Coronavirus (COVID-19): shielding - a way forward for Scotland

Changes to shielding advice

We have promised that our advice on shielding must be right for Scotland and based on the evidence. On this basis we are making some changes to the shielding advice.

Extension to shielding

The original advice was to shield for at least 12 weeks, which comes to an end on 18 June. The levels of infection in the community are now significantly lower than they were in March, but the evidence suggests that it is advisable that people with the highest clinical risk should continue to shield. Having set out to save lives it does not feel right to prematurely end shielding until we are confident the evidence supports it, and we do not yet know the full effect of easing lockdown for the general population.

We are therefore advising people to continue to shield until at least 31st July.

We will review this extension to the shielding period as we monitor Covid infection levels to make sure it remains the correct decision. We know this will be very disappointing news. You will continue to get all existing support, including help to access food, pharmacy, and many other services. The Chief Medical Officer is writing to everyone who has been asked to shield on 8 June and this new letter will act as a fit note for your employer up to 31 July.

Moving to a new approach for shielding

We are working to make sure that the extension of shielding to the end of July marks a transition to a new approach to shielding. Blanket advice aimed at everyone who has been asked to shield cannot work indefinitely: it is hard to follow, and will become harder as people around you gradually come out of lockdown.

Instead, to ensure you are protected in a more sustainable way, we aim to move to a new approach in the course of the summer that will allow you to regain more control over your lives. We will do this by providing you with more support to make informed decisions about living in a world with Covid, and we will support you translate those decisions into your daily lives.

This will include more detailed clinical advice about your personal risk from Covid depending on your individual conditions and profile. We also want to give you ways of monitoring the changing picture of the virus in your local community so you have a better sense of the chance of infection if you go out, as well as practical advice on how to protect yourself. These tools will need to be accessible and user-friendly.

This approach is dependent on us understanding as much as possible about the chances of you catching the virus and the risk to you if you do catch it. The evidence to support this is growing but we need to be sure it is robust enough before we start using it to change our approach. There is coordinated work being carried out across the four nations to create this evidence and we hope that we will start to see the benefits of that in the next month or two. We realise this might feel a long time to wait and it is increasingly difficult for you to shield yourself which is why we want to take any steps we can to make it a bit easier for you.

Outdoor Exercise

Throughout the period of lockdown we allowed the general population to go outdoors for exercise once a day – but on the conditions that they were strictly following physical distancing and did not meet anyone from outside their household. This was allowed even when the R was high and the number of infectious people was high, because being outdoors was thought to carry a fairly low chance of catching the virus, especially when combined with physical distancing and good hand hygiene. For the shielding population we felt that was still too risky, because of the increased risks of severe illness if they did catch Covid.

Our clinical advisors have been looking at the evidence around Covid throughout this pandemic. They are now telling us that the chance of catching the virus when you are outdoors, keeping two metres away from anyone else and not meeting with other people is very low.

The following change to the shielding advice has been agreed on the recommendation of our clinical and scientific advisory groups. This is why we are now confident advising that shielding people can take outdoor exercise from the 18th June provided they follow the recommended advice. This is dependent on the infection rate being low enough, which we will review – and announce in the daily briefing and via the SMS service – on 18 June.

While many people will welcome this, we know this may feel uncomfortable and daunting for many people who have been shielding indoors for so long. Some may decide they are just not comfortable going out just yet, and that is understandable. But there are clear benefits to physical and mental health from getting outdoor exercise. These include helping improve sleep, boosting wellbeing, improving muscle health and bone strength, as well as reducing stress and anxiety. To help you make that decision, we will provide you with tailored advice on preparing yourself to go outside, keeping yourself safe when doing so and minimising the risk when you come home.

What is the advice?

People who are shielding can now consider going outdoors for exercise. We would recommend that, if you do go outside for exercise you take the following precautions:

Go outdoors for a walk, wheel, run or cycle. We do not recommend that you take part in outdoor activities such as golf, hiking, canoeing, outdoor swimming, angling, etc. You:

• Can go out on your own or with someone you live with
• Should maintain strict physical distancing, also known as social distancing, at all times. This means keeping 2 metres (or three steps) away from other people
• Should choose times and areas that are quiet, if you can
• Should wash your hands for at least 20 seconds as soon as you get back home
• Should not meet with anyone you do not live with

We recognise that, when you've been staying at home for a long time with limited opportunities to be physically active, you may need to take a gradual approach to incorporating more physical activity into your life and building up your strength to exercise safely outside. There is a range of NHS resources that you may find helpful, including exercises to improve strength and balance and gentle exercises that can be performed while sitting. Paths for All have also produced a leaflet of ten simple exercises aimed at helping people with long term conditions to become more active.

There are also a range of resources to support your mental wellbeing. For example, the Clear Your Head website provides a number of hints and tips, many of which can be followed within shielding restrictions. And helplines such as the NHS Mental Health Hub and Breathing Space provide an additional source of support.

Future changes to advice

The extension of the shielding period to 31 July does not mean we will not make further changes to the advice before then. We want to gradually provide advice on how you can increase your freedoms, as we have done for those who are not shielding. We are continually monitoring the virus and as soon as we think it is safe for you to do something, we will update our advice. Likewise, as soon as we can provide you with information that will allow you to understand your own risk and make decisions about what is right for you, we will do so.

Once the evidence supports broadening the advice beyond exercise, we will also encourage local authorities, retailers and other partners to consider how they can support this, for example by adapting opening times and processes to allow people who are shielding to safely access services.

One area we are looking at is to provide advice to people who are supporting you – your shielders. This could be your family, carers, or people who live in your household. It will be important to have discussions with your shielders about their behaviour that might keep you safe. For example, when we get to the stage where we advise you that you can meet with people outside your household, there will be steps you can take that will make this as safe as possible and we will set those out for you. This may be along the lines of asking them to consider if they have just come from a high risk location, then to warn the shielding person and discuss the risk with them before meeting them.

We will set out updated guidance for you by 31 July at the latest.

It is not just your household, families and friends that will need to be considerate of your needs. As we progress through the route map, the wider public will also need to understand that their actions have a direct impact on your live, and that they have a role to play in supporting you to regain some normality, just as they have been able to do.