Government updates guidance for the clinically extremely vulnerable ahead of national lockdown


Updated guidance for the clinically extremely vulnerable has officially been issued today by the UK government.

Ministers and health officials are urging those who are classed as such to take further precautions on top of the new national lockdown measures.

The newly-updated guidance comes ahead of the four-week national lockdown in England – announced by Prime Minister Boris Johnson in a direct address to MPs in the House of Commons last Saturday evening – which is due to be voted on in Parliament today and will take effect from 0.01 GMT on Thursday 5th November.

The guidance is urging medically vulnerable individuals to stay as home as much as possible and avoid all non-essential travel out of the home, but unlike the previous shielding advice, exercise is still permitted, and they should still attend routine medical appointments unless told otherwise by a doctor.

Those considered extremely clinically vulnerable will be receiving a letter in the post with new updated advice.

Others living in a household with someone who is clinically extremely vulnerable are not advised to follow this guidance however, and should instead continue to attend work and school in accordance with the general advice and regulations set out.

Who classes as Clinically Extremely Vulnerable?

People who are defined as clinically extremely vulnerable are at very high risk of severe illness from coronavirus (COVID-19) and there are two ways in which a person may be identified as clinically extremely vulnerable:

  1. You have one or more of the conditions listed below, or
  2. Your hospital clinician or GP has added you to the Shielded Patients List because, based on their clinical judgement, they deem you to be at higher risk of serious illness if you catch the virus.

According to the guidance, adults with the following conditions are automatically deemed to be clinically extremely vulnerable:

  • Solid organ transplant recipients
  • Those 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 six months, or who are still taking immunosuppression drugs.
  • Those with severe respiratory conditions including all Cystic Fibrosis, severe asthma and severe Chronic Obstructive Pulmonary Disease (COPD).
  • Those with rare diseases that significantly increase the risk of infections (such as Severe Combined Immunodeficiency (SCID), Homozygous Sickle Cell Disease, etc).
  • Those on immunosuppression therapies sufficient to significantly increase risk of infection.
  • Adults with Down’s Syndrome.
  • Adults on dialysis or with Chronic Kidney Disease (Stage 5).
  • Pregnant women 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, and GPs and hospital clinicians have been provided with guidance to support these decisions.

The updated guidance, which clinically extremely vulnerable individuals are strongly urged to follow in addition to national measures, includes:



Those classed as clinically extremely vulnerable should stay at home as much as possible, except to go outdoors for exercise – which can be done with those they live with or in their support bubble – or to attend health appointments.

They should try to keep all contact with others to a minimum and avoid busy areas.

Whenever they do go out, they should continue to maintain strict social distancing, wash their hands regularly and avoid touching their face, as well as try to stay two metres away from other people within your household, especially if they display symptoms of the virus or have been advised to self-isolate.


If those classed as clinically extremely vulnerable cannot work from home, they should not attend work.

They may be eligible for Statutory Sick Pay, Employment and Support Allowance, Universal Credit or the Coronavirus Job Retention Scheme during this period of national measures.

People in the same household who are not clinically extremely vulnerable can still attend work, in line with the new national restrictions.

Education Settings

As evidence has shown there is a very low risk of children becoming very unwell from COVID-19, most children originally on the shielded patient list now no longer need to be and can therefore still attend school.

Parents who are unsure should contact their child’s usual GP or hospital clinician to check whether they should still be considered clinically extremely vulnerable.

If a GP or clinician has advised that a child should remain on the shielded patient list, they are advised not to attend school, but children who live with someone who is clinically extremely vulnerable, but aren’t themselves, should still attend school.


Those classed as clinically extremely vulnerable should avoid all non-essential travel.

They should however continue to travel to hospital and GP appointments unless told otherwise by their doctor.

They are strongly advised not to go to any shops or pharmacies, but should they need help to travel to an appointment, they are encouraged to speak to their healthcare professional to arrange transport support with NHS Volunteer Responders.

You can read the updated guidance in full here.


For the latest information, guidance and support during the coronavirus (COVID-19) pandemic in the UK, please do refer to official sources at


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