Publication - Advice and guidance

Coronavirus (COVID-19): shielding support and contacts

Details of shielding support for vulnerable people to arrange for food and medicine deliveries, and other support services.

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

Highest risk group

Some specific groups of people are considered to be at the highest risk of severe illness if they become infected with coronavirus. People they live with, and other people they see, should strictly follow social distancing measures in order to protect them.

If you are in this group you will receive a letter from the Chief Medical Officer (CMO) or be contacted by your doctor. If you are in this group you should follow shielding measures

If you do not fall into this group and cannot get support from friends and family, there is further information on how you can access support

The highest risk (shielding) group includes the following people:

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

This group includes 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. They are:
  1. People with cancer who are undergoing active chemotherapy or have had radical radiotherapy specifically for lung cancer
  2. People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  3. People having immunotherapy or other continuing antibody treatments for cancer
  4. People having other specialised, targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  5. People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe Chronic Obstructive Pulmonary Disease (COPD), severe bronchiectasis and pulmonary hypertension.

People in this group include:

  • All patients with cystic fibrosis
  • If you have asthma you are only in this group if you have severe asthma. Having severe asthma means being on regular inhalers AND long term steroid tablets, e.g.prednisolone, OR regular injections to control your asthma
  • If you have COPD you are only in this group if you have 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. Usually you will be on several different inhaler medications that include two long acting preventers (Long Acting Beta Agonists and Long Acting Anti-Muscarinic Antagonists) in the last year, 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 and 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 at a higher risk of severe illness from COVID-19.
Your clinician will know if you should be in the highest risk group and will make sure that you are added. If you are added to this group you will receive a letter telling you what to do.

People on immunosuppression therapies sufficient to significantly increase risk of infection or 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 at highest risk should they contract Covid-19 infection. The following situations put people into the highest risk group for Shielding

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

Patients on a single Disease Modifying medications (DMARD) or Biologic such as Methotrexate, Azathioprine, Ciclosporin, Leflunomide plus others, would not be considered automatically in the highest risk group if they are otherwise healthy, but should be discussed with the specialist or GP if 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 then you fall within this group.

People who are receiving renal dialysis treatment

People receiving and those starting renal dialysis.

We are grateful for the help of GPs and hospital clinicians in continuing to identify the patients that need to take the strictest measures to protect themselves. We are asking GPs and hospital clinicians to ensure everyone who is at the highest risk is sent a letter, even if they do not have one of the conditions listed. If your clinician thinks you are at the highest risk then you will be contacted by letter.

If you think you fall into one of these groups, and you have not received a letter, please contact your GP or hospital specialist. 

If you believe that you have been incorrectly identified, please discuss this with your GP or hospital specialist.