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20 November 2020

What is the latest 'shielding' guidance?

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

Last updated on Friday 20th November 2020.

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, new shielding measures for clinically extremely vulnerable people began on Thursday 5th November and will last until Wednesday 2nd December. After this date, the Government will look to return to a regional approach and will issue further guidance at that time. You can find links to the different sections of the shielding guidance below:

The NHS Volunteer Responders programme is 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

    In Wales, shielding was paused on 16th August 2020 and there are no plans for it to resume at this time. Instead, people who are 'extremely vulnerable' are being advised to follow new, less restrictive guidance.

    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.

    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. If shielding does become necessary once again, the Chief Medical Officer for Wales will write to you.


Northern Ireland

In Northern Irelandshielding was paused on 31st July 2020. This means that people who were previously shielding no longer need to follow shielding advice, but should continue to following strict social distancing rules.

The Chief Medical Officer and his team have looked at this position again in light of the increased numbers of cases of Coronavirus in Northern Ireland, but after careful consideration have decided that shielding should remain paused. This position will, however, be kept under review.

    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.

    Please note that registration for priority online food delivery was suspended on 31st July 2020, however those who registered before this date can continue using the service.


    Scotland

    Scotland currently has a system of local COVID protection levels (tiers) in place. Each local area has a COVID protection level and each level has its own specific guidance on shielding. There are 5 different levels, from 0 to 4. The lowest level is 0 and the highest level is 4.

    You can find out about the different COVID protection levels here.

    You can find out the COVID protection level in your local area here.

    This advice does not apply to anyone living in a residential care or nursing home. Care homes are following the separate guidance for care home settings.

    If you are on the shielding list, you may sign up to receive text message updates from the Scottish Government to alert you when there is increased risk in your area – to sign up send your CHI number (at the top of your shielding letter) to 07860064525.

    You are also encouraged to download the Protect Scotland app to help prevent COVID-19 from spreading again.

    There is a free national COVID-19 helpline available 9am - 5pm on Monday to Friday. Call 0800 111 4000 to access the helpline and speak to someone from your local authority.

    Priority access to online supermarket delivery slots will continue for anyone who had signed up before August, however new registrations to the scheme are no longer being accepted. You can still arrange for your prescription to be delivered

    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 text messaging service.


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.)
  • Hydoxychloroquine
  • 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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