Advice on Coronavirus (COVID-19)
Shielding updates for England and Northern Ireland
The government has announced changes to the shielding guidance in England and Northern Ireland. This is based on evidence that fewer people are now infectious, meaning that it is much less likely you will be exposed to the virus. For some people, these measures will come as welcome news, but we know some of you will be understandably anxious.
From 4 July social distancing in England will be a minimum of 1 meter. The other home nations have yet to announce changes.
From 6 July, those shielding will be allowed to meet in groups of up to 6 people outside, including those from different households, while maintaining strict social distancing. People shielding will no longer need to observe social distancing with other members of their household. People shielding will also be able to form a support bubble, if they are in a single adult household. For more detailed guidance see
From 1 August, shielding guidance will be lifted altogether in England and Northern Ireland from the end of July. From 1 August, people who are currently shielding should adopt strict social distancing measures instead.
From 1 August, food and medicine boxes from the National Shielding Service will stop. However, people who were on the shielding list will still be able to benefit from priority supermarket slots, services provided by NHS Volunteers and other local volunteer groups.
From 1 August, people shielding can go into work, if they cannot work from home, but only if their workplace is COVID-19 safe and they can keep a safe distance from others.
Will I be informed?
Everyone who is currently on the shielding list in England and Northern Ireland will receive a letter outlining these new changes. People on the shielding list might be advised to shield again if there is an increase in coronavirus cases.
Has the risk from COVID-19 gone away?
No, people shielding should remain cautious, as you are still at risk of becoming severely ill if you catch coronavirus. This is an important move towards some kind of normality and a time to enjoy the summer months with family and loved ones. However, the decision to go outside is yours. If you do decide to go out, for now, the best ways to protect yourself are to:
- follow social distancing guidance when you do go out
- to help you to get used to being outside more you may want to try short trips outside or spend time in the company of your social bubble
- choose people in your social bubble who you trust to be following the Government’s guidance
- spend as long as you feel comfortable outside – it is perfectly normal to feel frightened and worried as you adjust to the drastic changes COVID has made to the way the way society operates. Do it in small steps to build your confidence.
- maintain good hand hygiene
- take particular care to minimise contact with other people outside your social bubble
- go outside when there are fewer people around, such as early in the morning
- ideally spend time in open areas
- do not share or exchange personal belongings (such as cups) with other people
- avoid going into enclosed spaces, as well as shops and other buildings.
Shielding in Wales
Shielding advice in Wales is in place until at least 16 August 2020.
In Wales, a letter is being sent to everyone in Wales who is shielding to tell them this and next steps. The Chief Medical Officer will then send another letter advising what to do after 16 August 2020.
People who are shielding can take unlimited exercise and meet people from another household if they want to.
‘Outdoor exercise is unlimited, as long as individuals strictly follow social distancing rules and hygiene practices. Those who are shielding can meet outside with people from another household - but should not go into another person’s house or share food with them. There are no other changes being made to the advice for those who are shielding at this stage. People who are shielding should continue to follow all the other advice previously given. You should not go shopping or attend work outside of home. They should continue to have food and medicine delivered to them’.
Shielding advice in Scotland
The shielding advice in Scotland has been extended to 31 July.
People shielding in Scotland can go outside for any amount of time. People shielding in Scotland can:
- meet up with one other household a day outdoors, with a maximum of 8 people in the group altogether
- take part in non-contact outdoor activities, such as golf, hiking and fishing.
‘You can go outdoors for a walk, wheel, run or cycle. We do not recommend that you take part in outdoor activities such as golf, hiking, canoeing, outdoor swimming, angling, etc. in the same way as the rest of the population can just now. You can go out on your own or with someone you live with; maintain strict physical distancing, also known as social distancing, at all times, even if you live with the person you're out with, this means keeping 2 metres (or three steps) away from other people at all times; should not meet with anyone you do not live with; should choose times and areas that are quiet, if you can; should wash your hands for at least 20 seconds as soon as you get back home.’
Looking after your mental health
Lots of people are feeling anxious or struggling with their mental health at the moment and this may be especially so for those who are in the vulnerable groups contemplating the easing of shielding.
Here are some of our tips:
- Don’t make the virus the focus of your conversations with friends and family.
- Control what you can control and plan for how you will deal with situations that you may find difficult.
- Focus on the present and talk and share your anxiety and problems with coping with people who you trust
- Make sure you are looking after yourself, so you feel more able to cope with whatever happens.
- Learn and practice ways to calm yourself. This could be through doing some deep breathing exercises, thinking of a beautiful scene, a happy time etc.
- Only look at reliable sources of information, like the NHS and the websites for UK Government and devolved administrations.
- Limit your exposure to the news.
The Mental Health Foundation has a good list of tips to look after your mental health.
Other sources of helpful information and organisations are listed here:
Shielding and employment
If you have a shielding letter, your employers should be supporting you in shielding. If you can work from home in your job, it is fine for you to continue working while shielding, as long as you are well. If you are unable to work from home, you should not be working while shielding.
The following gives advice for the UK PID community concerning the Coronavirus (COVID-19) outbreak (dated 24th March 2020).
We are advising CGD patients to follow these guidelines. As each individual case of CGD is different and if you do have concerns we recommend contacting your medical team.
'Essential workers' with CGD should consult their occupational health team for an individual risk assessment.
Based on a consensus view from immunology specialists, PID patients, Primary Immunodeficiency Disorder for which CGD is one, have been classified into three risk groups:
- An extremely vulnerable group (highest at-risk group)
- Moderate risk group
- Lower risk group with risk equivalent to or only marginally higher than that of the general population
The guidance on who falls into which group is available at the UK PIN website here.
What you need to do
It is vitally important that all patients should check and confirm the category that they are in.
All patients at a minimum should by now be following the lockdown guidance, which already affords a high level of protection by physical isolation from others who are potentially infected.
Check what to do at https://www.gov.uk/coronavirus
If patients have other high-risk features, the advice for them should be changed to the shielding category – advice detailed below.
Extremely Vulnerable Patients should follow the advice issued by the government for the most vulnerable who need to be shielded. For details please follow the link: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19
Guidance for X-linked CGD Carriers
X-linked CGD Carriers are being asked to follow the guidance sanctioned by UKPIN and BSR - British Society for Rheumatology:
1. If you are on 'treatment for immunodeficiency' (eg prophylactic antibiotics) then you would be considered vulnerable
2. If you also have an additional risk (eg age 70, significant lung disease, on immunosuppressive drugs (but NOT just hydroxychloroquine or sulphasalazine) then you would be considered very vulnerable
3. If you are not on treatment for immunodeficiency but are on immunosuppressive drugs (NOT just hydroxychloroquine or sulphasalazine) then you would be considered vulnerable
4. If you are on an immunosuppressive drug (NOT just hydroxychloroquine or sulphasalazine) and have an additional risk factor (eg age 70, significant lung disease etc) then you would be considered very vulnerable
5. If you are on two or more immunosuppressive drugs (not including hydroxychloroquine or sulphasalazine) then you would be considered very vulnerable
6. If none of the above apply then you would have the same risk as the general population
The situation is changing all the time and we advise you to monitor the latest government advice at: https://www.gov.uk/coronavirus
What is COVID-19?
Coronaviruses are a family of viruses that can cause anything from a common cold to severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). COVID-19 is probably, overall, more at the cold and flu-like end of the spectrum of these infections. To date about 80% (80 in 100) of patients recover completely with no treatment. About 1 in 6 people get difficulty in breathing severe enough to need to attend hospital and about 2% (2 in 100) of people, particularly those with cancer, existing lung or heart problems might die from this infection (https://www.who.int/news-room/q-a-detail/q-a-coronaviruses).
Is it worse than influenza?
Every year the WHO estimates about 3-5 million severe cases of influenza worldwide with 250,000 – 650,000 deaths. This would suggest that the risk from coronavirus is similar to that of season flu for most people. The main difference is that we have vaccines that limit the spread and infection with influenza, but at present there is no vaccine and no community immunity to COVID-19 to halt spread.
How is COVID-19 spread?
The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch COVID-19 by touching these objects or surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out or exhales droplets.
Reducing the chance of infection and transmission
Since it is spread by droplets, good hand hygiene is the top priority in preventing transmission of COVID-19, like most respiratory viruses. When out and about, alcohol-based hand-gel can be used to sanitise your hands. Washing your hands, thoroughly and frequently, with soap and water throughout the day will also help reduce the chance of infection.
Should I wear a mask?
Masks are generally not effective, most people do not have appropriate training for a good fit, they need replacing regularly and there is probably greater risk of contaminating your face from your hands adjusting a mask than the benefit from wearing one. The exception is a healthcare setting when you are given a mask, shown how to wear it and it is disposed of appropriately.
Am I specifically at risk of catching COVID-19 with my immune deficiency?
Having many immune problems does not specifically predispose you to increased risk of acquiring this type of viral infection, the risk comes from being exposed to it.
Are PID adults or children at greater risk of becoming very sick?
As indicated by the advice above specific PID conditions and major health problems as a consequence of PID, or as well as PID, are the major risk factors alongside increasing age.
Should my partner or I stop going to work?
The plans for isolation and social distancing are to reduce the probability that members of the household will be exposed to COVID-19. The government advice is that everyone should now reduce unnecessary travel and group gatherings, and work from home where possible. This is to reduce exposure to the virus.
I think I have COVID-19, what do I do?
Stay calm; the majority of people do not have severe disease. Maintain household hygiene measures to protect those around you but isolate yourself as much as possible.
For most patients who are following basic measures of rehydration and medicine to lower temperature who are improving no further action will be necessary. If you are not getting better check again with NHS111/24 and then contact your PID centre to see if they need to provide more specific advice.
I have a PID and think a household member has COVID-19, what do I do?
Stay calm; the majority of people do not have severe disease. Maintain household hygiene measures to protect the person with a PID. The current advice is to manage the person at risk somewhere else if possible (e.g. they go to a family member). Where this is not possible e.g. a child with PID looked after by a parent with COVID-19, then minimising contact as much as possible, ensuring hand and household hygiene are key.
If your family member is not getting better contact NHS111/NHS24 and follow their advice.
I think I have COVID-19. Can I go to my Immunologist for review?
Access online 111.NHS.UK or NHS24 and follow their advice. Contact your immunology centre by phone to update them if you are not getting better. Hospitals now have specific arrangements for receiving patients with suspected COVID-19 and these are outlined on NHS 111/24. You should not be attending your immunology centre with suspected COVID-19.
The advice is to avoid unnecessary travel, should I go to my regular outpatient appointments?
To reduce the risk to patients of acquiring COVID-19, most hospitals are now reviewing patients wherever possible by telephone. Some patients will need to attend in person and hospitals are doing all they can to protect those patients and staff from COVID-19. Specific arrangements for blood tests taken outside of booked clinics are being made in some centres. Centres may send you a message to actively confirm altered arrangements. If you have an upcoming appointment and are unsure, contact the clinic booking number for your centre.
Keep up to date
It is important for the whole of society to keep themselves informed. Everyone should follow the general advice given by the Government.
This advice has been approved by PID UK Medical Advisory Panel 24th March 2020