Intended for healthcare professionals


Clinically extremely vulnerable adults should not leave home for work, says new advice

BMJ 2020; 371 doi: (Published 04 November 2020) Cite this as: BMJ 2020;371:m4292
  1. Zosia Kmietowicz
  1. The BMJ

People in England who are clinically extremely vulnerable will receive a letter this week urging them to stay at home as much as possible, including not going to work if they cannot work at home, and only to leave the house to exercise outdoors or to attend health appointments.

New guidance1 from the government says that people at highest risk of becoming severely ill from covid-19 should not go to shops or pharmacies because of the increase in cases across the country. Children who were originally asked to shield, however, do not need to do so this time because the evidence has shown there is a low risk of children becoming unwell from covid-19, it says.

The advice has been given as new measures to try to stem the rise of cases of covid-19 in England take effect on Thursday 5 November, after prime minister Boris Johnson acknowledged that hospitals would be overwhelmed if no action was taken.2 Modellers had warned that there could be 85 000 deaths across the UK between 1 July 2020 and 31 March 2021 if restrictions on people’s activities were not tightened.3 Over 1500 patients were admitted to UK hospitals on 3 November, with 11 458 inpatients in hospital altogether and reports of some hospitals already struggling to cope.

The government said that upper tier councils in England would receive over £32m (€36m; $42m) to support clinically extremely vulnerable people, for example by helping them access food and signposting them to local support or befriending services.

The list of people seen as clinically extremely vulnerable includes those with reduced immune systems, such as those with organ transplants, or people with specific cancers or severe respiratory conditions, such as cystic fibrosis. Most people will have received letters previously from the NHS or their GP advising them about their inclusion.4 But the list has been updated as new evidence emerges about who is at greatest risk. People with chronic kidney disease (stage 5) and those undergoing dialysis, for example, as well as adults with Down’s syndrome, have been added to the list by the NHS.

Jenny Harries, deputy chief medical officer for England, said, “We have previously said that where the conditions of transmission of the infection alters significantly we would alert patients in relative regions. With the prevalence of the virus continuing to increase across England and across the world, it’s right that we adjust our advice for the clinically extremely vulnerable accordingly.

“Our guidance for this group has always been advisory, but I would strongly urge all those who are clinically extremely vulnerable to take these extra precautions to keep themselves as safe as possible.”

The guidance says that people with more general underlying health conditions or who are 70 or over may also be more vulnerable to covid-19 than the general population, and are advised to stay at home as much as possible.