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Coping with changes to shielding and guidance for the clinically extremely vulnerable

Across the UK, shielding is now paused and there are differing coronavirus (COVID-19) restrictions are in place across the UK. We hope the information below will help as you and your family adjust to this changing situation.

Last updated: 2 November 2020


In March 2020, across the UK people with cystic fibrosis (CF) were advised to ‘shield’ due to the COVID-19 pandemic, and their household members were advised to follow ‘stringent social distancing’. This has been tough for many affected, and every household has faced their own individual challenges. Shielding is now paused, but there are now differing tiers of restrictions, and some country-wide lockdowns, in place across the UK. As this situation continues to evolve, we have tried to provide answers to some of your frequently asked questions.

Shielding is hard – will I have to do it again in the future?

Shielding has now been paused across the UK, and the Government has stated it will only reintroduce formal shielding advice for a limited period and in the areas worst affected by COVID-19. The Government has stated it will write to anyone who needs to shield again in future. Otherwise, those who were shielding are advised to follow the guidance for their local COVID alert level.
For the clinically extremely vulnerable, this usually means taking extra precautions to protect themselves from COVID-19. More details and links to guidance by nation can be found here.

The Government and UKCFMA advice has always been to follow the shielding guidance issued by the Government, until shielding is paused or reviewed where you live in the UK. Following shielding guidance is not straightforward for many people – you have to balance your physical and mental health needs and do what is right for you and your household.

The advice on shielding has always been guidance, designed to keep all of those thought to be clinically extremely vulnerable to the virus as safe as possible. You can decide whether your household follows the guidance, and you can decide what exactly shielding means for you. This will continue to be the case if shielding is reintroduced locally or nationally at any point.

As an adult, if you want to, you can ask to be removed from the shielding list altogether which would mean you wouldn’t receive government advice to shield again in the future. If you are thinking about doing this, it’s really important that you consult with your CF team in detail. You should also consider wider factors – for example, the support you may need to ensure your workplace is risk-assessed and made ‘COVID-safe’ for you. There may be implications for your rights now or in the future if you are not ‘on the list’ so it’s worth thinking this through when making your decision.

What if I want to continue to follow shielding guidance when shielding is officially paused?

The is very much a personal decision for you and your family, and may also depend on practical things like the type of work you do. If everyone in your household can work from home, you can access online shopping, and have a support network around you if you need help, you may feel you want to carry on following the guidance to remain as safe as possible. Equally, you may be asked to return to your workplace and you may have concerns about this – we have information on your employment rights to help you make decisions about this.

What evidence is there to help me make my decisions and who can help me?

One of the key challenges for all of us is that COVID-19 is completely new, and this means there is limited knowledge available for the CF community to be able to make decisions based on scientific evidence. We are monitoring outcomes for people with cystic fibrosis who are diagnosed with the virus and update the statistics for COVID-19 in people with CF every two weeks.

However, the number of people with CF who have had the virus is still very low – too low for us to be able to provide data for specific groups at this stage (eg children or those with high lung function). It’s difficult to draw any conclusions about levels of risk from this data, but it does suggest that shielding has protected people with CF from catching the virus through the height of the pandemic.

In making any decision about what to do, the key people who can advise you are your CF team – they will know your CF health or your child’s CF health best and can provide individual tailored advice. The Cystic Fibrosis Trust cannot give medical advice and we can’t tell you whether something is safe or not.

Making decisions about levels of risk is not new to the CF community – it’s something people with CF will have faced many times in their lives, and something parents of children with CF will have dealt with frequently. While the pandemic is new to all of us, the same skills and thought processes you have used to deal with potential risks in the past will be useful to you. You will need to think about all the pros and cons for you (and your family) and think about specific situations that you might be or might not be comfortable with – for example, you may feel safe going for a socially distanced walk with a friend and that your mental and physical health will benefit, but going to your local supermarket (when permitted) may fill you with anxiety and you might feel the worry that would come from it means it isn’t worth a trip to the shops, so you might decide to continue to rely on online shopping deliveries.

There is a huge amount of information online about the virus and what may or may not be safe or what risks there might be in different activities, and we know there is a lot of misinformation too. Some people find detailed research studies helpful in supporting their decisions, and some people don’t. When looking at information online, it’s important to consider whether the source/study is reliable – when we look for information online to support our work, we stick to official guidance (eg NHS) and look for research in well-known published journals (eg the British Medical Journal, The Lancet). You could discuss research you have read with your CF team.

What do I do if I feel nervous about starting to go out after spending so long at home?

It’s understandable that you might feel worried about going out and resuming some normal activities, even if and when you are advised that these carry very low risk to you. If you have been home throughout shielding, you may find some things are different to what you remember before the pandemic – queues outside shops, people wearing face-coverings, socially-distanced conversations with friends you pass in the street. It has taken time for us all to adjust to this, and you may need some time too.

You can speak to your CF team about your concerns about particular risks, and you may also want to seek support from a specialist CF psychologist if you are struggling to cope with anxiety about going out. You may have stopped some of your usual exercise while at home, so you may want to speak to your CF physiotherapist about how to build your exercise back up again when you feel ready.

In our video, you can hear from two CF psychologists about managing uncertainty and assessing risk.

What about school – are children with CF expected to attend school even when there are high local cases or lockdowns?

Schools across the UK reopened in August and September 2020. Understandably, some families felt very positive about their children attending school and others more anxious.

Since September, there have been varying regional restrictions and lockdowns across the UK. Largely, schools have remained open, and advice has been that children who were previously shielding should attend school.

We know that everyone with CF is different – if you don’t feel it is safe for your child to attend school attend (either because they have CF, or because someone else in the household does), please do seek specialist advice from your CF team.

You may also wish to view our Q&A which addresses many questions about your child’s return to school.

What if I’m worried about the risk of going back to work?

Many people with CF have shared their concerns that shielding will be or has been paused before they feel safe returning to their usual workplace. On 31 October, the Government announced that people who were shielding in England should work from home during the England-wide lockdown taking place from 5 November to 2 December, and should not go to work. We are awaiting further details on what support will be available for the clinically extremely vulnerable during the new lockdown, and will update our webpages when more is known.

We also have existing information on your employment rights in relation to COVID-19 and you may want to seek advice from your CF team about any potential risks to you in your workplace. If you have financial worries, our helpline team can support you to look at any financial support that may be available for you. You can contact them on helpline@cysticfibrosis.org.uk or 0300 373 1000.

Coronavirus updates and FAQs

Important information for people affected by cystic fibrosis about coronavirus (COVID-19), and the latest guidance on how to stay safe.

Financial support and welfare advice

Resources and information from the Trust, as well as useful external websites and services, that can provide financial and welfare support to families living with cystic fibrosis during this time.

Mental and physical health

Helpful advice on how you can maintain your emotional and physical wellbeing through a range of activities.