Self-Care, Stay At Home and 'Social Distancing' Advice
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Shielding - self isolation letters for the high risk and extremely high risk patient
We have had a number of queries from patients and relatives asking where their letter was. It is confusing but here are some questions and answers.
Am I in the high risk or very high risk category? Will I get a letter?
The Government has defined two categories of patients. Those that are a high risk if they caught Covid-19 and those at very high risk. The Government is currently making lists from disease databases and when complete they (not the GP Practice) will send letters directly to households.
High risk patients are essentially those aged 70 or over and those that get invited for a flu jag because of a medical condition not just because they are over 65. The government list is:
- aged 70 or older (regardless of medical conditions)
- under 70 with an underlying health condition listed below (i.e. 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
- 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 BMI of 40 or above)
- those who are pregnant
The Very High Risk Patients
Group 1 - Solid organ transplant recipients
Group 2 - People with specific cancers
This is made up of five sub-groups. They are:
- 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; and
- People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.
Group 3 - People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD
Severe Asthma has been defined as:
“Patients who have been prescribed a medicine for asthma for at least 4 of the 6 months (July to December 2019) AND have also been prescribed Prednisolone for at least 4 of the 6 months (July to December 2019)” and
"patients who have been prescribed a regular medicine for asthma (eg inhaled steroid, montelukast, LABA like formoterol or atimos, theophylline) AND are on regular Prednisolone tablets over the previous 6 months up to the end of December 2019 at an average daily dose of 5mg or more.
Severe COPD was defined as:
“Patients who have been prescribed Roflumilast in either or both November and December 2019 OR who have been prescribed a Long Acting Beta Agonist (LABA) – like formoterol or atimos AND a Long Acting Muscarinic Agonist (LAMA) like Braltus, or Incruse Elipta or Eklira Genuiar AND an inhaled corticosteroid (ICS) like clenil or fluticasone (as either 3 separate medicines, combinations of single and dual medicines like Fostair or NEXThaler or Relvar Ellipta or as triple therapy like Trimbow or Trelegy Ellipta) in either or both November and December 2019”
Group 4 - People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell disease)
Group 5 - People on immunosuppression therapies sufficient to significantly increase risk of infection
And patients on long term high dose of steroid treatment at equivalent of Prednisolone greater than or equal to 20mg per day for more than 4 weeks
Group 6 – People who are pregnant with significant heart disease, congenital or acquired
What advice or help will I get?
The High Risk patients will receive a letter sent by the government advising them to be particularly stringent social distancing and hand washing. The advice is here.
The Very High Risk patients will receive a different letter sent by the government.
- it advises very high risk patients to stay at home at all times and avoid all face to face contact for at least 12 weeks
different advice if they get symptoms of persisting new cough and temperature over 37.8 to call right away to NHS24 on 111. Do not call your GP or hospital.
- The letter is evidence for their employer that they cannot work outside the home. They do not need a sick line just that letter.
- It gives advice how to stay safe
- It asks for a mobile phone number to stay in contact
- It says the GP practice will be in touch at some point to get more information including contacts of carers and next of kin and backup carers.
- There is likely to follow help where needed from other organisations for delivery of medicines and basic food items.
What if I think I have been missed out?
If in the meantime whist you are waiting for a letter and you think you are in the High or very high risk categories you can still be following the advice.
After the government has made the lists and sent out letters the government has asked us to double check that no-one has been missed off the Very High Risk list only, and notify the health board and get a letter sent out. If after mid April you still feel you are in the Very High Risk group and haven't had a letter the contact the practice and advise reception that you have not had a letter and which condition in the very high risk group you have and we will investigate for you.