The government will be sending letters to 1.5 million people in England urging them to self-isolate for an extended period amid warnings the coronavirus outbreak is “accelerating”.

Health officials have urged those considered most at risk from the disease because of their health conditions to begin “shielding” themselves by staying at home.

When will the letters go out?
Letters will go out this week “strongly advising” people not to go out for at least 12 weeks from Monday.

Why is it 1.5 million people and who are they?
Health officials believe this group is considered most at risk from COVID-19 because of their health conditions and will need to self-isolate for at least 12 weeks.

Why is it called shielding?
Shielding is a practice used to protect extremely vulnerable people from coming into contact with coronavirus. It is designed to ensure people who are clinically extremely vulnerable minimise all interaction between those who are extremely vulnerable and others.

Who is classed as extremely vulnerable?
According to the new guidance, people falling into this extremely vulnerable group include:
• Solid organ transplant recipients
• 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.

If I am shielding what should I avoid?
The government advice states:
• Strictly avoid contact with someone who is displaying symptoms of coronavirus. These symptoms include high temperature and/or new and continuous cough.
• Do not leave your house
• Do not attend any gatherings. This includes gatherings of friends and families in private spaces for example family homes, weddings and religious services.
• Do not go out for shopping, leisure or travel and, when arranging food or medication deliveries, these should be left at the door to minimise contact.
• Keep in touch using remote technology such as phone, internet, and social media.
• Do use telephone or online services to contact your GP or other essential services.

How long will shielding last?
This advice will be in place for at least 12 weeks from the day you receive your letter.

What does the advice mean if you look after someone who is extremely vulnerable?
If you care for but don’t actually live with someone who is extremely vulnerable you should still stringently follow guidance on social distancing.

How can you get help with foods and medicines if you are shielding?
Ask family, friends and neighbours to support you and use online services. If this is not possible, then the public sector, business, charities, and the general public are gearing up to help those advised to stay at home. You can visit from Tuesday 24 March 2020 to register for the support that you need. This includes help with food, shopping deliveries and additional care you might need.

What about picking up prescriptions?
The government is helping pharmacies to deliver prescriptions. Prescriptions will continue to cover the same length of time as usual. If you do not currently have your prescriptions collected or delivered, you can arrange this by:
1. Asking someone who can pick up your prescription from the local pharmacy, (this is the best option, if possible).
2. Contacting your pharmacy to ask them to help you find a volunteer (who will have been ID checked) or deliver it to you.
3. You may also need to arrange for collection or delivery of hospital specialist medication that is prescribed to you by your hospital care team.

Can people still visit you, including those who are providing care for you?
Contact regular visitors to your home, such as friends and family to let them know that you are shielding and that they should not visit you during this time unless they are providing essential care for you. Essential care includes things like help with washing, dressing, or feeding. All people coming to your home should wash their hands with soap and water for at least 20 seconds on arrival to your house and often whilst they are there.

What is the advice for parents and schools with extremely vulnerable children?
The advice also applies to extremely vulnerable children in mainstream and special schools.

If someone else is living with you do they have to also have to participate in shielding?
If you have someone else living with you, they are not required to adopt these protective shielding measures for themselves. They should do what they can to support you in shielding and they should stringently follow guidance on social distancing, reducing their contact outside the home. If this is the case then look at the government advice on shielding which breaks down how you can live together and take part in shielding

Do you have to take the measures advised?
In the guidance, the government says: “Shielding is for your personal protection, it is your choice to decide whether to follow the measures we advise. Individuals who have been given a prognosis of less than six months to live, and some others in special circumstances, could decide not to undertake shielding. This will be a deeply personal decision. We advise calling your GP or specialist to discuss this.”

What if I don’t receive a letter?
If you think you fall into one of the categories of extremely vulnerable people listed above and you have not received a letter by Sunday 29 March 2020 or been contacted by your GP, you should discuss your concerns with your GP or hospital clinician.

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