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11 January 2021

What is the latest 'shielding' guidance?

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

Last updated on Monday 11th January 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. If you fall into this ‘clinically extremely vulnerable' category, you should previously have been contacted directly by the NHS or your GP to advise you of this. 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

In England, national lockdown restrictions currently apply and, as such, clinically extremely vulnerable people are being advised to shield once again

You can find the full shielding guidance here, and links to specific sections of the guidance below:

People who are clinically extremely vulnerable will get priority access to vaccination against COVID-19 before the general population and in line with the priority ordering set by the Joint Committee on Vaccination and Immunisation (JCVI). You will be contacted again by the NHS with more information on when and how you will be invited to get the vaccine.

Even if you have had both doses of the vaccine, the Government advises that you should continue to follow the shielding advice until further notice while the impact of vaccination continues to be assessed. 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.

    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

Wales is currently in lockdown (alert level 4) and, as such, clinically extremely vulnerable people are being advised not to attend work or school outside the home. The Welsh Government is writing to everyone on the Shielding Patient List to confirm this advice.

You are encouraged to still go outside to exercise and attend medical appointments, and you may remain as part of a support bubble, but you must stay at home as much as possible.

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

Priority supermarket delivery slots continue to be available to people who are considered extremely vulnerable. If you need further support and you do not have family, friends or neighbours to help you, you should contact your local council.


Northern Ireland

In Northern Ireland, lockdown rules currently apply and clinically extremely vulnerable people who are working and are unable to do so from home are now advised not to attend the workplace. The Chief Medical Officer will write to clinically extremely vulnerable people to advise of this change.

This is advice only. People are free to make their own judgements about whether or not they should attend work, depending on the COVID-security of their working environment. However, the general restrictions which apply to everyone must be followed.

This is not a return to shielding as it was previously. clinically extremely vulnerable people are not being advised not stay permanently indoors, and are encouraged to continue to go outside for exercise, provided they observe social distancing when they do so.

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

The current regulations are in place until Saturday 6th February, but will be reviewed on Thursday 21st January.

A free helpline is available to those in vulnerable groups to access information, advice and support in relation to COVID-19, between 9am and 5pm on Monday to Friday. You can access the helpline by phone on 0808 802 0020, email at covid19@adviceni.net, by texting ACTION to 81025, or by completing this form on the Advice NI website.


How do I know whether or not I am in the 'clinically extremely vulnerable' category?

If you fall into the ‘clinically extremely vulnerable' category, you should previously 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.

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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