Coronavirus - Extremely vulnerable people.

What does extremely vulnerable mean?

Extremely vulnerable is a new classification, which refers to approximately 85,000 people in Wales who have one of a very specific list of pre-existing and long-term health conditions. 

The impact of their pre-existing, long-term health condition on their immune system puts them at very high risk of serious illness if they are exposed to coronavirus.

We are asking this group of people to take a series of special measures – called shielding – to protect themselves from getting ill.


How is this different to the at-risk category?

This is a very different group to the at-risk group. The at-risk group covers people who are over-70, pregnant women and people with pre-existing and long-term conditions, who are at an increased risk of developing a serious illness if exposed to coronavirus. 

This group should follow the stay-at-home rules but they can go out to collect shopping and food if they (and the people in their household) are symptom free.

The at-risk group is:  Those who are 70 and over (regardless of medical conditions)  Those 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):  o chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis o chronic heart disease, such as heart failure o chronic kidney disease o chronic liver disease, such as hepatitis o chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy o diabetes o problems with your spleen – for example, sickle cell anaemia or if you have had your spleen removed o a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy o being seriously overweight (a BMI of 40 or above) o those who are pregnant


How many people at classed as extremely vulnerable?

85,000 people in Wales are classed as extremely vulnerable. This figure has been revised upwards from the initial figure of 75,000.


How do I know if I’m in the extremely vulnerable group of people?

Everyone in the extremely vulnerable category will receive a letter from the Chief Medical Officer for Wales Dr Frank Atherton, setting out the steps you should take to protect your health. These are known as “shielding” measures.

The NHS has worked very hard on this list to check it contains the names of those people who are in the extremely vulnerable category.

GPs have also been provided with a list of the people who have been sent letters to check against their patient lists. They will contact any additional high-risk people who may not have been identified to ensure they also receive the advice in the letters from the Chief Medical Officer.


What long-term illnesses are covered by the extremely vulnerable category?

People with certain specific long-term or pre-existing health conditions are classed as extremely vulnerable to serious illness if they are exposed to coronavirus. 

The following are the specific conditions, which make people extremely vulnerable:

  • 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 six months or who are still taking immunosuppression drugs. 
  • People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD
  • People with severe single organ disease (for example, liver, heart, kidney, neurological)  People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID (Severe Combined Immunodeficiency), homozygous sickle cell disease)
  • People on immunosuppression therapies sufficient to significantly increase risk of infection
  • People who are pregnant and children up to the age of 18 with significant heart disease, congenital or acquired.


What do I need to do if I’m classed as extremely vulnerable?

Everyone in the extremely vulnerable category will receive a letter from the Chief Medical Officer for Wales Dr Frank Atherton, setting out the steps you should take to protect your health. These are known as “shielding” measures.

We are asking everyone in this group to stay at home for at least 12 weeks and to take extra precautions in the home – all these are set out in the letter.

If you are shielding, you should not go out to shop for food and other basic necessities, including medicines – everyone in this group will need support from family and friends or local support networks. If this is not available, support will be available via your local authority to ensure you have access to food and you can get your regular medicines and other necessities while you are shielding. 

The letter contains a special contact number for each local authority – this is the phone number people should call if they need support. It is also the number to call to order a free weekly food parcel (see below)

Local authorities have been working closely with the Welsh Council for Voluntary Action (WCVA) to put in place all the arrangements to make sure support is available locally for people who are shielding.


Can I leave my home if I am shielding?

You should not leave the house if you are shielding. Where possible ask friends and family to help you get the things you need such as food and medicines. If you do not have anyone to help, call the local authority number provided on the letter you received.

If you have routine medical appointments your GP practice or hospital care team will contact you to make different arrangements where possible.

If you need to contact your GP practice or hospital team, do so by phone or email – they will be able to advise you about what to do next.


Can I go out once a day to exercise?

No. For people who are in this extremely vulnerable group, going outside, even for exercise, carries too much risk.

Please try and find alternative ways to keep as active as possible at home.


How will I get food if I’m shielding?

If you do not have any support from family, friends, neighbours or support groups close by who can help you while you are shielding, you will be able to request a free weekly food box delivery. Each food box will contain enough food for one person shielding for a week – if two people in a household are shielding, you will be able to request two boxes.

To request a free weekly food box, please call the special number for your local authority, which is contained in the letter you received from the Chief Medical Officer to request a food box,


When will I be getting my food box?

Deliveries will start at the end of the week ending April 3. The food box will be delivered directly to your home. Local authorities also have arrangements in place to help people who are in immediate need – before the deliveries begin


What will be in my food box?

The box will contain essential foods in packages and tins but only limited fresh produce. All the contents will be labelled. We hope to improve the variety.

A box will provide food and essentials for one person for one week. If there are two eligible people in the house, there will be two boxes.


How do I collect my medicines if I am shielding?

If you have been asked to adopt shielding measures because you have received a letter from the Chief Medical Officer, please ask your family, friends or neighbours if they can collect your medicines from the pharmacy for you if your local pharmacy does not offer a delivery service.

If this isn’t possible and you need a delivery, medicines are being delivered by your regular community pharmacy. Pharmacies will have a record of who has been identified for ‘shielding’ in your area. Please telephone your local pharmacy to discuss this further. 

Volunteers will support pharmacies to ensure medicines can be delivered to people’s homes – all volunteers will receive training in infection prevention control and medicine delivery.