Extremely high risk of severe illness

Some groups of people are considered to be at extremely high risk of severe illness with COVID-19 and should strictly follow shielding measures. Their household and other contacts should strictly follow social distancing measures in order to protect them.

This group includes people who:

  • have had solid organ transplants
  • have cancer and are receiving active chemotherapy
  • have lung cancer and are either receiving or previously received radical radiotherapy
  • have cancers of the blood or bone marrow, such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • are receiving immunotherapy or other continuing antibody treatments for cancer
  • are receiving other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibiotors
  • have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
  • have severe chest conditions such as cystic fibrosis or severe asthma and severe COPD
  • have rare diseases that significantly increase the risk of infections such as SCID and homozygous sickle cell
  • are receiving immunosuppression therapies that significantly increase risk of infection

Letter to High Risk patients from Dr Catherine Calderwood Chief Medical Officer

Directorate for Chief Medical Officer
Catherine Calderwood MA Cantab. FRCOG Hon FRCP Edin, FRCP (Glas), FRCS (Ed), HonFFPH
Chief Medical Officer

Dear Patient,

Your CHI number: [CHI NUMBER]

If you need support and you have a mobile phone, please text us on 07860 064525. Please include your CHI number, which is the ten-digit number at the top of this letter. This will connect you to a text message service. This service is for you as someone at higher risk of severe illness from COVID-19. This will help you to make sure you have the food and medicines you need while you stay at home. It will let us keep you up to date with the latest information.

If you do not have a mobile phone, you will still be able to access support with daily living by calling your local assistance centre. Their contact details will be available at www.nhsinform.scot .

We know that this is a very worrying time, especially for patients with significant underlying illnesses. Your safety and the continued provision of the care and treatment you need is a priority for the Scottish Government and the NHS in Scotland. This letter gives you practical and detailed advice on how to protect yourself and access the care and treatment you need.

The NHS has identified you, or the named person you care for, as someone at risk of severe illness if you catch Coronavirus (also known as COVID-19). This is because you have an underlying disease or health condition that means if you catch the virus, you are more likely to be at risk of serious illness than others.

The safest course of action is for you to stay at home at all times and avoid all face-to- face contact for at least twelve weeks from today, except from carers and healthcare workers who you must see as part of your medical care.

We recognise this is difficult, and it may feel like a big step, but by doing this it will help to protect you from coming into contact with the virus, which could be very dangerous for you.

If you are in touch with friends, family or a support network in your community who can support you to get food and medicine, follow the advice in this letter. If you do not have contacts who can help support you, more advice is given at Section 5 in this letter.

Over the coming days, councils and health professionals will be working together to keep in contact with you to make sure you have access to food supplies and any medicines you need.

If, at any point, you think you have developed symptoms of coronavirus, such as a new, continuous cough and/or high temperature (above 37.8 °C), seek clinical advice by phoning the NHS on 111. Do this as soon as you get symptoms.

This is different to the advice that we are giving people who do not fall into the very high risk group, who are only being asked to contact the NHS if they feel very unwell. We are asking you to get in touch sooner than we are advising everyone else.

Things you should be doing to stay safe.

You, or the person you care for, should:

  • DO STRICTLY AVOID contact with anyone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature (above 37.8 °C) and/or a new and continuous cough. You might want to have a thermometer at home to check your temperature if you are worried that you may have a fever.
  •  DON’T leave your home.
  •  DON’T attend any gatherings. This includes gatherings of friends and families in private spaces e.g. family homes, weddings and religious services.
  • DON’T go out for shopping, leisure or travel. When arranging food or medication deliveries, these should be left at the door to minimise contact.
  • DO keep in touch using remote technology such as phone, internet, and social media.
  • DO use telephone or online services to contact your GP (for non-coronavirus issues) or other essential services.
  •  DO regularly wash your hands with soap and water for 20 seconds. Ask carers or support workers who visit your home to do the same.

The rest of your household need to support you to stay safe and must stringently follow guidance on social distancing, reducing their contact outside the home. In your home, you should:

  • minimise the time you spend with others in shared spaces (kitchen, bathroom and sitting areas) and keep any shared spaces well ventilated
  • aim to keep 2 metres away from others and encourage them to sleep in a different bed where possible
  • use separate towels and, if possible, use a separate bathroom from the rest of the household, or clean the bathroom with cleaning products after every use
  •  avoid using the kitchen when others are present, take your meals back to your room to eat where possible, and ensure all kitchenware is cleaned thoroughly using a dishwasher at the 60 degrees setting if possible, otherwise in very warm soapy water.

If the rest of your household are able to follow this guidance to help keep you safe, there is no need for them to wear any special medical clothing or equipment.

We want to reassure you that you will still get the usual medical care you need during this period. Due to the situation, demand for all health services is very high and your GP practice will be in touch with you as soon as they can to arrange with you how best to ensure that. Please only get in touch with them if you have any significant concerns.

Other advice you may find helpful:

1. Carers and support workers who come to your home

Any essential carers or visitors who support you with your everyday needs can continue to visit, unless they have any of the symptoms of coronavirus. All visitors should wash their hands with soap and water for 20 seconds when they arrive, before and after preparing food and frequently during their visit.

It is also a good idea to speak to your carers about what happens if one of them becomes unwell. If you need help with care but you’re not sure who to contact please visit Care Information Scotland.

2. Medicines that you routinely take

The government is helping pharmacies to deliver prescriptions, prioritising those who are not currently able to leave the house. Prescriptions will continue to cover the same length of time as usual. If you do not currently have your prescriptions collected or delivered, you can arrange this by:

  •  Asking someone who can pick up your prescription from the local pharmacy, and leave them at your door for you (this is the best option, if possible).
  • Contacting your pharmacy to ask them to help you find a volunteer (who will have been ID checked) to deliver it to you or they may deliver it themselves.
  • If you get medicines or equipment from your hospital care team, they will make arrangements to have them delivered to you.

3. Planned GP practice appointments

Wherever possible, we will provide care by phone, email or online. But if we decide you need to be seen in person, we will contact you to arrange a visit.

4. Planned hospital appointments

NHS Scotland has written to your hospital to ask them to review any ongoing care that you have with them. It is possible that some clinics and appointments will be cancelled or postponed. Your hospital or clinic will contact you by phone or letter if any changes need to be made to your care or treatment. Otherwise you should assume your care or treatment is taking place as planned. Please contact your hospital or clinic directly if you have any questions about a specific appointment or the care you usually get from hospital.

5. Support with daily living

Please discuss your daily needs during this period of staying at home with carers, family, friends, neighbours or local community groups to see how they can support you.

The government will be offering support to help you self-isolate, including the delivery of food packs and medications. It would be helpful for us to have your mobile phone number, so that we can get in touch with you through an SMS service to offer you this support. If you have a mobile phone, please text us on 07860064525. Please include your CHI number, which is the ten-digit number at the top of this letter. This will connect you to a text message service. This service is for you as someone at higher risk of severe illness from COVID-19. This will help you to make sure you have the food and medicines you need while you stay at home. It will let us keep you up to date with the latest information. You can see more details at NHS Inform Scotland.

If you do not have a mobile phone, you will still be able to access support with daily living by calling your local assistance centre. Their contact details will be available at  NHS Inform Scotland.

If you do not have anyone who can help you, here is a selection of organisations who can advise you and can signpost you to other services:

Young Scot

Age Scotland: Freephone 0800-12-44-222
And for support in dealing with anxiety around impacts of Coronavirus:

6. Financial assistance

This letter is evidence for your employer, to show that you cannot work outside the home. You do not need to get a separate fit note from your GP.

If you’ve been financially affected by coronavirus, and if you’re eligible, you should apply for Statutory Sick Pay, Universal Credit or Employment and Support Allowance. The UK Government has introduced some temporary changes to make this process easier. Find out more at Universal Credit.

Money Talk Team, from the Citizens Advice network in Scotland, can help you see what benefits you might be entitled to, and offer you advice to help make your money go further. You can call the team on 0800 085 7145 or visit the Money Talk Team website at Financial Health Check Service.

7. Urgent medical attention

If you have an urgent medical question relating to your existing medical condition (ie not Coronavirus), or the condition of the person you are caring for please contact your GP practice, or your specialist hospital care team, directly. Where possible, you will be supported by phone or online. If your doctor decides you need to be seen in person, we will arrange to visit you in your home, or where necessary, see you in a hospital.

To help the NHS provide you with the best care if you need to go to hospital as a result of catching coronavirus, we ask that you have ready a single hospital bag. This should include your emergency contact, a list of the medications you take (including dose and frequency), any information on planned appointments and essential things you would need for an overnight stay (snacks, pyjamas, toothbrush, medication etc). If you have an anticipatory care plan, please include that.

8. Looking after your mental well-being

We understand that this may be a worrying time and you may find staying at home and having limited contact frustrating. At times like these, it can be easy to fall into unhealthy patterns of behaviour, which can make you feel worse. Simple things you can do to stay mentally and physically active during this time include:

  • look for ideas for exercises to do at home on the NHS website
  • spend time doing things you enjoy – reading, cooking, jigsaws and other indoor hobbies
  • try to eat healthy, well-balanced meals, drink enough water, exercise regularly, and try to avoid smoking, alcohol and recreational drugs
  • try spending time with the windows open to let in fresh air, arranging space to sit and see a nice view (if possible) and get some natural sunlight. Get out into the garden or sit on your doorstep if you can, keeping a distance of at least 2 metres or 6 feet from others.

You can find additional advice and support from the NHS Inform advice website.

Yours sincerely,

Dr Catherine Calderwood 
Chief Medical Officer