Those patients who are considered EXTREMELY VULNERABLE and should be following SHIELDING measures include:

1. Solid organ transplant recipients. 2. 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 • people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs 3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD. Please see the page at the end of this document for what constitutes ‘severe’ 4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell). 5. People on immunosuppression therapies sufficient to significantly increase risk of infection. 6. Women who are pregnant with significant heart disease, congenital or acquired.

The above list is taken from the gov.uk website. Further information on recommendations can be found at https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable- persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Those patients who at INCREASED RISK and should follow SOCIAL DISTANCING measures 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

The above list is taken from the gov.uk website. Further information on recommendations can be found at https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable- people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable- adults

What constitutes Severe Asthma or COPD?

The British Lung Foundation advise the following meet the criteria for severe COPD

• Everyone who has severe or very severe airflow obstruction. This is measured using a breathing test called spirometry where you blow out as hard as you can. If the amount of air you can blow out in one second is less than 50% of the normal range of values, it is classed as severe. Severe or very severe airflow obstruction is sometimes described as GOLD grade 3 or GOLD grade 4. • People who are limited by breathlessness – this means that you can’t walk as fast as other people of your age because of breathlessness. This may be described in clinic letters as an MRC breathlessness score of 3, 4 or 5 • People who have had to be admitted to hospital in the past because of an acute attack of the lung condition. • People who have had 2 or more exacerbations or flare-ups in the past year that needed emergency treatment with steroids or antibiotics from the GP or hospital. • People who are on regular steroid tablets, called prednisolone to treat their condition • People who have oxygen therapy at home • People who use non-invasive ventilation at home – using a mask connected to a ventilator, sometimes called BiPAP, to support their breathing at night

Asthma UK advise the following meet the criteria for severe Asthma

• You are taking ALL THREE OF: o a steroid preventer inhaler (at any dose) o another preventer medicine (e.g. you are on a combination inhaler, or take a medicine such as formoterol or salmeterol, or tiotropium as well as your steroid inhaler, or if you are taking montelukast) o regular or continuous oral steroids (which means you had 4 or more prescriptions for prednisolone between July and December 2019) • Or you have been admitted to hospital in the last 12 months for your asthma • Or you have ever been admitted to an intensive care unit for your asthma • Any biologic therapy, also called a mAb (Xolair/omalizumab, Nucala/mepolizumab, Cinqaero/reslizumab, Fasenra/benralizumab) • Antibiotic tablets or liquid for asthma every week as a preventer (e.g. azithromycin) • A combination inhaler that also contains a long-acting bronchodilator (e.g. Seretide, Fostair, Symbicort) at a high daily steroid dose (see the table below) • An inhaler with a high daily steroid dose (see the table below) AND you are taking Montelukast

Guidance on what constitutes a high steroid dose can be found in a table at the following https://www.asthma.org.uk/advice/triggers/coronavirus-covid-19/