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21 August 2020

What is the latest 'shielding' guidance?

Shielding is intended to protect people who are 'clinically extremely vulnerable' from COVID-19.

Last updated on Friday 21st August 2020.

'Shielding' is a measure which is intended to protect people who are deemed to be 'clinically extremely vulnerable' to severe illness and hospitalisation from COVID-19 by minimising their interaction with others. If you fall into this ‘clinically extremely vulnerable' category, you should have been contacted directly by the NHS and initially advised to stay at home for a period of at least 12 weeks (until 30th June 2020) and avoid any face-to-face contact with others.

What is the current shielding guidance?

England

The current guidance for the clinically extremely vulnerable in England is that, as of 1st August, shielding has been paused. From this date, the Government is advising you to adopt strict social distancing rather than full shielding measures. Strict social distancing means you may wish to go out to more places and see more people but you should take particular care to minimise contact with others outside your household or support bubble.

This means that people in England who have been shielding:

  • No longer need to follow previous shielding advice
  • Can go to work as long as the workplace is Covid-secure, but should carry on working from home wherever possible.
  • Clinically extremely vulnerable children should attend education settings in line with the wider guidance on reopening of schools and guidance for full opening: special schools and other specialist settings. Where possible children should practice frequent hand washing and social distancing.
  • Can go outside as much as you like (including to buy food, to places of worship and for exercise) while maintaining strict social distancing, but you should still try to keep your overall social interactions low.
  • Can visit businesses, such as supermarkets, pubs and shops, while keeping 2 metres away from others wherever possible or 1 metre, plus other precautions.
  • Should continue to wash your hands carefully and more frequently than usual and ensure that you maintain thorough cleaning of frequently touched areas in your home and/or workspace.
  • Will no longer receive free food parcels, medicine deliveries and basic care from the National Shielding Service.

  • You will still be able to get:

  • Local volunteer support by contacting your local authority.
  • Prescriptions, essential items and food you buy delivered by NHS Volunteer Responders.
  • Priority slots for supermarket deliveries (if you previously registered for free food parcels).

  • People in England who have been shielding should remain cautious as you are still at risk of severe illness if you catch Coronavirus. You could be advised to shield again if the situation changes and there is an increase in the transmission of COVID-19 in the community. Your name will be kept securely on the shielded patient list by NHS Digital. The Government will write to you if the advice changes.

    Information about what to do if you are clinically extremely vulnerable and the area in which you live becomes subject to a local lockdown can be found here.


    Wales

In Walesas of 16th August 2020, shielding has been paused. People in Wales who have previously followed shielding advice no longer need to do so, and can now follow the same rules as the rest of the population.

This means:

  • You no longer need to stay 2 metres or 3 steps away from people you live with or who are part of your extended household.
  • You can now go to work, if you cannot work from home, as long as the business is COVID secure (has taken reasonable measures to minimise risk to employees).
  • Children who have been shielding can return to school when schools re-start.
  • You can now go out for any reason, including going to shops to buy food, but you should stay 2 metres or 3 steps from other people.

  • As part of the support arrangements, food boxes will end, but priority supermarket slots will continue to be available and medicine deliveries will be available via the National Volunteer Prescription Delivery Scheme until the end of September.

    The Welsh Government will keep a record of everyone on the shielding patients list in case they should need to ask anyone to shield again in future.


Northern Ireland

The current guidance in Northern Ireland is that, as of 31st July 2020, shielding has been paused.

This means that people in Northern Ireland who have been shielding no longer need to follow the previous shielding advice, but should continue to following strict social distancing rules.

Pausing, rather than stopping shielding is just a precaution and there are no plans for it to restart at the moment. The pause is indefinite, but it remains possible that shielding guidance will need to be reactivated if the risk increases in the future.

For information about support after the end of shielding in Northern Ireland, please click here.


    Scotland

In Scotland, as of 1st August 2020, shielding has been paused and most people who have been shielding can now follow the same advice as everyone else in Scotland. This advice applies to most people who have been asked to shield (including any children and young people who are still on the shielding list), but it does not apply to anyone living in a residential care or nursing home.

This means that most people in Scotland who have been shielding can:

  • Meet indoors with up to 8 people from 2 other households with physical distancing
  • Meet outdoors with up to 15 people from 4 other households outdoors with physical distancing
  • Go inside pubs and restaurants
  • Attend places of worship for congregational services, communal prayer and contemplation
  • Return to work or school
  • Return to university or college as part of the phased return to campus
  • Use formal childcare providers – this now includes children who have been shielding

  • This is in addition to previous guidance on:

  • Stopping physically distancing from the people you live with or who are in your extended household.
  • Using toilets in other people’s homes and allowing other people to use yours at home.
  • Using public transport wearing a face covering unless you are exempt.
  • Travelling further than 5 miles from home, as far as you want.
  • Booking all types of holiday accommodation or travelling to a second home – and staying over with people outside of your household.
  • Going inside shops and leisure venues wearing a face covering unless you are exempt.
  • Visiting outdoor public gardens

People in Scotland who have been shielding should continue to strictly follow physical distancing and hygiene measures.

The Scottish Government will keep its shielding advice under constant review. If they see an increase in infection rates that gives them concern, they may ask you to take extra steps again to stay safe. If so, they’ll let you know by letter and through the SMS Shielding Service.


How do I know whether or not I should be shielding?

If you fall into the ‘clinically extremely vulnerable' category, you should have been contacted directly by the NHS and initially advised to stay at home for a period of at least 12 weeks (until 30th June 2020) and avoid any face-to-face contact with others.

If you are only taking a single medication that affects your immune system and have no other medical issues, it is unlikely that you will fall into the ‘clinically extremely vulnerable’ category requiring shielding, but very careful social distancing is advised.

We have put together the following information to help make it clearer for people who are living with psoriasis or psoriatic arthritis whether or not they fall into this ‘clinically extremely vulnerable’ category. If you think you fall into the 'clinically extremely vulnerable' category but you have not received a letter or been contacted by your GP, you should discuss your concerns with your GP or hospital clinician.

In psoriasis and psoriatic arthritis, people who are 'clinically extremely vulnerable', at the highest clinical risk from COVID-19 and will definitely be advised to 'shield' include:

  • People who have any of the medical conditions on this list from the UK Government (whether they also have psoriasis/psoriatic arthritis or not).
  • People who are taking TWO or more immunosuppressive or biologic medicines (please see the list below) for their psoriasis and psoriatic arthritis (except a single biologic in combination with methotrexate, hydroxychloroquine or sulphasalazine).
  • People who take either Infliximab originator (Remicade) or biosimilars (e.g. Flixabi, Inflectra, Remsima, Zessly), which are given by infusion.
  • People who take ONE immunosuppressive or biologic medicine (or a biologic combined with methotrexate, hydroxychloroquine or sulphasalazine) who are ALSO 'clinically vulnerable' as defined by this list.

A list of the immunosuppressive and biologic medicines used for psoriasis and/or psoriatic arthritis:

  • Immunosuppressive medications: Ciclosporin, Fumaric Acid Esters (FAE, Fumaderm and Skilarence – Dimethyl Fumarate), Leflunomide, Methotrexate. This does NOT include Acitretin or Sulphasalazine.
  • Biologics: Any Adalimumab biosimilar (e.g. Amgevita, Hulio, Hyrimoz, Imraldi) or Adalimumab originator (Humira), Anakinra (Kineret), Cimzia (Certolizumab pegol), Cosentyx (Secukinumab), Etanercept originator (Enbrel) or Etanercept biosimilars (e.g. Benepali, Erelzi), Ilumetri (Tildrakizumab), Kyntheum (Brodalumab), Infliximab originator (Remicade) or Infliximab biosimilar (e.g. Flixabi, Inflectra, Remsima, Zessly), Simponi (Golimumab), Skyrizi (Risankizumab), Stelara (Ustekinumab), Taltz (Ixekizumab), Tremfya (Guselkumab)
  • Small molecule immunosuppressants: Otezla (Apremilast), JAK inhibitors e.g. Xeljanz (Tofacitinib)

'Clinically vulnerable' - at a higher clinical risk from COVID-19 (but not the highest risk) - Very careful social distancing is advised - Advised to 'shield' only if there are other concerns, high-risk circumstances or comorbidities (to be decided by your clinician):

You will be asked to 'shield' if you meet any of the following criteria AND you are recommended to do so by your clinician:

  • If your psoriasis or psoriatic arthritis is well controlled with minimal activity, you have none of the comorbidities listed here, and you are taking only ONE of the following: an immunosuppressive medication, a biologic, or a small molecule immunosuppressant (please see the list above for specific examples).
  • If your psoriasis or psoriatic arthritis is well controlled with minimal activity, you have none of the comorbidities listed here, and you are taking ONE biologic (see list above) in combination with methotrexate.
  • If your psoriasis or psoriatic arthritis is well controlled with minimal activity, you have none of the comorbidities listed here, and you are taking ONE immunosuppressive medication (see list above) plus Hydroxychloroquine or Sulphasalazine.

No need to 'shield' but should still follow social distancing measures:

There is no need to 'shield', but you must continue to follow the latest NHS advice, including social distancing measures, as per the rest of the UK population, if you are taking any of the following medications, either alone or in combination:

  • Topical skin treatments (creams, gels etc.)
  • Hydroxychloroquine
  • Acitretin
  • Sulphasalazine

The British Association of Dermatologists have put together a useful FAQ section here that includes the following examples:

Examples of the type of patient who would NOT be advised to self-isolate are:

  1. A person with hidradenitis on Humira (adalimumab) who is 45 and has none of the described comorbidities.
  2. A person who is 50, on methotrexate up to 25 mg per week, and Humira (adalimumab).
  3. A person who is 57, on hydroxychloroquine and mycophenolate mofetil and has no other comorbidities.

Examples of the type of patient who WOULD be advised to self-isolate

  1. A person on any single agent biologic - e.g. you are only using one biologic such as Humira (Adalimumab) or Cosentyx (Secukinumab) at a standard dose, who is more than 70 years old.
  2. A person on any single agent biologic at a standard dose, who is on medication for hypertension or diabetes or asthma or Ischaemic Heart Disease, or who is pregnant.
  3. A person on a single agent biologic at a standard dose, with renal (kidney) impairment.
  4. A person on a single agent biologic at a standard dose, and up to 25mg weekly of methotrexate, who develops any medical problems described in the above three points.

  5. Guy's and St Thomas' NHS Foundation Trust have also put together some
    Dermatology and coronavirus frequently asked questions. These include a number of FAQs specifically about immunosuppressant medications, social distancing, shielding, and a handy self-assessment risk calculator. Please note, while this resource contains really useful information for everyone, please only contact Guy's and St Thomas' if you are already one of their patients.

    If you have psoriatic arthritis, you may also find this risk stratification guide from the British Society for Rheumatology useful if you are taking an immunosuppressant medication and you are unsure whether or not you fall into the 'extremely vulnerable' category requiring 'shielding'.

    The Arthritis and Musculoskeletal Alliance (ARMA) has produced a handy resource on 'making decisions about shielding'. While this resource has a particular focus on the previous shielding guidance (from 6th July 2020) in England, much of the information may still be helpful even after shielding was paused on 1st August 2020.

Finally, full guidance on shielding to protect 'extremely vulnerable' people can be found here:

For the latest information on COVID-19, please visit the NHS website here.

The Psoriasis Association is the UK's leading national charity and membership organisation for people affected by psoriasis – patients, families, carers and health professionals Read More >

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