19 July guidance on protecting people who are clinically extremely vulnerable from COVID-19

This guidance comes into effect on 19 July 2021


Who this guidance is for


This guidance is for everyone in England who has been identified as clinically extremely vulnerable from coronavirus (COVID-19). This includes those people who have been identified by the NHS as being clinically extremely vulnerable and those identified through the COVID-19 population risk assessment. All of those identified have been added to the Shielded Patient List, and more information on the criteria used is available below. If you have been identified as being clinically extremely vulnerable, you will previously have received a letter from the NHS or from your GP telling you this. You may also have been advised to shield in the past.



What has changed

Shielding advice was paused on 1 April 2021. If you require additional care and support to help you stay safe and well, there is further advice below.

As restrictions will be eased following the move to Step 4 of the roadmap, we will be advising clinically extremely vulnerable people, as a minimum, to follow the same guidance as everyone else. It is important that everyone adheres to this guidance.

However, as someone who is at a higher risk of becoming seriously ill if you were to catch COVID-19, you may wish to think particularly carefully about additional precautions you might wish to continue to take. Individuals may choose to limit the close contact they have with those they do not usually meet with in order to reduce the risk of catching or spreading COVID-19, particularly if they are clinically extremely vulnerable and when COVID-19 disease levels in the general community are high. It is important to respect and be considerate of those who may wish to take a more cautious approach as restrictions are lifted. We understand you may have concerns and wish to know how you can continue to take precautions to keep yourself safe. There are things that you can continue to do to lower your risk of infection and prevent the spread of COVID-19, and some examples are outlined in the sections below.

Although the vast majority of the population, including the clinically extremely vulnerable, will be well protected by the vaccine, no vaccine is 100% effective and there is emerging evidence that suggests that some immunocompromised and immunosuppressed individuals may not respond as well to COVID-19 vaccines as others. However, all COVID-19 vaccines should offer some degree of protection. Therefore, it is really important that you have both your first and second dose of the coronavirus vaccine.

A recent study from Public Health England (PHE), which looked at more than 1 million people in at-risk groups, found that people who are immunosuppressed are significantly better protected from symptomatic infection following the second dose of a COVID-19 vaccine.

We are continuing to work to better understand who is less well protected by the COVID-19 vaccines, and there are various studies underway that are looking at this

If you have any questions or concerns about what it means to be clinically extremely vulnerable and about how COVID-19 may impact your health condition, have a look at the NHS website.

If you are concerned about your general physical and mental wellbeing or if you are immunocompromised or immunosuppressed and have any concerns about what this means for you, then please contact your GP practice or specialist who can provide you with support and guidance on any further measures you can take to further reduce your risk of infection.


Vaccination


Everyone on the Shielded Patient List should already have been offered a COVID-19 vaccine. If you have not yet received your first dose, please contact your GP, book your vaccination appointment online or call 119. If you have received your first dose, you should still ensure you take up your second dose of the vaccine. Having 2 doses should further increase your level of protection. For some with immunosuppression it may only be with your second dose that a significant immune response is triggered.

The JCVI’s interim advice, based on existing evidence, is to offer COVID-19 booster vaccines to the most vulnerable, starting from September 2021. The booster programme will aim to provide additional resilience against variants, and maximise protection in those who are the most vulnerable to serious disease from COVID-19 ahead of the winter months, when there is increased pressure on the NHS as non-COVID-19 emergency demand is at its highest.

A booster dose would be offered to groups in 2 stages and, if possible, delivered alongside the annual influenza vaccination. In the first stage, a booster would be offered to:

  • adults aged 16 years and over who are immunosuppressed

  • those living in residential care homes for older adults

  • all adults aged 70 years or over

  • adults aged 16 years and over who are considered clinically extremely vulnerable

  • frontline health and social care workers

As soon as practicable after the first stage, the second stage would see a booster offered to:

  • all adults aged 50 years and over

  • adults aged 16 to 49 years who are in an influenza or COVID-19 at-risk group

  • and adult household contacts of immunosuppressed individuals

Further details of any booster campaign, including when, for whom and which vaccine(s) would be used, will become available once the JCVI has considered further evidence and made its final recommendations.

Children under 16 years of age, even if they are clinically extremely vulnerable, are at low risk of serious illness and death from COVID-19 and are not currently recommended for vaccination. However, as set out in chapter 14a of PHE’s Green Book, vaccination may be appropriate for those 12 to 15 years of age with severe neuro-disabilities who tend to get recurrent respiratory tract infections. This would particularly apply to those who spend time in specialised residential care settings for children with complex needs.

This option should be discussed between parents/guardians and the child’s clinician or GP. For other children aged 15 and under, whilst further research is being completed, vaccination is not yet recommended.

No vaccine is 100% effective and therefore even if you have had both doses, there is still no absolute guarantee that you will not become ill from COVID-19. As such, you should continue to follow the guidance that is in place for everyone.