Coronavirus: what does vulnerable and high risk mean?

A photo of Naveen Puri
Associate Clinical Director, and Lead Medical Appraiser, Bupa Global & UK
07 April 2020
Next review due April 2023

Any one of us can catch coronavirus, but some people are at a higher risk of severe illness if they get it. That’s why it’s so important to understand if this applies to you and know what to do to protect yourself and others.

Who is at risk?

Vulnerable and extremely vulnerable

There are two main groups who are at an increased risk of severe illness from coronavirus: vulnerable (increased risk) and extremely vulnerable (at very high risk). I’ll explain what each of these terms means in more detail below.

What does ‘vulnerable’ mean?

People who are vulnerable include those who are:

  • 70 and over
  • under 70 with an underlying health condition
  • pregnant

Which underlying conditions does this include?

You’re vulnerable if you have:

  • long-term (chronic) 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 (MND), multiple sclerosis (MS), a learning disability or cerebral palsy
  • diabetes
  • problems with your spleen – for example, sickle cell disease or if you’ve 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
  • a body mass index (BMI) of 40 or above (you’re seriously overweight)

What should vulnerable people do to protect themselves?

If you’re vulnerable, follow the social distancing rules that apply to everyone but follow them more strictly.

This means to significantly limit your face-to-face contact with friends and family.

Social distancing guidelines advise the following.

  • Don’t interact with anyone who has symptoms of coronavirus (high temperature and/or a new continuous cough).
  • Don’t use public transport unless you absolutely have to.
  • Work from home if possible.
  • Avoid large and small gatherings in public spaces.
  • Don’t meet up with your friends and family. Keep connected in other ways.
  • Use the phone if you need to contact your GP or use online services.

What does ‘extremely vulnerable’ mean?

People who are classed as extremely vulnerable are those who are at ‘a very high risk’ of severe illness from the virus because you have a serious underlying health condition.

This applies to you if have one of the following.

  • You have received a solid organ transplant, for example, kidney, liver, pancreas, heart, and lung.
  • You have a specific cancer. This includes if you’re having active chemotherapy; have lung cancer and are having radical radiotherapy; if you have a blood or bone marrow cancer; if you’re having immunotherapy or antibody treatments; if you’re having targeted cancer treatments; if you’ve had a bone marrow or stem cell transplant within the last six months or you’re still taking immunosuppression medication.
  • You have cystic fibrosis, severe asthma and severe COPD.
  • You have a rare disease that significantly increases your risk of infection.
  • You’re having immunosuppression therapies at levels that will increase your risk of infection. These are treatments that suppress your immune system (the system of your body that fights off disease).
  • You’re pregnant and have significant heart disease.

There is more information on the Public Health England website.

What should extremely vulnerable people do to protect themselves?

Shield yourself

If you’re in this group, you need to shield yourself. This means you’re at very high risk of serious illness, so you need to do more than other people to protect yourself. So it’s vital that you minimise any interaction with other people.

If you’re extremely vulnerable, don’t leave you home and avoid coming into contact with others in your household as much as possible. This has been put in place for several weeks. The NHS are contacting people in this group with support and advice and you can find more information on the government website.

What happens if I have a carer?

If you have carers coming in to help you, this is still ok, but they need to wash their hands for at least 20 seconds with soap and water when they arrive and often during the time they are there. If they develop any symptoms of coronavirus, then they must stay away and not visit you.

If you live with and care for your loved one (this includes dressing, washing and feeding) then you can continue to do so but you need to follow the advice above.

What support is available if I’m extremely vulnerable?

Ask your family, friends, carers, neighbours and community groups for support where you can for food supplies (or order online) and medicines. Many communities have set up schemes to help people who are vulnerable or extremely vulnerable. If you can’t get any help and need support, you can register on the government’s website.

What if I live with other people?

To shield yourself from those you live with there are some things you can do to minimise contact.

  • Limit time spent in the shared spaces of your house and keep them well ventilated (open the windows).
  • Keep two metres away from those you live with (this is about three steps).
  • Use the bathroom before others and clean it afterwards.
  • Eat your meals in your room. Use a dishwasher if you have one. Dry items with a separate tea towel.

What should I do if I live with someone who is extremely vulnerable?

If you live with someone who’s extremely vulnerable, you don’t have to follow the same shielding measures. Do what you can though to support who you live with to shield themselves, and be strict about following social distancing measures yourself.

Emotional support for each other

This is undoubtedly a difficult time for us all, whether you’re extremely vulnerable or someone you care about is. It can help to remember that these measures are in place to save lives. Helping your loved one with the things they need and keeping your distance are the most important ways to protect them.

Even if you’re in the same household, you can still keep connected by leaving little notes around the house, for example. If they’re upstairs and you’re downstairs, you could still video phone them and watch the same TV programmes together.

Here are some more ideas about how you can stay connected with your friends and family and how to look after your mental wellbeing at this time.

A photo of Naveen Puri
Dr Naveen Puri
Associate Clinical Director, and Lead Medical Appraiser, Bupa Global & UK

    • Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19. Public Health England., last updated 30 March 2020
    • Guidance on social distancing for everyone in the UK. Public Health England., updated 30 March 2020
    • Get coronavirus support as a clinically extremely vulnerable person. Public Health England., accessed 6 April 2020

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