Guidance published alongside the three-tier COVID alert system that takes effect across England from tomorrow offers advice for patients considered 'clinically extremely vulnerable' that varies depending on the alert level in force in their local area.
Shielding restrictions put in place during the first wave of the coronavirus pandemic in England will not be imposed automatically at any of the three tiers - medium, high or very high - the government has confirmed.
Patients previously asked to shield will be advised that they can go outside for exercise, for example, even if they live in an area designated at a 'very high' alert level.
However, the government has warned that in the worst affected areas 'more targeted' shielding advice could be put in place 'for a limited period of time'. In the event that this step is taken, clinically extremely vulnerable patients in affected areas would receive a personal letter advising them of the move.
The updated guidance published on 13 October sets out 'general principles' for all clinically extremely vulnerable patients, along with further advice for areas in each of the three tiers.
Patients in this group - which numbers around 2.2m people in England - are advised to take precautions such as social distancing with anyone outside their household, keep social interactions low, work at home where possible and shop only at quieter times.
In 'high' alert areas, clinically extremely vulnerable people are advised not to meet indoors with anyone outside their household or support bubble, minimise travel and shopping trips.
In 'very high' alert areas, patients are told they can go out for exercise, but should 'stay at home as much as possible' and meet friends and family from outside their household only in outdoor spaces such as parks.
All 2.2m patients considered clinically extremely vulnerable, and their doctors, will receive an initial letter shortly confirming how the guidance has changed.
Deputy CMO for England Dr Jenny Harries said: 'Over the last few weeks, we’ve seen a sharp increase in the prevalence of the virus across the country and we know those who are clinically extremely vulnerable are looking for practical advice on how they can carry on their lives while the virus remains in our communities.
'The new system will provide clarity on how best those in this group can keep themselves as safe as possible depending on the rates of transmission in their local area. While advisory, I would urge all those affected to follow the guidance wherever they can and to continue to access health services for their medical conditions.
'We will continue to monitor the evidence closely and fine-tune this approach to make sure everyone in this group is clear about the safest way to go about their daily lives, particularly over the coming winter months.'
Health and social care secretary Matt Hancock said: 'With coronavirus rates continuing to increase, now is the time to take action and ensure we protect the most vulnerable in our society.
'Today’s announcement will mean every person most at risk from serious outcomes from the virus will have specific advice targeted to local levels, which they can follow to keep themselves as safe as possible, while ensuring they can also keep as much normality in their lives as possible.'
If patients in areas worst affected by COVID-19 are told to shield again in future, including advice to 'stay at home, not go to work or school and limit social interactions to their own household and support bubble', they will also be eligible for a support package including food access support, medicines deliveries and any additional care or support required.