Last reviewed 1 December 2020

New guidance on shielding and protecting people who are clinically extremely vulnerable (CEV) from Covid-19, which comes into effect on 2 December 2020, has been issued by the Department of Health and Social Care (DHSC).

On 2 December England is moving back to a tiered system of local restrictions as the national restrictions across all of England are lifted. Announcing new measures, Health Secretary Matt Hancock said the new tiering system provides a framework that, if used firmly, should prevent the need to introduce stricter national measures.

The guidance contains updated advice on protecting CEV patients, based on the tiers of local restrictions in the different areas. It sets out the additional things people at the highest risk from Covid-19 are advised to do to keep themselves safe for each tier. It also gives updated shielding advice that is more targeted and will only apply in some of the worst affected areas and only for a limited period of time. Patients are only advised to follow shielding advice if they receive a new written shielding notification.

CEV patients who were advised to "shield" from Covid-19 exposure earlier in the pandemic can mix indoors and outdoors with people from up to three households between 23 and 27 December. The guidance recommends that they socially distance from those in their "bubble" who do not live with them. It also recommends that they avoid physical contact, consider who they sit next to, and wear a face covering if social distancing will be difficult, and warns that vulnerable patients forming Christmas bubbles "does involve greater risks" as it increases numbers of contacts. Alternatives are recommended such as spending time outside or using technology.

It aims to strike a better balance between providing practical steps to help keep CEV patients safe "while reducing some of the potentially harmful impacts on mental and social wellbeing that were associated with previous strict shielding”.

The updated guidance also contains tier-specific guidance for the period from 2 December onwards.

The Government reiterated it will not be reintroducing formal shielding measures for vulnerable patients at this stage; it will only consider this for some Tier 3 areas, for a limited time and on the advice of Chief Medical Officer Professor Chris Whitty.

The DHSC guidance is available at: