Public Health England individual guidance for COVID-19

Public Health England individual guidance for COVID-19

Last updated 17th April 2020

GPs have been given advice by RCGP on how to interpret ‘shielding’ recommendations at


Individual risk categories








Solid organ transplant recipients.

cancer undergoing active chemotherapy

lung cancer undergoing radical radiotherapy

cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment

immunotherapy or other continuing antibody treatments for cancer

people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs

severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.

rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).

immunosuppression therapies sufficient to significantly increase risk of infection.

Women who are pregnant with significant heart disease, congenital or acquired.

Very high, shielding

These individuals should receive a letter from the NHS informing them that they should be shielding.


There is some uncertainty regarding these letters. Some GPs are sending letters to patients in lower risk groups. Some patients have not yet received letters. Some employees are presenting letters that do not appear to be official NHS letters.


It is important to check the medical history, particularly in those who have not received letters, and advise in this case that they are in the shielding group despite the absence of an official letter.


If they are clearly not in this shielding group but have received a letter, a discussion with the treating clinician may be the best way to determine the individual risk. It may be appropriate to advise on the actual risk and reassure accordingly.

aged 70 or older (regardless of medical conditions)

under 70 with an underlying health condition listed below (ie anyone instructed to get a flu jab as an adult each year on medical grounds):

chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD) emphysema or bronchitis

chronic heart disease, such as heart failure

chronic kidney disease

chronic liver disease, such as hepatitis

chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), a learning disability or cerebral palsy


problems with your spleen – for example, sickle cell disease or if you have had your spleen removed

a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy

being seriously overweight (a body mass index (BMI) of 40 or above)

those who are pregnant

Increased risk of severe illness


(very high, high and increased in our tables)


These are very broad risk categories. It is important to take a detailed medical history in order to accurately determine risk.

The specific tables on this website can then be used to provide a more useful risk stratification


Travellers returning to UK don’t automatically need to self-isolate, but should follow the advice above, and advice if symptomatic.


Vulnerability levels

Very high (Red)

Risk of severe illness or death if contracts COVID-19. Read more

High (Orange)

Likely to need hospitalisation if contracts COVID-19, with protracted illness and heavy NHS burden. Read more

Increased/Moderate (Yellow)

Increased risk compared with healthy individual but should recover.

Low/Standard (Green)

No greater risk than healthy individual.