The constant news about the worldwide coronavirus outbreak can be worrying. Coronavirus has been the main news story since the outbreak began in Wuhan, China, at the end of December 2019. Since then, the outbreak has reached the UK and the number of infected people continues to rise. People with cancer and their families might feel especially worried about the virus, as cancer and its treatment can lower your ability to fight infection. To keep yourselves safe, we recommend that you follow Government advice.

Below is some information about coronavirus, and links to websites where you can find the latest information. There is also some advice on coronavirus for people with cancer in the form of a set of frequently asked questions produced by the One Cancer Voice group of cancer charities.

Coronaviruses are a large group of viruses that are responsible for different illnesses, including the common cold. The latest outbreak started in an animal in China and was then transmitted to humans.

The current outbreak is a new strain of coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and has not been previously diagnosed in humans. SARS-CoV-2 infects humans to cause coronavirus disease 2019 or COVID-19.

The following is a list of the main symptoms that may develop in the 14 days after exposure to someone who has COVID-19 infection:

  • High temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
  • New, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
  • Loss or change to your sense of smell or taste – this means you’ve noticed you cannot smell or taste anything, or things smell or taste different to normal.

 

If you are worried about symptoms, please call NHS 111 or go to the NHS 111 coronavirus advice website. Do not go directly to your GP or other healthcare environment.

Staying at home if you have symptoms (self-isolation)

If your symptoms are mild, NHS 111 will usually advise you and anyone you live with not to leave your home. This is called self-isolation.

  • Anyone with symptoms should self-isolate for 7 days from when their symptoms started
  • Anyone who does not have symptoms should self-isolate for 14 days from when the first person in your home started having symptoms.
  • Wash your hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitiser. This is particularly important after taking public transport.
  • Use an alcohol-based hand sanitiser that contains at least 60% alcohol if soap and water are not available.
  • Cover your cough or sneeze with a tissue, then throw the tissue in a bin.
  • Clean and disinfect frequently touched objects and surfaces in the home and work environment.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.

 

The NHS has made a video to explain how to wash your hands.

Guidance on social distancing

UPDATED: 24 June 2020

So far, everyone’s actions have helped to reduce the transmission of coronavirus in our communities. As the UK moves to the next phase in the fight against this deadly disease, the most important thing to do is to stay alert, control the virus, and in doing so, save lives.

The Government have issued new guidance for staying alert and safe (social distancing) and staying safe outside your home. This guidance applies in England only and can also be found on the NHS website here. The guidance refers to the NHS test and trace programme for testing people with coronavirus symptoms and tracing close contacts for self-isolation. There is also guidance for getting tested for COVID-19.

In England:

  • You can spend time outdoors, including private gardens and other outdoor spaces, in groups of up to six people from different households, following social distancing guidelines. See the guidance for meeting people from outside your household
  • You should go to work if you cannot work from home and your business has not been required to close by law
  • Children in early years (age 0-5), reception, year 1 and year 6 can return to childcare or school in line with the arrangements made by their school
  • You can be tested as part of the test and trace programme, which will enable us to return to normal life as soon as possible, by helping to control transmission risks.

 

From Saturday 13 June, you will now also be able to:

  • Form a ‘support bubble’ with one other household if you live alone or are a single parent with dependent children – in other words, you are in a household where there is only one adult
  • Attend a place of worship for individual prayer

 

From Monday 15 June:

  • You will be able to visit more shops and additional outdoor attractions – drive-in cinemas and animal attractions like zoos, farms and safari parks
  • Year 10 and 12 pupils in secondary schools and further education colleges will begin to receive some face to face support.
  • You will have to wear a face covering on public transport

If, after lifting restrictions, the government sees a concerning rise in the infection rate, then it may have to re-impose some restrictions.

In Scotland, from Monday 1 June everyone must stay at home as much as possible as you can spread the virus even if you don’t have symptoms.

Do:

  • Wash your hands with soap and water (or hand sanitiser) when you return home
  • Stay 2 metres (6 feet) away from other people at all times
  • Meet up with another household outdoors and in small numbers (no more than 8 people) staying 2 metres apart
  • Travel by foot, bike or car if you can and avoid non-essential use of public transport
  • Change your travel times to avoid rush hour
  • Work from home if you can – your employer should support you to do this
  • Use phone or online services to contact your GP or other essential services.

 

Do not:

  • Meet more than 1 other household each day
  • Meet anyone with coronavirus symptoms (new continuous cough, fever or loss of, or change in, sense of smell or taste)
  • Have large public gatherings with friends and family – keep in touch using remote technology such as phone, internet, and social media.

 

If parents don’t live together, children under 18 can be moved between their parents’ homes as long as no-one in either household has symptoms.

Governments in Wales and Northern Ireland are also introducing measures to return life to as near normal as possible, for as many people as possible, and as quickly and fairly as possible to safeguard livelihoods, but in a way that is safe and continues to protect the NHS.

This guidance is for everyone, including children. It advises on social distancing measures we should all be taking to reduce social interaction between people in order to reduce the transmission of coronavirus (COVID-19). It is intended for use in situations where people are living in their own homes, with or without additional support from friends, family and carers.

The Government are advising those who are at increased risk of severe illness from coronavirus (COVID-19) to continue to be particularly stringent in following social distancing measures.

This group includes those who are:

 

If you are vulnerable, shielding, or self-isolating and are in need of support, NHS volunteer responders may be able to help with shopping, collection of prescription medicines or a friendly chat. There is also guidance available for adult social care.

Government plan for coming out of lockdown – England only

The Government has set out its plan to return life to as near normal as possible in order to safeguard livelihoods, but in a way that is safe and continues to protect our NHS. Currently (26 May 2020) this plan only applies to people living in England. As part of this plan:

  • People and employers should stay safe in public spaces and workplaces by following the working safely during coronavirus (COVID-19) guidelines. This should enable more people to go back to work (where they cannot work from home) and encourage more vulnerable children and the children of critical workers to go to school or childcare
  • You should stay alert when you leave home: wash your hands regularly, maintain social distancing, and ensure you do not gather in groups of more than six, except with members of your household
  • You must continue to stay home except for a limited set of reasons but in line with scientific advice, you can take part in more outdoor activities.

UPDATE: 4 June 2020

Advice on coronavirus for people with cancer 4 June 2020

The Government is advising everybody to:

  • Stay alert
  • Stay at home as much as possible
  • Work from home if you can
  • Limit contact with other people
  • Keep your distance if you go out (2 metres apart where possible)
  • Wash your hands regularly

 

 

Do not leave home if you or anyone in household has symptoms of coronavirus.

In the first instance, please refer to wider Government guidance on:

The Government also have a wide range of information to help people at this time, including on employment, financial support, school closures and childcare. See: https://www.gov.uk/coronavirus

Summary of key lines for patients

Cancer services during the restoration and recovery from COVID-19

The NHS is currently moving into the next phase of its response to the COVID-19 outbreak: to restore and recover all services for patients. If you need to access care or treatment for suspected or diagnosed cancer, arrangements have been put in place to keep you safe from COVID-19.

If you have a worrying symptom, and you think it might be cancer, please contact your GP surgery straightaway. GP surgeries are offering online consultations and/or remote triage so that people do not have to attend in person unnecessarily.

If you have been asked to go to hospital for further investigation or for treatment if you are diagnosed with cancer, it is important that you attend. The NHS is reorganising the way that it delivers services to keep you safe:

  • COVID protected hubs have been established for cancer surgery across the country to keep patients safe. These are in COVID protected areas of a hospital or on separate hospital sites. The model is now being expanded to cover diagnostics too.
  • Wider measures are also being taken by all hospitals treating COVID patients to ensure that COVID and non-COVID patients are kept separate. This may include using separate entrances for COVID and non-COVID patients, ensuring staff and patients do not move between different parts of the hospital, and making sure that, as far as possible, staff are social distancing both inside and outside clinical areas.
  • The staff caring for cancer patients will be vigilant for any symptoms that they or their families are showing and are required to self-isolate in line with government guidance. Staff will be tested for the virus if they are displaying symptoms. Hospitals are also introducing testing for staff not displaying symptoms where there is testing capacity to do so.
  • All patients can support NHS staff to maintain COVID-protected environments by being aware of any symptoms they or their family may be displaying, and by following the advice of the clinical teams working with them. If a patient is uncertain whether they should come into the hospital, they should discuss this with their clinical team.

 

The NHS is here for you if you need it: help us to help you.

For people worried they have cancer

Q1 I am worried that I have symptoms of cancer. Should I still go to my GP?

It is important that you seek clinical advice if you have a worrying symptom. GP surgeries have been advised to offer online consultations and remote triage so that people do not have to attend in person unnecessarily. Please do contact your GP surgery directly if you are worried about a possible cancer symptom, for example if you have any of the following symptoms for no explainable reason:

  • Bleeding that doesn’t come from an obvious injury
  • A lump
  • Weight loss
  • Or any type of pain that won’t go away.

 

You can find a fuller list of the symptoms to look out for on the Be Clear on Cancer website.

 

Q2 I have just been referred by my GP with suspected cancer. Should I attend my diagnostic appointment?

If you have been asked to go to the hospital for further investigation, it is important that you attend. The NHS is reorganising the way that cancer diagnosis is delivered so that you can undergo diagnostic tests in places protected from the coronavirus. Because of that, you may be asked to self-isolate for seven days before any diagnostic procedures, even if you do not have coronavirus symptoms. You should discuss with the clinical team at the hospital if you have any concerns about attending.

Most people who go to their GP with symptoms do not have cancer. However, if you do have cancer, earlier diagnosis can mean more effective treatment and improved chances of survival.

If you have been asked to attend hospital, the only reason you should not go is if you have any symptoms of coronavirus. In this case, you should tell the hospital, cancel your appointment and self-isolate. The clinical team will discuss with you about when your appointment can be safely rescheduled.

People living with cancer now

Q3 Do I need to do anything differently as someone who is being treated/in remission from cancer/living with a chronic cancer?

People with certain cancers and those who have received or are receiving certain treatments are at risk of severe illness if they catch coronavirus (COVID-19). This includes:

 

The Government updated their guidance for these people on 31 May, and strongly advises them to continue to take precautions in order to keep themselves safe:

  1. If you wish to spend time outdoors (though not in other buildings, households, or enclosed spaces) you should take extra care to minimise contact with others by keeping 2 metres apart.
  2. If you choose to spend time outdoors, this can be with members of your own household. If you live alone, you can spend time outdoors with one person from another household (ideally the same person each time).
  3. You should stay alert when leaving home: washing your hands regularly, maintaining social distance and avoiding gatherings of any size.
  4. You should not attend any gatherings, including gatherings of friends and families in private spaces, for example, parties, weddings and religious services.
  5. You should strictly avoid contact with anyone who is displaying symptoms of COVID- 19 (a new continuous cough, a high temperature, or a loss of, or change in, your sense of taste or smell).

 

The NHS has written to people in these groups with advice and information about what to do during this time, and where to access support. This advice will be in place for at least to the end of June.

Please visit the Government website for more information regarding shielding advice.

If you are affected, and have a scheduled hospital or other medical appointment during this period, talk to your clinical team to ensure you continue to receive the care you need and determine which of these are absolutely essential.

 

Q4 Why has the shielding guidance been updated now?

The government has updated its guidance for people who are shielding taking into account that COVID-19 disease levels are substantially lower now than when shielding was first introduced. The number of cases is falling and the average rate of incidence of the virus has fallen from around 1/40 to 1/1000 cases per week, delivering greater reassurance that it is safe to cautiously reflect this in the guidance for those who have been advised to shield.

 

Q5 What support is available to me if I have been advised to shield?

Everyone who has received a letter advising that they are clinically extremely vulnerable should register online if you need any extra support. This may include having essential groceries delivered to your home or setting up regular calls with an NHS volunteer if you are experiencing feelings of isolation.

Information on the support available to people who are shielding can be found here.

 

Q6 I think I should be considered as extremely vulnerable, but I haven’t received a letter. What should I do?

The criteria for cancer patients were carefully defined, based on those with greatest clinical risk.

If you are unsure of your risk and what measures you should be taking, you should speak with your hospital specialist. If this is not possible, you should contact your GP.

 

Q7 Why have I been told by my clinical team that I no longer need to shield?

Your clinical team may inform you that you no longer need to shield if you are no longer considered to be ‘clinically extremely vulnerable’. Your clinical team should discuss this with you. If you have any questions regarding this, you should contact your clinical team.

 

Q8 Why have I received a text saying that I no longer need to shield?

You may have received a text saying that you no longer need to shield if your GP or clinical team feels that you are no longer considered to be ‘clinically extremely vulnerable’. Your clinical team should discuss this with you, but you may receive a text from the Government about this before this conversation has taken place. If you are not sure why you have received this text, you should contact your clinical team.

 

Q9 I don’t think I should be considered as extremely vulnerable, but I have received a letter saying I am. What should I do? I have received a letter saying I am considered as extremely vulnerable but I do not want to follow the guidance.

The criteria for cancer patients were carefully defined, based on those with greatest clinical risk. Some cancer patients may receive a letter because they have other conditions that place them in the highest risk cohort.

We understand that the restrictions imposed by shielding are difficult, both for you and for your family members and/or carers. The Government has issued shielding guidance, strongly advising you to stay at home as much as possible and keep visits outside to a minimum (for instance once per day) until at least the end of June. This is the safest thing to do to protect you from illness/ complications of COVID-19.

However, this is guidance and whether you follow the guidance or not is a personal decision for you to make. You may decide, having weighed up the risks and the implications of shielding, that you do not want to follow the guidance.

You may also choose to remain in your own home at all times if you do not feel comfortable with any form of contact with others.

Before deciding, we would ask you to discuss the matter with your GP or hospital specialist and those that may provide care for you. This may be particularly relevant for patients who are receiving end of life care. Please do talk to somebody before you decide what to do.

If you are unsure of your risk and what measures you should be taking, you should speak with your hospital specialist. If this is not possible, you should contact your GP.

 

Q10 I have received the letter more than once. Why?

Some people may receive the letter more than once because they have more than one condition that places them in the highest risk cohort.

Some people may receive a letter from the central NHS point and their local clinical team or GP, as both have identified them as clinically extremely vulnerable.

 

Q11 Will this categorisation of people be used to determine prioritisation for treatment?

Absolutely not. This is about identifying those people most at risk so they can take measures to protect themselves from developing serious illness from COVID-19. It is also about making sure they can access care and support during this time, including social care and help with practical needs such as getting medicines.

If you fall ill from COVID-19, or any other condition, and require treatment in hospital, you will still be treated as normal and will not be denied any medical intervention because you are in the shielding group.

 

Q12 What will happen to my cancer treatment? For example:

  • Will it be postponed?
  • Should I still go to hospital appointments?
  • How will my hospital decide whether I am a priority for treatment? Will there be national rules?
  • If treatment, including stem cell transplants, are deferred and I begin to relapse will this limit my eligibility for future lines of treatment?
  • Should I start chemotherapy treatment (particularly if it is a 2nd/3rd line for “mop up”) or postpone?
  • As a stage 4 patient will I be given life support if I have breathing difficulties due to the virus?
  • If I get the virus and recover, will this affect my cancer treatment and outlook?

 

The NHS is currently moving into the next phase of its response to the COVID-19 outbreak: to restore and recover NHS services so that they start to operate as they did before the pandemic. This means that cancer diagnosis, treatment and care are continuing, and the NHS is working to ensure that these services return to operating as they did before.

Changes are being made to the way services are delivered to keep patients and staff safe. For example:

  • COVID-protected hubs have been established across the country to ensure that cancer treatment continues. The hubs support hospitals across the NHS and independent sector to work together to maximise capacity and ensure that people receive the treatment that they need. Some patients may start to see their treatment move to a different hospital as these hubs are set up. You will remain under the care of your treating hospital and clinical specialist team and should contact them with any questions about your treatment and care.
  • Most hospitals have started to use more telephone consultations as a way of helping people to avoid long waits in clinics and for treatment. You may be called to arrange your treatments in this way, and planned treatments may need to be moved to help with running a smooth service.
  • Some patients may have their chemotherapy at home or have fewer radiotherapy appointments, to reduce visits to hospital while continuing with their treatment.
  • For some people, it may be safer to delay surgery. Your doctor may suggest a different treatment in the meantime, such as chemotherapy or hormonal therapy.

Wider measures are also being taken by all hospitals that are treating COVID patients to ensure that COVID and non-COVID patients are kept separate. For example, there may be separate entrances for COVID and non-COVID patients, all patients admitted to hospital as an emergency will be tested for COVID, and patients going into hospital for surgery or another elective procedure will be asked to isolate for 14 days and be offered a COVID test wherever possible.

Your clinical team are best placed to talk with you about your treatment and appointments. They will work with you to determine the best course of action in each individual situation. If you have any concerns or questions about your treatment, please speak to your clinical team.

 

Q13 I am on chemotherapy. If I experience sweats/cough/shivering should I call NHS 111 or the chemotherapy care line?

You should call the chemotherapy care line. If the chemotherapy care line is not available in your area, please speak to your clinical team about who you should call in this situation.

 

Q14 If I need to shield/self-isolate for more than seven days, what will happen in relation to treatment that has to be done weekly?

Your clinical team are best placed to talk with you about the effect on your treatment and appointments. They will work with you to determine the best course of action in each individual situation.

There is guidance if you think you or someone in your household have coronavirus: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection

 

Q15 How can I maintain my mental health during this time?

We understand that this may be a worrying time and you may find staying at home and having limited contact frustrating. At times like these, it can be easy to fall into unhealthy patterns of behaviour, which can make you feel worse. Simple things you can do to stay mentally and physically active during this time include:

  • Look for ideas for exercises to do at home on the NHS website
  • Spend time doing things you enjoy – reading, cooking and other indoor hobbies
  • Try to eat healthy, well-balanced meals, drink enough water, exercise regularly, and try to avoid smoking, alcohol and recreational drugs
  • Try spending time with the windows open to let in fresh air, arranging space to sit and see a nice view (if possible) and get some natural sunlight. Get out into the garden or sit on your doorstep if you can, keeping a distance of at least 2 metres from others.

 

You can find additional advice and support from Every Mind Matters and the NHS mental health and wellbeing advice website.

 

Q16 What are the symptoms likely to be? Will the symptoms be different because I have cancer? What should I look out for?

The NHS outlines the common symptoms of coronavirus on its website.

If you are experiencing symptoms of any infection or illness, including coronavirus, you should contact your cancer team know as you would normally. You can do this as well as calling 111 for advice about coronavirus symptoms.

 

Q17 Can you catch this virus more than once?

It is not yet known whether reinfection is possible, although many experts think it is unlikely.

 

Q18 What should I do if my clinician is diagnosed with coronavirus?

If your clinician is diagnosed with coronavirus and you have not seen them recently, then you are unlikely to have been exposed to coronavirus.

Health professionals are working to contact anyone who has been in close contact with people who have coronavirus. If you are concerned about the impact this will have on your treatment, contact your hospital for advice.

 

Q19 Should I go to work/see friends?

 

Q20 Will my clinical trial continue? Why has my trial been stopped?

You should contact your clinical team with questions about your individual treatment including any trials you are part of.

The National Institute for Health Research (NIHR) issued guidance earlier during the pandemic response which recognised that much research would need to pause, not least because many clinical research teams were asked to redeploy to help with providing patient care. The NIHR has now published a framework to support work towards the restoration of research that they fund and/or support.

 

People who have had cancer in the past

 

Q21 Does having had cancer treatment in the past (for example, stem cell transplants, chemotherapy, radiotherapy) – even if I am now in remission – increase my risk if I get the virus?

This depends on the type of cancer and the treatment you have had. Most people make a full recovery after cancer treatment and their immune system either recovers fully or is not affected. See Q3 for further information.

Family/friends/carers of people living with cancer

Please refer to the wider Government advice to protect yourselves and family/friends:

 

Q22 Should I consider not sending my child with cancer/sibling of a child with cancer to school?

If your child with cancer falls into any of the clinically extremely vulnerable groups outlined in Q3, they and others in the household should follow the measures to ‘shield’ them.

The government has set out the following advice on attending school for children and young people who fall into any of the clinically extremely vulnerable groups outlined in Q3 or who live with someone who is clinically extremely vulnerable:

  • Children and young people in eligible year groups are strongly encouraged to attend (where there are no shielding concerns for the child or their household).
  • Children, young people and staff who have been classed as clinically extremely vulnerable due to pre-existing medical conditions have been advised to shield. We do not expect people in this category to be attending school or college, and they should continue to be supported to learn or work at home as much as possible.
  • If a child/young person or staff member lives in a household with someone who is extremely clinically vulnerable, as set out in the guidance on shielding, it is advised they only attend an education or childcare setting if stringent social distancing can be adhered to and, in the case of children, if they are able to understand and follow those instructions. This may not be possible for very young children and older children without the capacity to adhere to the instructions on social distancing. If stringent social distancing cannot be adhered to, we do not expect those individuals to attend. They should be supported to learn or work at home.

Please refer to the wider guidance on which pupils can attend school on the Government website for more information.

 

The future

Q23 Will cancer patients be a priority for the vaccine if/when it is developed?

There is currently no vaccine for this form of coronavirus. Research is being done to develop a vaccine, but this will take many months.

 

Q24 If the pressure on the NHS grows, will my treatment be delayed?

See Q12.

 

Q25 Will there be problems accessing my cancer drugs?

There are currently no medicine shortages as a result of COVID-19. The country is well prepared to deal with any impacts of the coronavirus and we have stockpiles of generic drugs like paracetamol in the event of any supply issues.

The Department of Health and Social Care is working closely with industry, the NHS and others in the supply chain to ensure patients can access the medicines they need and precautions are in place to prevent future shortages.

There is no need for patients to change the way they order prescriptions or take their medicines. Patients should always follow the advice of doctors, pharmacists or other prescribers who prescribe and dispense their medicines and medical products. The NHS has tried-and-tested ways of making sure patients receive their medicines and medical products, even under difficult circumstances. If patients order extra prescriptions, or stockpile, it will put pressure on stocks, meaning that some patients may not get the medicines or medical products they need.

Detailed questions about the categorisation of extremely vulnerable people

 

Please look at the Government guidance on shielding in the first instance for more information, including the process for contacting people who are highest risk, how to access support, and what to do if you are living with someone who is shielding.

 

Q26 Does the extremely vulnerable people category include:

  • Only patients undergoing active chemotherapy for lung cancer? No. Everyone undergoing active chemotherapy is included.
  • Patients who have received chemotherapy in the past three months? People’s immunity remains compromised for some time after finishing chemotherapy and clinical teams will be aware of this when considering their highest clinical risk patient lists. If you have completed chemotherapy in the last 3 months, please contact your care team to discuss your specific circumstances. In the meantime, you should follow the Government guidance on shielding – in summary, stay at home and avoid face-to-face contact until at least the end of June.
  • Patients with blood disorders who are immunocompromised but not receiving chemotherapy? Yes. These patients are included within ‘people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment’.
  • Patients having radiotherapy for metastatic lung tumours? Yes. These patients are included within ‘people with cancer who are undergoing radical radiotherapy for lung cancer’.
  • Patients with metastatic cancer in the lungs who are not currently receiving treatment? People with metastatic cancer in the lungs could be more vulnerable and therefore at highest clinical risk from Covid-19. Vulnerability will depend on the type of cancer and treatments that you have had. If you have not received a letter, please contact your care team to discuss your specific circumstances. In the meantime, you should follow the Government guidance on shielding – in summary, stay at home and avoid face-to-face contact until at least the end of June.
  • Patients having any targeted treatments (more than just antibody treatments)? Would anti-angiogenesis targeted drugs fit into that? Yes, all these treatments carry excess risk and therefore people receiving these treatments would be included. These patients are included within ‘people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors’.
  • Transplant patients? Yes, if they have had a transplant within the last 6 months, and if they are taking any immunosuppression. These patients are included within ‘people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs’.
  • Patients autologous as well as allogeneic transplants in the last 6 months? Yes.
  • All patients with rare diseases? No, how rare the disease is not relevant. The issue is whether the disease significantly increases the risk of infection. If a patient has a rare disease and that disease significantly increases their risk of infection, they will be included in the category of extremely vulnerable people.

There is much work underway to consider how cancer services are restarted, both locally and at a national level, in the short term. We would urgently like to see a national plan published, detailing how the Government and the NHS intends to manage cancer services over the next few months as we attempt to control COVID-19, and how we fully recover services and get back on track to deliver transformed cancer outcomes.

Without a clear national vision and plan, progress on cancer survival and care in this country could stall. One Cancer Voice has set out a 12-point plan for the restoration (phase II) and recovery (phase III) of cancer services. Close monitoring and adequate action is needed to ensure inequalities are addressed. In addition, there are plans to significantly transform cancer services to deliver the improved outcomes that patients in this country expect and deserve.

Read the Covid and Cancer 12 point plan

During March the NHS wrote to those people considered to be at highest clinical risk from coronavirus (COVID-19) to inform them that they should stay at home at all times and avoid all face-to-face contact until the end of June 2020. This is known as ‘shielding’. This is set out in the guidance on shielding and protecting extremely vulnerable persons from COVID-19 (updated 23 June 2020).

People falling into this highest clinical risk group include:

  1. Solid organ transplant recipients
  2. People with specific cancers:
  3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD
  4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)
  5. People on immunosuppression therapies sufficient to significantly increase risk of infection
  6. Women who are pregnant with significant heart disease, congenital or acquired.

 

If you have been asked to ‘shield’ because you are considered clinically extremely vulnerable to COVID-19, you need to register on the Government website. You can also register for support by calling: 0800 028 8327.

You may be entitled to receive Government provided support, such as the delivery of essential groceries. To register, you will need your NHS number, which is noted on your prescriptions or can be found at the top of the Government letter which you should have received informing you that you are considered ‘clinically extremely vulnerable’.

The Government have also produced a list of frequently asked questions about shielding, which can be accessed here: Frequently Asked Questions about shielding

Changes to the shielding advice

England, Northern Ireland and Scotland: On 23 June the Government issued new advice for the 2.2 million people who have been self-isolating during the COVID-19 pandemic. Because infection rates are falling, these people will no longer need to shield from 1 August.

The UK Government advices that shielding can be relaxed because infection rates are falling and the chances of encountering the virus in the community continues to decline. One in 1,700 people are estimated to have the virus now, down from 1 in 500 four weeks ago.

The Government has taken advice from clinicians, GPs, charities, the voluntary sector and patient groups. However, the advice on shielding could change again if infection rates increase to become a threat to this extremely vulnerable group of people.

Current support for people who are shielding, such as food shopping and collection of prescription medicines will remain in place until the end of July to help people get back to normality.

The Government has written to the 2.2 million people who are currently shielding to explain the new guidelines. Here is a copy of the letter that went out on 22 June 2020: Shielding update: Letter to patients 22 June 2020 If you have any concerns about this advice or the content of this letter, please contact us.

Changes from 6 July

Before the end of July, the shielding measures will be relaxed in England, Northern Ireland and Scotland. From 6 July, people who have been shielding and live alone will be able to meet with up to five other people outdoors to form ‘support bubbles’. These people can also be from other households of any size.

The Government has issued ‘support bubble’ rules which were introduced in June for anyone living alone and single-parent households. People who are shielding and living alone will also be able to form a support bubble from 6 July with one other household. Support bubbles have been introduced in England, Northern Ireland and Scotland. A decision about whether to introduce support bubbles in Wales will be made in the next few weeks.

Changes from 1 August

For people in England and Northern Ireland if the rate of community transmission remains low people will no longer need to shield from 31 July.

In Scotland, the shielding advice applies to around 180,000 people and remains in place until at least 31 July.

In Wales, almost 130,000 people are self-isolating and the current shielding guidance runs until at least 16 AugustRead the Deputy Chief Officer for Wales statement here.

What do these changes mean for people who are currently shielding?

Until the shielding guidance changes on 1 August, vulnerable people who are self-isolating across the UK are advised to stay at home as much as possible and to practise social distancing when they go outside.

Those people who are considered to be extremely vulnerable to COVID-19 and are most at risk from becoming ill will no longer need to shield in England, Northern Ireland and Scotland. If they are not able to work from home, these people can return to work as long as their workplace is COVID safe.

However, they should still follow social distancing guidelines when outside their homes and wash their hands regularly to reduce the risk of being infected.

Because they are eligible to return to work, after 1 August the people who are currently shielding will no longer be eligible for statutory sick pay. This will not be the case if they develop COVID-19 symptoms, or someone they know develops symptoms, and they are told to self-isolate and cannot work from home.

Free essential food boxes will stop being delivered, but support from NHS volunteers and local councils is still possible.

They will still qualify for priority slots for online shopping and will be offered help with medicine deliveries and getting to medical appointments.

Read more in BBC News here

The UK government pledged to test 100,000 people per day for coronavirus by the end of April. This target was reached on 30th April, and now more of us are eligible for testing than had been previously.

The test currently available is a PCR test to determine whether you currently have COVID-19. Antibody tests to determine whether you have previously had COVID-19 and have immunity to the virus are not yet available.

Patients in hospital with coronavirus symptoms have been tested to find out if they have COVID-19. Going forward, everyone admitted to hospital will be tested, regardless of the reason for their admission. If you are not in hospital and would like to be tested, you must meet certain criteria.

The Government have issue guidance on coronavirus testing, including who is eligible for a test and how to get tested.

You can get a throat and nose swab test to see if you currently have coronavirus. This test is most effective within 3 days of the symptoms developing.

Who can be tested

The following groups of people can ask for a test through the NHS website:

  • Anyone living in England and Wales who has symptoms of coronavirus, whatever their age
  • Anyone living in Scotland and Northern Ireland aged 5 and over who has symptoms of coronavirus.

 

The following groups of people can access priority testing through the NHS:

  • Essential workers in England, Scotland, Wales and Northern Ireland
  • Anyone in England, Scotland, Wales and Northern Ireland over 5 years old who has symptoms of coronavirus and lives with an essential worker
  • Children under 5 years old in England and Wales who have symptoms of coronavirus and live with an essential worker (this test must be performed by a parent or guardian).

 

See the guidance on testing for essential workers and the list of essential workers. You can apply for a test online if you are an essential worker.

Most people infected with coronavirus (COVID-19) have mild to moderate symptoms and there is no evidence showing that COVID-19 adversely affects the kidneys. A small proportion of patients with COVID-19 develop severe infection and require hospitalisation. Of these hospitalised patients, a small proportion have a decline in their kidney function (glomerular filtration rate, GFR). For more information, please see the COVID-19 page on the Kidney Care UK website.

COVID-19 is a new virus and doctors still are learning about how this virus affects people. The long-term effects on kidney function in survivors of COVID-19 infection is not known.

If you are living with one kidney or you have lost part of a kidney due to a partial nephrectomy but you are otherwise healthy, then your risk of being infected with coronavirus (COVID-19) would likely be similar to someone with two kidneys.

However, every person is unique, and many factors can result in increased risk of COVID-19. If you are worried, you should ask your GP or healthcare team for information about your own individual risk.

The Government are advising people with long-term (chronic) kidney disease to be particularly stringent in following the social distancing guidelines. This is because people with chronic kidney disease are at increased risk of complications if they get COVID-19 infection. Most patients with kidney cancer do not have chronic kidney disease.

If you have chronic kidney disease, you can find more information about your risk of COVID-19 here.

Treatments for kidney cancer include the following:

 

The Government has issued guidance to define those people who are extremely vulnerable to severe illness if they are infected with coronavirus (COVID-19). This includes people who are on immunotherapy and/or targeted therapy, such as protein kinase inhibitors, for the treatment of advanced or metastatic cancer. These people should have been sent a letter from their healthcare team asking them to follow the ‘shielding’ guidelines to keep themselves safe.

What will happen to my cancer treatment?

You might have questions about your ongoing cancer treatment, such as:

  • Will it be postponed?
  • Should I still go to hospital appointments?
  • How will my hospital decide whether I am a priority for treatment? Will there be national rules?
  • If treatment, including stem cell transplants, are deferred and I begin to relapse will this limit my eligibility for future lines of treatment?
  • Should I start chemotherapy treatment (particularly if it is a 2nd/3rd line for “mop up” ) or postpone?
  • As a stage 4 patient will I be given life support if I have breathing difficulties due to the virus?
  • If I get the virus and recover, will this affect my cancer treatment and outlook?

 

Essential and urgent cancer diagnosis, treatment and care will continue. NHS staff are working hard to ensure cancer treatments can continue in the safest and best possible way. To do this during the pandemic there may need to be some changes to how treatments are delivered.

  • Cancer treatments, especially operations and chemotherapy, are riskier now than before. Cancer and its treatment can weaken the immune system, making a person more vulnerable to the virus.
  • In some cases, it may be safer to delay cancer treatment or give it in a different way, to reduce the risk from coronavirus.
  • Any decisions about surgery and other treatments will be based on how urgent it is and the level of risk. Your safety is a priority in making any decisions.

 

Changes are being made to the way services are delivered to keep patients and staff safe.

  • Most hospitals have started to use more telephone consultations as a way of helping people to avoid long waits in clinics and for treatment. You may be called to arrange your treatments in this way, and planned treatments may need to be moved to help with running a smooth service.
  • Some patients may have their chemotherapy at home or have fewer radiotherapy appointments, to reduce visits to hospital while continuing with their treatment.
  • For some people, it may be safer to delay surgery. Your doctor may suggest a different treatment in the meantime, such as chemotherapy or hormonal therapy.

 

Some patients may start to see their treatment move to a different hospital as the NHS sets up ‘cancer hubs’ to coordinate treatment and ensure it can continue safely.

  • In London, a ‘cancer hub’ led by The Royal Marsden in collaboration with University College London Hospital and Guy’s and St Thomas’ NHS Foundation Trust, is co- ordinating cancer services across the capital.
  • Similar models are being set up in other parts of the country (e.g. Christie Hospital in Manchester), drawing on learning from Italy, China and London. The hubs will support hospitals across the NHS and independent sector to work together to maximise capacity and ensure that people receive the treatment that they need.
  • You will remain under the care of your treating hospital and clinical specialist team and should contact them with any questions about your treatment and care.

 

Your cancer specialist team should discuss your treatment and care with you, including any changes. Your doctors will always have your safety at the centre of any decisions they make.

Nationally, the NHS has issued advice to clinicians to help inform these conversations with patients. The advice is also there to help clinicians to manage risks and prioritise treatment on the basis of clinical need.

Your clinical team are best placed to talk with you about your treatment and appointments. They will work with you to determine the best course of action in each individual situation. If you have any concerns or questions about your treatment, please speak to your clinical team.

The Association of the British Pharmaceutical Industry (ABPI) are in regular contact with both the pharmaceutical companies that supply medicines and the Government about any impact that the coronavirus could have on the supply of medicines to the NHS in the UK.

Pharmaceutical companies are not currently reporting any concerns about shortages of medicines or loss of manufacturing capacity as a result of COVID–19 restrictions.

There are robust procedures in place to manage the supply of medicines in the UK, and pharmaceutical companies will be taking all possible measures to secure supply for patients in line with Government guidance.

More information about the ABPI response to the coronavirus outbreak can be found here

We understand you might be worried about going to hospital for radiotherapy treatment during the coronavirus pandemic.

The Royal College of Radiologists (RCR) has teamed up with the Society and College of Radiographers, the Institute of Physics and Engineering in Medicine, Cancer Research UK and Macmillan Cancer Support to release tailored coronavirus information for patients undergoing radiotherapy treatment: Protecting people with cancer from coronavirus when going for radiotherapy

Cancer centres have continued to provide radiotherapy treatment throughout the coronavirus pandemic. But we want to reassure you that cancer teams are doing all they can to keep everyone safe.

Radiotherapy remains an effective treatment for many people with cancer and is an important therapy for curing cancer, as well as relieving symptoms.

Unlike some other cancer treatments, radiotherapy does not normally affect your immune system, making it one of the safest treatment options as we work around coronavirus.

Cancer centres have continued to run radiotherapy services throughout the coronavirus pandemic, where safe to do so. It is important that you continue to go for treatment when advised by your cancer team.

The safety of people with cancer and the staff looking after you is a top priority for hospitals. Cancer teams are using a range of precautions to protect you from coronavirus during your visit to the radiotherapy department.

Precautions might include:

  • Asking if you have symptoms of coronavirus before you go for treatment, and on arrival in the department
  • Changing how to get into the radiotherapy department so that you only move in areas of the hospital that are protected from coronavirus
  • Minimising contact in communal waiting areas by arranging seating at least two metres apart or asking you to wait outside the department until your cancer team phones for you to go in. Relatives may have to wait outside the department
  • Your cancer team wearing personal protective equipment such as face masks, gloves and aprons. They may also ask you to wear a face mask
  • Asking you to wash your hands when you enter and leave the department
  • Giving shorter courses of radiotherapy where possible and backed by good evidence. For example, many cancer centres are now giving people with breast cancer fewer radiotherapy doses (which means fewer hospital visits) thanks to the results of recent trials
  • Delaying radiotherapy for a short time if it is safe to do so. For example, for prostate cancer, where hormone treatments can safely be used instead.

 

Please talk to your cancer team if you have any concerns about the risks of attending your radiotherapy appointment.

Are you self-isolating and in need of support? Find out more about how an NHS Volunteer Responder can help you.

We know that some kidney cancer patients have not received a letter to inform them that they are at the highest clinical risk from coronavirus (COVID-19) and they are extremely vulnerable. However, these people are experiencing problems in getting essential shopping and collecting repeat prescriptions, and still require help or support due to shielding or isolation.

If you don’t have support from family or friends, help is available from the NHS Volunteer Responder scheme. If you are currently not supported and need some help with shopping, a prescription collection or a friendly chat, then the NHS Volunteer Responders are ready to help. Please take a look at the following link for details on how to connect:

 

NHS Volunteer Responders

 

 

 

Help may also be available via your local council; they might have a volunteer scheme running locally. Each council website should have a call centre helpline number for help and support during these challenging times.

The government have issued a list of frequently asked questions about the coronavirus outbreak to help clarify what you can and can’t do during lockdown (updated 12 June 2020):

Coronavirus outbreak FAQs: what you can and can’t do

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