Shielding is intended to protect people who are 'clinically extremely vulnerable' from COVID-19.
Last updated on Monday 3rd 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?
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.
Shielding guidance has been and continues to be advisory.
In Wales, people who are shielding may now leave the house for unlimited outdoor exercise and can also meet outside with people from another household as long as social distancing is maintained. Social distancing within the home should continue where possible.
People in Wales who are shielding can also now form an 'extended household' with one other household of any size, however social distancing within an extended household should continue where possible.
Current shielding guidance in Wales will remain in place until 16th August 2020. Shielding will then be paused as long as infection rates in Wales continue to fall. The Chief Medical Officer for Wales will write again to those who are shielding advising what to do after 16th August 2020.
Planned changes from Sunday 16th August:
- Shielding in Wales will be paused for everyone on the shielding list (children and adults) unless the number of COVID-19 cases in the community starts to rise significantly.
- People in Wales who have been shielding can go to work, as long as the workplace is COVID-secure, but you should carry on working from home if you can.
- People in Wales who have been shielding can go outside to buy food, – keeping 2 metres (or 3 steps) away wherever possible. (Those who are receiving food boxes will continue to receive them until 16th August after which date they will cease but priority shopping slots will continue to be available).
- Children and young people in Wales who have been shielding can go back to school or college/university.
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.
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:
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:
medications: Ciclosporin, Fumaric Acid Esters (FAE, Fumaderm and Skilarence
– Dimethyl Fumarate), Leflunomide, Methotrexate. This does NOT include
Acitretin or Sulphasalazine.
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)
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.)
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
- A person with hidradenitis on Humira (adalimumab) who is 45 and has none of the described comorbidities.
- A person who is 50, on methotrexate up to 25 mg per week, and Humira (adalimumab).
- 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
- 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.
- 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.
- A person on a single agent biologic at a standard dose, with renal (kidney) impairment.
- 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.
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.