Clarification for very high risk patients and those in vulnerable groups

We are getting many queries from patients who are in a defined vulnerable group (ie they are eligible for an annual flu vaccination) who want to know whether they fall into the very high risk category, and therefore whether they will receive a shielding letter from Welsh Government.

Shielding letters are being sent out by Welsh Government and not by GP Practices.  We have been informed that WG is still in the process of sending these letters out and that we will get a list of patients who have received the letters in due course but we have not yet received this.

To clarify, there are two separate groups of people.

Vulnerable groups which include:

  • Aged 70 or older (regardless of medical conditions)
  • Under 70 with an underlying health condition listed below (ie anyone instructed to get a flu jab as an adult each year on medical grounds):
  • Chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
  • Chronic heart disease, such as heart failure
  • Chronic kidney disease
  • Chronic liver disease, such as hepatitis
  • Chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy
  • Diabetes
  • Problems with your spleen – for example, sickle cell disease or if you have had your spleen removed
  • A weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy
  • Being seriously overweight (a body mass index (BMI) of 40 or above)
  • Those who are pregnant

Very high risk groups which include:

  • Solid organ transplant recipients.
  • People with specific cancers:
  • People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
  • People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • People having immunotherapy or other continuing antibody treatments for cancer
  • People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  • 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 COPD.
  • People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
  • People on immunosuppression therapies sufficient to significantly increase risk of infection.
  • Women who are pregnant with significant heart disease, congenital or acquired.

It is the very high risk group (the second group listed above) which will receive the shielding letter.  However, there is a copy of the shielding letter at the end of this post, so that everyone can see the advice that is being given to this group of people.  There is no clear definition for severe asthma or severe COPD.

Those in a vulnerable group (the first group listed above) are being strongly advised by the government to follow strict social distancing guidance and to work from home wherever possible.  Employers are being strongly advised to support them in this.  If you fall into this group, we cannot provide you with a sick note.  However, we can provide you with a print out from your medical record to confirm that you are in a vulnerable group.  If you fall into this group, you should discuss your situation with your employer.  You may find the following links to the government guidance for employers and to ACAS, useful in your discussion.

https://www.acas.org.uk/coronavirus/vulnerable-people-and-high-risk

https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19

IMPORTANT ADVICE TO KEEP YOU SAFE FROM CORONAVIRUS

You are receiving this letter because you have an existing health issue – or you care for someone who does. This means it is very important you take extra steps to avoid catching coronavirus (also known as COVID-19).

For most people coronavirus will be a mild illness. Some people with existing health issues can get seriously ill if they get the virus.

We want to do everything we can to keep you safe. But we need your help.

It is important you stay safe and keep getting the treatment and care you need. We also need you to follow some important advice.

This letter tells you how to look after yourself and about the help you can get.

The best way to avoid getting coronavirus is to stay at home for the next 12 weeks. You should not have any visitors apart from your carers and healthcare workers.

You, or the person you care for, should:

  • Avoid any contact with anyone who has a high temperature (above 37.8 °C) or a new and continuous cough. These are symptoms of coronavirus.
  • Stay at home for the next 12 weeks.
  • Stay away from people, even friends and family. Do not go out at all.
  • Arrange for food and medicine to be delivered to your home. It should be left at the door so you don’t come in to contact with anyone.
  • Keep in touch with people using the phone, the internet and social media.
  • Use the phone or internet to contact your GP or the other services you need.
  • Wash your hands regularly with soap and warm water for at least 20 seconds. Make sure carers and healthcare workers do the same when they visit.

If you live with someone, or care for someone with an existing health issue, you should:

  • Try to keep away from them as much as you can. Try not to be in the same room. If you have to be in the same room try and keep a window open.
  • Keep three steps away from other people. Do not sleep in the same bed if you can avoid it.
  • Do not share towels. Use different bathrooms if you can. If you share a bathroom, clean it after every use.
  • Avoid using the kitchen at the same time as others and eat your meals in separate rooms. Clean all cups, plates and cutlery thoroughly.

Ask friends, family or neighbours to bring you food and medicine. Please ask them to follow the advice in this letter.

If you do not have people who can help, you should call your local council. You can find the number at the end of this letter.

You will continue to get the healthcare you need during this period. Your GP practice and hospital care team know you are at a higher risk. They will be in touch if any changes are needed to your care.

If you or the person you care for develops symptoms of coronavirus – a high temperature (above 37.8 °C) or a new and continuous cough – you should use the online coronavirus service (https://gov.wales/check-if-you-need-coronavirus-medical-help) or, if you do not have access to the internet, call 111.

Please see the following detailed, advice:

1. Carers and support workers who come to your home

Carers or support workers who support you with your everyday needs can continue to visit you, unless they have symptoms of coronavirus.

All carers or support workers must wash their hands with soap and warm water for 20 seconds when they enter your home and often while they are in your home.

It is a good idea to speak to your carers now and make a plan about what would happen if one of them becomes unwell.

If you don’t have friends or family who can help, contact your local council. Contact details for each local council are included at the end of this letter.

2. Your medicines

If you do not have your prescriptions collected or delivered, you will need to arrange this.

  1. Ask someone who can pick up your prescription from your local pharmacy to help (this is the best option).
  2. If you do not have anyone who can help, telephone your pharmacy and ask them to deliver your prescription. Let them know you are in a high-risk group and are being asked to stay at home for 12 weeks.

You may also need to arrange any specialist medication prescribed to you by your hospital care team to be collected or delivered to you.

3. Planned GP appointments

Wherever possible, GP appointments will be provided by phone, email or online. If you need to be seen, your GP practice will contact you to let you know what you should do.

4. Planned hospital appointments

Your hospital or clinic will contact you if any changes need to be made to your care or treatment. Please phone your hospital or clinic if you have any questions about your appointment.

Some hospital appointments may need to be cancelled or postponed. This is part of the plans to help the NHS to respond to the coronavirus outbreak. You will still be able to contact your hospital care team if you have an urgent issue.

5. Support with daily living Please discuss any needs you have with your carers, family, friends, neighbours or local community groups to see how they can support you.
If you do not have anyone who can help you, please contact your local council. The contact details for each local council are at the end of this letter.

If you are employed, please show this letter to your employer. You cannot go to your normal place of work – you will need to work at home for the next 12 weeks. You do not need to get a fit note from your GP.

If you need help from the welfare system visit: https://www.gov.uk/universal-credit.

6. Urgent medical attention

If you have an urgent medical question relating to your existing medical condition, or about the person you are caring for, contact your GP practice, or your specialist hospital care team. Where possible, you will be supported by phone, or online. If your doctor decides you need to be seen, the NHS will contact you to arrange how to do this.

7. What if I get coronavirus?
If you, or the person you care for, develop symptoms of coronavirus – a high temperature (above 37.8 °C) or a new and continuous cough – you should use the online coronavirus service (https://gov.wales/check-if-you-need-coronavirus-medical-help) or, if you do not have access to the internet, call 111.

If you get coronavirus and you need to go to hospital you will need to take a bag with the things you need for an overnight stay. Take an emergency contact number and any medication you are on.

If you have an advanced care plan, please include it.

8. Looking after your well-being

We understand that you might be worried. Staying at home for a long time and not seeing people can be boring and lonely.

There are some things you can do to help you feel happier and less anxious. Ideas include:

  • Look for ideas for exercises to do at home on the NHS website;
  • Spend time doing things you enjoy – reading, cooking and other indoor hobbies;
  • Try to eat healthy, well-balanced meals ( https://gov.wales/eatwell-guide ), drink enough water, exercise regularly, and try to avoid smoking, alcohol and recreational drugs;
  • Try spending time with the windows open to let in fresh air. Sit where you can see out of the window. Get some natural sunlight, get out into the garden or sit on your doorstep if you can;
  • Stay in touch with people via phone, email or social media if you can.

There are also services available to support you. Talking about worries and problems can make things easier. The C.A.L.L. Helpline is a dedicated mental health helpline for Wales, which provides confidential listening and emotional support and will help you contact support available in your local area, including voluntary and charitable organisations. It can be contacted on 0800 132 737 or by texting ‘help’ to 81066. The C.A.L.L. website is at: http://callhelpline.org.uk/

Further information about coronavirus, including the latest guidance is available on the Welsh Government and Public Health Wales websites:

https://gov.wales/coronavirus

https://phw.nhs.wales/topics/latest-information-on-novel-coronavirus-covid-19/

We will continue to do all we can to keep you safe.

Yours sincerely,

dr_frank_atherton_sig

DR FRANK ATHERTON
Chief Medical Officer