Looking towards the end of shielding

Shielding advice was issued in late March 2020 to advise those who were considered “clinically extremely vulnerable” to severe COVID-19 illness should they catch the virus. This group of clinically vulnerable people included blood cancer patients, although your doctor may have given you specific advice as to whether shielding was necessary for you.

This advice included minimising contact with other people, including not leaving the house for essentials or exercise and distancing yourself from those you live with if you were not shielding.

As the pandemic went on, this advice has been relaxed. The advice now depends on where you live too.

England:

Following the announcements on the 22^nd of June, those shielding in England should have received a letter with information on the next steps for shielding. If you haven’t received the letter, you can find full information here: 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. We have also summarised the information below.

From 6 July 2020, the following changes have been made for people who have been advised to shield:

– You can meet in a group of up to six people outdoors with strict social distancing. This includes people from different households.

– If you live alone or with dependent children under 18, you can form a ‘support bubble’ with one other household. This means you can spend time together indoors without needing to social distance.

– You no longer need to social distance from other household members.

It is still important to keep in mind to follow strict social distancing outdoors or with anyone not in your support bubble.

It is also expected that shielding will be “paused” on the 31^st of July and all previous advice to shield will be lifted. On the 1^st of August, certain support services will end, and you will be expected to return to work if your employer requests you do so and if the workplace is COVID secure. For further details, please see the government website or your most recent letter about shielding.

It is important that you continue to follow all general guidance on reducing the possibility of catching the virus, such as social distancing, hand hygiene and wearing face coverings on public transport.

Scotland:

In Scotland, shielding will be paused on the 1^st of August. Most support services are due to end on this date. This will be reviewed regularly and further updates can be found here: https://www.gov.scot/news/updated-advice-for-people-shielding/.

In the meantime, as of 18 June 2020, people that have been advised to shield can:

– now go outside and can take part in non-contact outdoor activities.

– can meet one other household outdoors (no more than eight people).

A strict physical distance of two metres should be maintained from others at all times.

Additionally, from Friday 10 July, it is advised that you can:

• stop physically distancing from the people you live with
• go indoors to use a toilet in someone else’s house, when visiting them outdoors
• meet up to eight people outdoors, from two other households, in a single day
• travel further than five miles from your house, as far as you want
• book self-catering accommodation or travel to a second home – try only to stay with people you live with at home
• People who live alone, or who live only with children under 18, can agree with another household to form an “extended household”. You can visit this household indoors and stay over, without physical distancing.

Children aged 11 and under are to be able to play outdoors, without physical distancing, in groups of up to eight and of no more than two other households. This now includes children aged 11 and under who live with someone who is shielding.

Wales:

In Wales, the shielding advice is in place until at least 16 August 2020. The Chief Medical Officer will provide letters with updated advice beyond the shielding end date. Further information can be found here: https://gov.wales/guidance-on-shielding-and-protecting-people-defined-on-medical-grounds-as-extremely-vulnerable-from-coronavirus-covid-19-html

People advised to shield in Wales can go outside for exercise as many times as they like, keeping in mind certain precautions:

• You can go outside on your own, with household members or with people from another household (with strict social distancing).
• Advised to avoid gatherings of large numbers of people, including weddings and other celebrations.

You can also form an extended household, to meet with one other household indoors, if you feel this would help you and can be done safely.

Northern Ireland:

In Northern Ireland, shielding will be paused on the 31st of July. Guidance online will be updated regularly and further information can be found here: https://www.nidirect.gov.uk/articles/coronavirus-covid-19-pausing-shielding-extremely-vulnerable-people.

From 6^th of July, people advised to shield are now able to:

– leave the house and spend time outdoors, with strict social distancing.

– form a support bubble with one other household, if you are living alone. A bubble means you can go indoors and do not need to social distance.

It is important to note that any changes to the shielding guidance are not mandatory to follow. If you are worried/anxious about going outside, please discuss these concerns with your GP or haematology team.

Most devolved nations have indicated that after the shielding pause date (see previous question for the precise dates), some of the support for those shielding will end. In all countries, the list of those shielding will be retained by the NHS, so rapid guidance can be given if needed in the future.

In England:

• Free food parcels from the National Shielding Service will end.
• Priority online supermarket deliveries will continue. NOTE: you must have registered on the gov.uk support website by the 17^th of July to get priority.
• The NHS volunteer scheme will be available if you still struggle to access essential items.
• You will be expected to return to work, if your employer requests you do so, and your workplace is COVID-secure.

In Wales, further advice for after shielding ends will be sent by letter. Support will continue until then.

In Scotland, further guidance will be issued by the end of July to detail what support will be available when shielding pauses.

In Northern Ireland, a letter will be sent to detail what support will be available after shielding pauses. Those receiving food boxes will do so until the shielding end date.

Many of you will have heard that Leicester and some surrounding areas have had to reintroduce stricter measures to control the spread of COVID-19 locally. This included shielding guidance being made stricter too, advising those shielding not to go out where possible. This was communicated via letter to those on the shielding list. We are monitoring how this goes to feedback any potential issues to the government. Please get in touch with us if you are in this area and have any concerns or issues accessing support.

For any national resurgence of the virus, the shielding list will be maintained to allow rapid advice to be given to those at risk. This is why the decision to make the guidance less strict is being referred to as “pausing” rather than “ending” shielding.

If anybody in the house starts to show symptoms of coronavirus, then you all must start following the self-isolation guidance for suspected coronavirus. This includes separating the person displaying symptoms from other people within the household. The length of time you quarantine for depends on several factors. Further details here: https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-and-treatment/when-to-self-isolate-and-what-to-do/

You should also request a test for COVID-19 as soon as possible https://www.nhs.uk/conditions/coronavirus-covid-19/testing-and-tracing/get-an-antigen-test-to-check-if-you-have-coronavirus/. If you are negative, you will be able to stop self-isolating early. If you are positive, your close contacts can be notified to stop them potentially spreading COVID-19 further.

Once the period of self-isolation for the symptoms is over, the person shielding must return to following current shielding guidance until shielding is paused. This includes if you were the one to have symptoms or test positive; there is not yet enough information to say whether it is possible to catch coronavirus more than once, so you should act as if it is (i.e. continue to shield) until more information is available from the government.

If you develop symptoms, government guidance is to use the 111 service, either online or by calling, to seek further advice. You may also like to let your haematology team know in case they have any advice for you too. This will also help teams to keep an accurate record of patients who have had coronavirus.

We know that shielding will have been a difficult experience for most and different for everyone.

If you are concerned about the risk of catching the virus, this is understandable. The best person to ask about any concerns you have would be your consultant or clinical nurse specialist. They will be able to take into account your medical advice, as well as the current situation with the COVID pandemic, when giving you advice.

Whilst we are unable to give specific advice about your risk of COVID, we at Leukaemia Care are always happy to listen to your concerns and worries. We can also help you make sense of any advice you have received or help you find further support. You can find our contact details at the end of this blog.

The shielding advice issued in March 2020 was designed to cover as many people as possible who could be potentially at risk. Many of you will have discussed with your healthcare team about your individual risk, as there are some factors beyond cancer that can make you higher risk (other illnesses, gender, age).

There have been some reports of a move towards a “risk assessment” or a formal way to calculate someone’s risk from COVID-19 becoming available soon. There is some research going on in this area which does incorporate cancer as a factor into the proposed calculation, along with ethnicity, gender, age and many other risk factors. However, it is at a very early stage and there is no information on how and where it will be used yet. There are many unknowns about the virus still.

If you are in need of more information about your own personal risk if you were to catch COVID-19, please speak to your healthcare team for further advice. Whilst we are happy to help you make sense of any information you have received, the Leukaemia Care team are unable to give personalised risk advice.

Whilst the risk of catching COVID-19 has not gone away completely, it has reduced. As mentioned in previous questions, the best thing you can do is to talk to your healthcare team to gain a better idea of your own personal risk. Whilst we are happy to help you make sense of any information you have received, the Leukaemia Care team are unable to give personalised risk advice.

There are also some things you can do to make going out safer, such as:

Maintaining social distancing

Keeping the number of people you meet with to a minimum

Going out at quieter times where possible.

Government advice is that you should not return to a workplace outside your home until the 1^st of August. Your most recent shielding letter should be sufficient proof of the need to shield.

From the 1^st of August, you are expected to return to work if your workplace environment is COVID-secure. Being COVID-secure would include things like social distancing being possible and appropriate PPE provided, although the exact needs would depend on where you work.

If you are not sure if you should be returning to work, speak to your doctor or nurse as soon as possible. We know discussing returning to work with your employer can be difficult. If you have any concerns about this, get in touch with us using the contact details at the end of the blog.

We now have a Welfare Officer who can advise on financial or housing issues. She can also help you find the right support for employment issues. She has written several blogs to help you access the support you need: one about the government financial support here (LINK) and one about redundancy here (LINK).

You can contact the Welfare Officer for more information using the contact details at the end of this blog.

Cancer treatment has been affected by COVID-19; all decisions were made to take into account the likelihood of vulnerable people catching COVID-19. If you have any concerns about your treatment and any changes during the pandemic, please use the contact details at the bottom of the blog to get in touch.

The decision as to when your treatment is needed, or whether it may be delayed or changed, is a decision that will be made between you and your clinician. General guidelines are being developed for doctors to help them make these decisions in the new climate, and they should explain the basis of their decisions when discussing this with you.

If you are asked to attend hospital for any reason, you should do so. Hospitals are used to dealing with COVID infections now and have many processes in place to prevent spread, such as requiring face coverings to be worn by everyone indoors and reducing the amount of time spent in waiting rooms. If you would like to know the specific precautions for your hospital, don’t be afraid to ask your haematology team for more information.