Publication - Advice and guidance

Coronavirus (COVID-19): shielding advice and support

Details of shielding advice to help people make informed decisions and access support services.

Coronavirus (COVID-19): shielding advice and support
Highest risk group

Highest risk group

Some groups of people are at the highest risk of severe illness from coronavirus.

If you are in this group you will receive a letter from the Chief Medical Officer. 

Grouping How would I know if I am in this group?
Solid organ transplant recipients

People who have had a transplant of heart, lung, stomach or other part of intestine, liver and kidney.

People will be in this group because they need to take medications to prevent rejection of the transplanted organ.

People with specific cancers This is made up of five sub-groups. 
  1. People with cancer who are undergoing active chemotherapy. Or people who have had radical radiotherapy for lung cancer.
  2. People with cancers of the blood or bone marrow who are at any stage of treatment. This includes cancers such as leukaemia, lymphoma or myeloma.
  3. People with cancer who are having immunotherapy or other continuing antibody treatments.
  4. People with cancer who are having other specialised, targeted treatments which can affect the immune system. This includes protein kinase inhibitors or PARP inhibitors.
  5. People who have had bone marrow or stem cell transplants in the last 6 months. Or people who are still taking immunosuppression drugs.
People with severe respiratory conditions

People in this group include:

  • anyone with cystic fibrosis
  • anyone with severe asthma and is on regular inhalers and long-term steroid tablets to control their asthma. For example, Prednisolone or regular injections
  • anyone with severe COPD. This means being too breathless to walk 100 yards, having 2 or more lung infections per year or requiring oxygen to help with your breathing. This usually means anyone who has been on several different inhaler medications in the last year. This must include two long acting preventers (e.g. Long Acting Beta Agonists and Long Acting Anti-Muscarinic Antagonists), and a steroid inhaler
  • if you are on home oxygen for your lung condition
People with rare diseases including all forms if interstitial lung disease / sarcoidosis. Also, includes inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell disease)

There are many conditions classed as a rare disease. Not everyone with a rare disease will be in the shielding group

Your clinician will know if you should be in the highest risk group. They will make sure that you are added to the list. Once added you will receive a letter.

People on immunosuppression therapies that significantly increase risk of infection. Or people who have had their spleens removed

Immunosuppressive therapy may be used to keep a person from rejecting a bone marrow or organ transplant. It may also be used to treat conditions in which the immune system is overactive, such as autoimmune diseases and allergies.

In some cases these treatments may put people into the shielding group. Situations include:

  • People on high dose corticosteroids (equivalent to Prednisolone 20mg or more) for 4 weeks or more
  • People on specific single therapies, e.g. Cyclophosphamide. These medications are usually prescribed by specialists in hospitals. Clinical judgement is needed to determine if medications indicate highest risk
  • People on lower dose of corticosteroids (equivalent to Prednisolone 5mg per day for 4 weeks or more), in combination with other disease modifying medication
  • People on several different disease modifying medications taking into account their other chronic medical conditions

People on a single Disease Modifying medications (DMARD) or Biologic such as Methotrexate, Azathioprine, Ciclosporin, Leflunomide plus others, would not automatically be in the shielding group if they are otherwise healthy. This should be discussed with your specialist or GP if you are not sure.

People who are pregnant with significant heart disease, congenital or acquired If you are being followed up by a specialist heart clinic during your pregnancy.

People who are receiving renal dialysis treatment

People receiving and people starting renal dialysis.

Contacting those identified

Thank you to the clinicians who are helping us identify the people who need to shield to protect themselves. We are asking GPs and hospital clinicians to make sure that anyone who is at the highest risk is sent a letter. This might be someone who does not have one of the conditions listed above.

Contact your GP or specialist care provider, if you think you fall into one of these groups and have not received a letter.

Not everyone who has an annual flu vaccine for medical reasons will be contacted. They are asked to strictly follow physical distancing guidance. This will reduce their risk of being infected with coronavirus.

There is also support available if they cannot get help from friends and family.

How we have identified people

We have used GP practice, local health board or securely stored national data to identify people. This is so we could write to them. This information has been shared appropriately within the NHS in Scotland. It did not include medical records.

We will notify GPs and health boards about those who have been contacted. This is so that they can also provide support.

We will only share contact details with local authorities and our partner retailers. This will allow them to provide support and deliver groceries and medication.

During this outbreak, we will keep your contact details in case we need to contact you again. This action is only being taken due to the current coronavirus outbreak. No details of medical conditions or health records are being shared. You can request to be removed from the list by asking your GP or specialist care provider.

First published: 3 Aug 2020 Last updated: 5 Aug 2020 -