Clinically extremely vulnerable people should resume shielding in Tier 4 areas

The government has updated its Covid guidance for those who are clinically extremely vulnerable and living in a newly implemented Tier 4 area.

The updated guidance advises that people who fall into both of these categories should begin shielding again, and that they do not have to go into work if they cannot work from home. The advice also stipulates that they should not go out to shops or pharmacies.

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Children who are classed as clinically extremely vulnerable and living in Tier 4 areas are advised not to attend classes, although schools are currently broken up for the Christmas holidays.

Support bubbles can still be formed and people can meet within them in Tier 4 areas.

How to tell if you’re affected

Currently, London, Kent and Medway, Buckinghamshire, Berkshire, Surrey (excluding Waverley), Hastings and Rother, Havant, Gosport and Portsmouth, Hertfordshire, Essex (excluding Tendring, Uttlesford and Colchester), Central Bedfordshire, Bedford, Milton Keynes, Luton, and Peterborough are all in Tier 4.

Letters are being sent out to all those affected by the new guidance later this week, although these are expected to be delayed due to Christmas.

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Those who are classed as clinically extremely vulnerable, but live in Tiers 1, 2 and 3 should still go to work if they cannot work from home and do not need to shield, according to government advice. says, “In the future, the government will only reintroduce formal shielding advice in the very worst affected local areas and for a limited period of time. Currently, this only applies to those areas placed into Tier 4 on 20 December.”

Who classes as being clinically extremely vulnerable?

Those with the following conditions are automatically deemed clinically extremely vulnerable:

  • solid organ transplant recipients
  • people with specific cancers:
  • 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 disease)
  • people on immunosuppression therapies sufficient to significantly increase risk of infection
  • problems with your spleen, for example splenectomy
  • adults with Down’s syndrome
  • adults on dialysis or with chronic kidney disease (stage 5)
  • 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. GPs and hospital clinicians have been provided with guidance to support these decisions