The Deputy Chief Medical Officer for England issued further advice linked to the categories of local COVID-19 alert levels where people live. This is for people who fall within the categories of ‘extremely vulnerable’, and you may receive a letter that provides the following information with recommendations you should follow.
Extremely vulnerable people are
- 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 that 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
It also applies to
- solid organ transplant recipients
- people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
- people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), 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
- other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs.
People who are defined as clinically extremely vulnerable are at very high risk of severe illness from COVID-19. If you are in this group, we recommend that you follow the advice to help protect yourself at each alert level as set out in the guidance.
In addition to the rules you must follow at each alert level, you can take additional precautions. Continue to maintain strict social distancing, wash your hands regularly and try to keep the number of social interactions that you have low. The fewer social interactions you have, the lower your risk of catching COVID-19.
The advice for the clinical extremely vulnerable is in addition to the basic restrictions in the Local COVID alert levels framework everyone must follow. You can read about the COVID alert levels on the GOV.UK website.
Additional advice for Christie patients
What do I need to do?
We advise all of our Christie patients that you:
- follow the Government staying alert and safe guidance very carefully
- keep in mind that the risks of becoming more unwell with COVID-19 may be higher for those over 65, who are from black and ethnic minority groups, are significantly overweight or have underlying health problems apart from cancer, for example diabetes
- follow guidance on wearing face masks, avoid touching your face and wash your hands for at least 20 seconds each time, frequently through the day
- avoid unnecessary contact with others
- if you do need to shop, maintain your distance carefully
- avoid busy social environments, especially where others may not be following social distancing
- take additional precautions as described in the previous section of you are in the extremely vulnerable group and especially if you live in areas where there are high or very high local alert levels.
Is this the same as shielding?
At the start of the pandemic, all vulnerable patients were advised to shield and take extreme precautions for a prolonged period of time regardless of where they lived.
Although the actions in this guidance are not called shielding, they are about taking precautions that are proportional to the level of COVID-19 cases and level of risk for you, in your local area.
In areas where there are high levels and you are keeping at home but need assistance, please contact your local authority/Council for help. If you are worried about coming to The Christie, please contact your specialist team. It may be possible to arrange telephone calls with you rather than a clinic visit in this period of time.
Is it safe to come to The Christie?
It is important that you keep your appointments with us even if you are in areas of medium and high alert.
At The Christie, from the onset of the pandemic in March, we have put in place a number of steps to keep you as safe as we can when you need to attend for appointments and treatment. These will remain in place.
The Christie is a ’COVID protected site’ so that we can undertake tests and provide treatments for people with cancer safely, and minimise the risk of any transmission of the infection. We try to reduce the need for patients to attend the hospital as far as possible, for example by using telephone consultations.
If you have started on treatment, it is important to complete this.
I have not received a letter about taking precautions, but I think I am on one of the treatments listed above
Some treatments do not have as much risk as others, but because there are many different types of treatments for cancer, it is sensible to take precautions until you have checked with check with your specialist team. They will be able to advise you.
I was on one of the treatments mentioned, but finished all my treatment some time ago. I have had a letter telling me to take precautions, is this still necessary?
The letters were sent through a national action (not via The Christie) to inform to all who were identified as being in one of the vulnerable categories from March 2020 onwards.
If you are no longer on treatment and have made a good recovery, any risk from a COVID infection will be much less than when you were on treatment. It is still sensible to follow the standard guidance on regular hand washing, use of face mask, keeping a distance form others and keeping social contacts to as few as possible.
However people who have been treated for blood or bone marrow cancers such as leukaemia, lymphoma or myeloma should continue to be very careful.
If you underwent a bone marrow or stem cell transplant in the last 6 months, and are still taking immunosuppressant medication, you are still vulnerable so should follow the precautions that apply for the level of COVID risk in your area.
The Anthony Nolan website also provides helpful information for patients affected by blood or bone marrow cancer.
Where can I get any further advice on what precautions I should be taking?
You are welcome to call our Christie Hotline on 0161 446 3658 who may be able to help or will direct you to one of your specialist team who know more about your situation.
What do I do if I develop symptoms that could be due to COVID?
If you have finished treatment in the last 3 to 4 weeks and do develop any symptoms that could be attributed to your therapy, it is important you contact The Christie Hotline on 0161 446 3658, rather than 111.
Our staff members have detailed information about your case and your cancer that 111 does not have. We can provide better and more specific advice for you. Of course, you should dial 999 for any medical emergencies, as you would normally.
If you wish to discuss anything in this letter please get in touch with your clinical team or call our Christie Hotline on 0161 446 3658. We know this is a worrying time for cancer patients and we are here to help you as much as possible.
You might also find the following sources of information useful:
- NHS Health at Home: information about NHS services such as how to order repeat prescriptions online and get them delivered
- Looking after your mental health and wellbeing during the COVID-19 pandemic
- Government advice on employment and financial support
About coronavirus and you
If you have symptoms associated with coronavirus including a new continuous cough and a high temperature or loss of taste and smell, you are advised to stay at home for 7 days.
Please do not book a GP appointment or attend your GP practice.
If you live with other people, they should stay at home for at least 14 days, to avoid spreading the infection outside the home. After 14 days, anyone you live with who does not have symptoms can return to their normal routine.
But, if anyone in your home gets symptoms, they should stay at home for 7 days from the day their symptoms start. Even if it means they're at home for longer than 14 days. The most up-to-date public guidance is always on the NHS website.
If your symptoms are serious, or get worse, NHS 111 has an online coronavirus service that can tell you if you need further medical help and advise you what to do.
For patients who have appointments at The Christie and develop symptoms, please contact your specialist team and do not attend the hospital unless advised by them to do so.
If you are currently undergoing treatment and become unwell please ring The Christie Hotline on 0161 446 3658 rather than NHS 111 for initial guidance.
The level of virus activity is being monitored carefully across the country and here in Greater Manchester. As a system, and here at The Christie, we are prepared to take further precautions should these be needed through a flare up on new cases of people ill with COVID-19.
National guidance on maintaining cancer care during the pandemic can be found on the NHS website:
- Clinical guide for the management of essential cancer surgery for adults during the coronavirus pandemic
- Advice on maintaining cancer treatment during the COVID-19 response
- Clinical guide for the management of non-coronavirus patients who require acute treatment for cancer
Please refer to wider Government guidance through the Gov.UK coronavirus page for more information.