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22 June 2020

What is the latest 'shielding' guidance?

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

Last updated on Monday 22nd June.

'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

As of Monday 1st June 2020, people in England who are shielding can now leave the house once a day with members of their own household or, if they live alone, meet one person from another household outdoors (ideally the same person each time). Social distancing must be maintained at all times. However, if you are shielding you are still strongly advised to stay at home as much as possible and keep visits outside to a minimum. Current shielding guidance in England will remain in place until Monday 6th July 2020, when some measures will start to be relaxed (please see below).

From Monday 6th July 2020:

  • People in England who are shielding can, if they wish, meet in a group of up to 6 people outdoors, including people from different households, while maintaining strict social distancing.
  • People in England who are shielding will no longer need to observe social distancing with members of their own household.
  • If you are shielding and an adult living alone or with dependent children under 18, you may from this date, form a ‘support bubble’ with one other household. All those in a support bubble will be able to spend time together inside each other's homes, including overnight, without needing to socially distance.
  • All the other current shielding advice in England will remain unchanged until 31st July.

  • From Saturday 1st August 2020:

  • The advice to ‘shield’ will be paused in England. 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.
  • People in England who have been shielding can go to work, if they cannot work from home, as long as the workplace is COVID-safe.
  • Children who are clinically extremely vulnerable can return to their education settings if they are eligible and in line with their peers. Where possible children should practice frequent hand washing and social distancing.
  • People in England who have been shielding can go outside to buy food, to places of worship and for exercise but should maintain strict social distancing.
  • People in England who have been shielding should remain cautious as you are still at risk of severe illness if you catch Coronavirus, so the advice is to stay at home where possible and, if you do go out, follow strict social distancing.
  • The food and medicine boxes facilitated by the National Shielding Service will stop as of 1st August as individuals who have been shielding are advised they can visit shops and pharmacies. However, other forms of support – such as priority supermarket delivery slots and the NHS Volunteers Scheme, amongst a range of local volunteer schemes – will continue. If an individual is concerned about support after 1st August, they should contact their local authority.
  • The categorisation of ‘clinically extremely vulnerable’ will remain in place and people in this cohort should continue to follow the guidance specific to them, available here. After 1st August, the Government will continue to maintain the Shielded Patient List. They will monitor the virus continuously over coming months and if it spreads too much, they may need to advise this group to shield again.
  • Shielding guidance has been and continues to be advisory. Everybody in the ‘clinically extremely vulnerable’ categorisation will be written to outlining the steps detailed above.


    Wales

In Wales, from Monday 1st June 2020, people who are shielding may now leave the house locally for unlimited outdoor exercise and can also meet outside with people from another household as long as social distancing is maintained. Current shielding guidance in Wales will remain in place until at least 16th August 2020 and no changes to the guidance beyond this date have yet been announced.


Northern Ireland

In Northern Ireland, updates to the shielding guidance were announced on Monday 8th June 2020. People in Northern Ireland who are shielding may now go outdoors either alone or with members of their own household. If they live alone, they can meet one person from another household outdoors (ideally the same person each time). Social distancing must be maintained at all times. Current shielding guidance in Northern Ireland will remain in place until Monday 6th July 2020, when some measures will start to be relaxed (please see below).

From Monday 6th July 2020:

  • If the risk continues to be low, people who are following the shielding advice in Northern Ireland will be able to meet up to six people outside of their home, as long as social distancing is strictly observed.
  • If you are shielding alone in Northern Ireland, from this date you will also be able to form a 'support bubble' with one other household. Social distancing will not be required with the other household in your bubble; this will allow you to visit, stay over and spend more time with the second household. The second household can be of any size but both households should not be part of more than one bubble and should continue to socially distance outside the bubble.
  • From Friday 31st July:

  • It is anticipated that shielding for extremely vulnerable people in Northern Ireland will be paused. More information about this can be found here.
  • Further letters will be issued to all those who have been advised to shield in Northern Ireland, with details of the change and ways you can continue to get the help you need.

  • Scotland

In Scotland, as of 18th June 2020, individuals who are shielding may leave the house to exercise or meet with people from another household in small groups outdoors, as long as social distancing is maintained at all times. There are no limits on the number of times you can go out, or for how long you can stay out, however you are still strongly advised to stay at home as much as possible. For now, people living in a residential care or nursing home are advised to remain indoors and not meet up with other people. Shielding guidance in Scotland will remain in place until at least 31st July 2020 and no changes to the guidance beyond this date have yet been announced.

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.)
  • Hydoxychloroquine
  • 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' with a particular focus on the updated shielding guidance from 6th July 2020 in England. 

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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