COVID-19 [ SARS-CoV-2 ] : Social distancing and Shielding our most vulnerable citizens

COVID-19 [ SARS-CoV-2 ] : Social distancing and Shielding our most vulnerable citizens

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STAY AT HOME – PROTECT THE NHS – SAVE LIVES

Remain updated with the following two government websites www.nhs.uk and www.gov.uk to ensure that you are au fait with the latest health advice on COVID-19.

COVID-19 is a rapidly evolving situation, the WHO stated that COVID-19 was a public health emergency of international concern on 30th January and declared a global pandemic on 11th March, currently almost 200 countries have confirmed cases. The UK government introduced new measures on March 23rd to significantly reduce our day-to-day contact with other people, these ‘lockdown’ measures have been extended for a further period, the length of which will be reviewed in early May, these measures may oscillate between a partial to a more stringent lockdown for the remainder of this year. Since the global coronavirus pandemic the terms ‘shielding’ and ‘social distancing’ have entered our lexicon in a medical context, in this article I explain what these terms mean and why they matter.

Reducing social interaction between people in order to reduce the transmission and exposure of coronavirus to us individually and those in our society who are extremely vulnerable is of paramount importance. COVID-19 disproportionately affects those with comorbidities and those who are older. Recent data released from New York State shows that, just over 86 per cent of reported COVID-19 deaths involved at least one comorbidity and research at Imperial College London has shown that almost 20 per cent of over-80s infected with COVID-19 require hospital admission, compared with around 1 percent of people under 30 and we know that the immune system of an older person is less responsive than that of a younger person. 1.5 million people in the UK have a much greater risk of developing serious complications from coronavirus infection [COVID-19] due to their health conditions.

The respiratory illness COVID-19 can affect any of us, we are all vulnerable, but some of us are more vulnerable than others. There are two population groups that have been defined as having a higher risk level of a becoming seriously unwell with coronavirus infection. These groups are defined as having a ‘very high risk’ (also called clinically extremely vulnerable) or ‘high risk’. Being at very high risk requires you to follow shielding and being at high risk requires you to follow social distancing. 

Social distancing means that you reduce social interaction with others to an absolute minimum and also significantly limit your face-to-face interaction with friends and family. Social distancing is something that is requested of the whole population at present. Social distancing is even more important for those over 70 [regardless of medical conditions], under 70 with certain medical conditions [ie anyone advised to get a flu jab as an adult each year] and women who are pregnant, these three groups are collectively deemed to be at high risk of serious illness from COVID-19 than the wider population. Some over 70s feel that their inclusion on this list represents ageism in our society, Doctors are cognisant of this but their inclusion in the high risk category is a pragmatic generalisation due to their increased risk as a sub-group of the whole population. Of course there is wide variation in health levels in all groups of our population, and some over 70s are in exceptionally good health.

The Government is currently advising people in the very high risk group to shield until the end of June, if you are on the ‘shielding’ list, you will have received a letter and a text to confirm this. NHS Digital initially identified 900,000 patients, this has now increased to 1.28 million patients being on the ‘shielding’ list. Your GP may also have contacted you to advise you that you should be shielding and also sent you a letter after this discussion. 

Shielding means that you must not leave your house and also minimise contact with other members of your household. Shielding requires that you should not attend any gatherings, including gatherings of friends and families in private spaces, for example, family homes, weddings and religious services. Anyone who has symptoms of COVID-19 must not be in contact with someone who is shielding. An essential visitor or carer to someone who is shielding must wash their hands with soap and water for at least 20 seconds on arrival and often while they are with the person who is shielding.

www.gov.uk defines the following medical conditions as placing someone to be at the greatest risk of severe illness from COVID-19.

  • Solid organ transplant recipients.
  • People with specific cancers : people with cancer who are undergoing active chemotherapy, people with lung cancer who are undergoing radical radiotherapy, 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 and 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 [COPD].
  • People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections, such as Severe combined immunodeficiency [SCID] and 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.

Everyone who has received a letter advising that they are at the highest risk [clinically extremely vulnerable] should register on www.gov.uk or call 0800 028 8327.  If you believe that you should be on this list but have not been contacted by your GP or received a letter, you should discuss your concerns with your GP or Hospital Specialist. 

Medicines and essential groceries will be delivered to your home if you do not have family, friends or neighbours to support you or are unable to use online services. Local voluntary organisations and charities are also there to assist. Shielding is advised to be undertaken for your protection if you have been identified as being at highest risk, however if for example, you have a terminal illness with less than a few months to live, and you decide that you do not want to shield, it is advisable to discuss this with you GP or Hospital Specialist.

Staying at home for 12 weeks has consequences for your physical and mental well being, it’s important to continue your daily routine as much as possible and structure your week so that you enjoy a variety of daily activities. Walking and exercising in local open spaces for a limited period daily, whilst at all times staying 2 metres [6ft] from others is essential. Talking to friends and family on the phone, sharing concerns, staying in touch online and spending time on enjoyable indoor hobbies will help.

STAY AT HOME – PROTECT THE NHS – SAVE LIVES

Dr Raj Chandok

FRCGP FRSA MSc MBBS DC DRCOG DFFP D Med Ed

General Practitioner

Principal, Dr G Singh & Partners

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