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21 July 2021

What is the latest 'shielding' guidance?

Advice for people who are deemed to be 'clinically extremely vulnerable'.

Last updated on Wednesday 21st July 2021.

There is specific advice 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. Most people who fall into this ‘clinically extremely vulnerable' category will previously have been contacted directly by the NHS or their GP to advise them of this.

In February 2021, more people in England were added to the 'clinically extremely vulnerable' list after being identified by the QCovid risk prediction model. QCovid estimates a person’s risk of catching COVID-19 and becoming seriously unwell, based on multiple risk factors, including age, sex registered at birth, ethnicity, body mass index (BMI), specific health conditions and treatments.

If you have been added to the 'clinically extremely vulnerable' list by QCovid, you should have received a letter or email explaining why. You should also have been invited to receive the COVID-19 vaccine as a matter of priority. Your invitation letter or email should have arrived separately.

The latest guidance for 'clinically extremely vulnerable' individuals in England, Wales, Northern Ireland and Scotland can be found below.

What is the current guidance for people who are 'clinically extremely vulnerable'?

England

Shielding in England was paused on Thursday 1st April 2021. There is still advisory guidance in place for people who are clinically extremely vulnerable, which can be found here. You can find links to individual sections of this guidance below:

Everyone on the Shielded Patient List should already have been offered a COVID-19 vaccine in line with the priority ordering set by the Joint Committee on Vaccination and Immunisation (JCVI). If you have not yet received your first dose, please contact your GP or book your vaccination online here. If you have received your first dose, you should still ensure you take up your second dose of the vaccine when it is offered to you. Having two doses should further increase your level of protection. For some people who are immunosuppressed it may only be with your second dose that a significant immune response is triggered.

No vaccine is 100% effective and therefore even if you have had both doses, there is still no absolute guarantee that you will not become ill from COVID-19. As such, you should continue to follow the guidance that is in place for everyone.

The NHS Volunteer Responders programme remains available to help support those who need it. Volunteers can collect and deliver shopping, medication and other essential supplies, help with a regular, friendly phone call, and provide transport to and from medical appointments. Call 0808 196 3646 between 8am and 8pm, 7 days a week to self-refer or visit www.nhsvolunteerresponders.org.uk for further information.


Wales

Shielding in Wales was paused on Thursday 1st April 2021. There is still advice in place for people who are clinically extremely vulnerable, which can be found here. You can find links to individual sections of this guidance below:

    Everyone on the Shielding Patient List (aged 16 years and over) has already been invited to receive the COVID-19 vaccine. If you have recently been added to the Shielding Patient List you will be prioritised for vaccination. Please allow approximately a week from the date of your letter to be invited, while systems are updated.

    Even if you have had both doses of the vaccine, you are advised to continue to follow social distancing and hand and surface hygiene advice strictly. The people you live with should continue to follow the public health rules and guidance as long as they are in place, including if you have received the vaccine and also if they have received the vaccine.

    Clinically extremely vulnerable people can now go to work, if they cannot work from home, as long as the business is COVID-secure.

    You can go to the shops yourself, however if you do not feel comfortable doing so, you should ask friends, relatives, neighbours or volunteers to go shopping for you. Priority supermarket delivery slots are also available to you online. If you need further support and you do not have family, friends or neighbours to help you, you can find information about getting food and essential supplies here.

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


Northern Ireland

    Since 12th April 2021, people in Northern Ireland who are clinically extremely vulnerable have been able to return to the workplace if they are unable to work from home. This is provided their employer has taken the proper measures to ensure social distancing in their place of work, and they can travel to work in a way which allows for social distancing.

You can find the full guidance for clinically extremely vulnerable people here, and links to specific sections of the guidance below:

If you fall into the ‘clinically extremely vulnerable' category, you should have been contacted directly by the NHS or your GP to advise you of this.

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 (highest risk), but you may still be 'clinically vulnerable' (higher risk).

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 this 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', and at the highest clinical risk from COVID-19 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'.

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):

You will be moved up to the 'clinically extremely vulnerable' list ONLY 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 do not have a health condition which makes you 'clinically vulnerable', 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 do not have a health condition which makes you 'clinically vulnerable', 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 do not have a health condition which makes you 'clinically vulnerable', and you are taking ONE immunosuppressive medication (see list above) plus Hydroxychloroquine or Sulphasalazine.

At no higher risk but should still follow social distancing measures:

You are not in either of the 'clinically extremely vulnerable' or the 'clinically vulnerable' categories, 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 has put together a useful risk stratification grid, which can be found here.

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 'clinically extremely vulnerable' category.

Finally, full guidance on shielding and protecting people who are 'clinically extremely vulnerable' from COVID-19 can be found here:

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

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