about the restrictions in each level here: https://www.gov.scot/publications/coronavirus-covid-19-protection-levels/pages/overview/. The Scottish Government will announce which level applies to each location prior to the system coming into place.

Below we have provided some extra details about the guidance for the clinically extremely vulnerable in Scotland. This information specifically relates to the new level system due to come into place on the 2nd of November.

Has shielding restarted again?

Most people in the clinically extremely vulnerable group will think of shielding in terms of the guidance issued in March, where people were asked to stay at home all the time. With the new level system, the Scottish Government have set out a new system of shielding, where the clinically extremely vulnerable are given advice tailored to the risk levels.

The government has also said that there will be support in place to help everyone stick to the additional guidance, although information on this is currently limited. Please contact your local council, contact our Advocacy Team on the details at the bottom of this blog or call the COVID-19 helpline for Scotland (0800 111 4000) if you are concerned about your ability to follow guidance without support.

What can I do to protect myself in the level that my area is in?

The government has indicated that, for all levels, the clinically extremely vulnerable will not be told to stop exercising outside, nor will they be told to distance themselves from people they live with.

Level 0 and level 1 shielding

  • Contact with others: follow the level advice to the general population
  • Shopping: strictly follow the guidelines when shopping
  • If you cannot work from home: following a workplace risk assessment, your employer should make the necessary adjustments to your workplace to protect you. You can discuss getting a fit note with your GP or clinician if you still feel unsafe.
  • School/formal childcare: follow the level advice to the general population

Level 2 shielding

  • Same as level 1, except:
  • Contact with others: reduce the number of people or households you have face to face contact with
  • Avoid: one metre zones

Level 3 shielding

  • Contact with others: limit meeting people outside your own household, avoid indoor public spaces.
  • Shopping: strictly follow the guidelines when shopping and limiting the number of times you go to a shop. Shop at quieter times.
  • If you cannot work from home: speak to your employer to ensure all appropriate protections are in place. If they are not, discuss getting a fit note with your GP or clinician.
  • School/ formal childcare: parents or guardians should discuss with their GP or clinician whether children should still attend.

Level 4 shielding

  • Contact with others: contact with people outside your own household if you can. You should not take public transport.
  • Shopping: Strictly follow the guidelines when shopping and limiting the number of times you go to a shop. Shop at quieter times.
  • If you cannot work from home: The Chief Medical Officer will issue an automatic two week fit note to give people on the shielding list protection while they speak to their GP or consultant and get a personal fit note if necessary.
  • School/formal childcare: children on the shielding list should not attend in person.

What if I work in an area which is a level that is higher than the area you live?

At all levels, travel between areas for essential purposes, which includes work that cannot be done from home, is permitted.

If you cannot work from home and are concerned about travelling to a higher risk area, speak to your employer and healthcare professionals in the first instance. They should support you to understand the restrictions in place based on the level of risk in the area that the workplace is in. If you have any concerns remaining, please contact our Advocacy Team on the details at the end of the blog.

Should my children still go to school?

For children who have been diagnosed with a blood cancer, the guidance depends on the level of risk in their area. Please see that previous question “what can I do to protect myself” for further information.

For people with blood cancers who are living with children who are of school age, there is no formal guidance for this group. Please get in touch with your haematologist and your child’s school if you have concerns.

I have been diagnosed in the last 6 months; will I be told what I need to do?

All blood cancer patients who have been diagnosed in the last 6 months are highly likely to be included in the clinically extremely vulnerable population, as these definitions have not changed since March at the time of writing. If you would like to check this, please speak with your haematologist directly.

3. I live in Wales, what is the status of shielding?

In Wales, there was a 16-day lockdown in place across the whole country, which ended on the 9th of November. People are now encouraged to follow general guidance, such as limiting the number of people you meet with and observing social distancing, which you can read more about here: https://gov.wales/coronavirus-regulations-guidance. This link includes information for those who are clinically extremely vulnerable if you scroll down to the relevant section on shielding.

Shielding is not currently in place in Wales. The government will write to those on the list if this changes and shielding resumes. The advice to the extremely vulnerable currently is to be strict in how you apply the general guidance, but no extra actions are needed at this time.

4. I live in Northern Ireland, what is the status of shielding?

Northern Ireland

Northern Ireland had a nationwide lockdown for 4 weeks from Friday 16th October. A few restrictions were lifted on the 20th of November, such as allowing close contact beauty services. However, it has been announced that tighter restrictions return from the 27th of November for two weeks.

At the time of writing, the formal shielding has not been reinstated under the current lockdown restrictions, nor will it be reinstated under restrictions due to be in place from the 27th of November. There is some limited additional advice for those who are clinically extremely vulnerable. The latest information can be found here: https://www.nidirect.gov.uk/articles/coronavirus-covid-19-regulations-guidance-what-restrictions-mean-you#toc-4 (scroll to medically vulnerable and older people section).

5. What happens if I or someone I live with begin to show symptoms?

If anybody in the house starts to show symptoms of coronavirus, then you all must start following the self-isolation guidance for suspected coronavirus. This includes separating the person displaying symptoms from other people within the household. Further details here.

If you, the extra high-risk person, develops symptoms, government guidance is to use the 111 service, either online or by calling, to seek further advice. You may also like to let your haematology team know, in case they have any advice for you too. This will also help teams to keep an accurate record of patients who have had coronavirus.

Does the new UK wide Christmas advice apply to the clinically extremely vulnerable?

On the 24th of November, all UK nations put out a joint statement saying that there will be a relaxation of rules on COVID-19 to allow up to 3 households to meet over the festive period. These are being called an “extended Christmas bubble”; you can meet with up to 2 other households, but you must choose these two and only meet with those two; you cannot change who is in your bubble over time. The bubbles will be allowed from the 23rd of December for 5 days, after which you need to go back to following the guidance for the tier in which you live. You can read more here: https://www.gov.uk/government/publications/making-a-christmas-bubble-with-friends-and-family/making-a-christmas-bubble-with-friends-and-family#if-you-are-clinically-extremely-vulnerable.

Point 5 in the guidance (see link above) indicates that the clinically extremely vulnerable, such as blood cancer, are able to form a Christmas bubble if they want to. However, the guidance acknowledges that this is riskier for people who are clinically extremely vulnerable. If you are considering forming a bubble for Christmas, you might wish to ask those you plan to meet to take extra precautions to avoid COVID-19 in the week or so before you meet with them, or choose to form a bubble with just one other household rather than two. Please speak to your clinical team if you would like further advice for your individual situation.

For more information about self-isolation, including help finding financial support, dealing with employers and assistance with the government support, please email advocacy@leukaemiacare.org.uk.

You can also call our helpline: 08088 010 444, or use our whatsapp service: 07500068065. The helpline team will take your details and pass them onto the advocacy team.

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