For many, the Government plans to ease shielding guidance will be a huge relief, as the past three months have been long and stifling. For others, this change will heighten anxiety levels, raising concerns about the basis for the change and the implications for health. The balance between staying safe and maintaining physical (being able to go out and exercise) and mental health (keeping in face-to-face contact with family and friends, retaining a sense of normality by performing usual activities) is important.
However, every individual will have their own sense of what is important to them and, regardless of the advice and guidance offered by the Government and their medical team, will ultimately need to make their own decision about how to act on the latest guidance.
The last few months have seen a spectrum of outcomes from COVID-19 infections. We have witnessed persons in seemingly good health succumb to the disease, and others with blood cancers prevail in the face of COVID-19. This backdrop provides a warning that we cannot be complacent about risks as they remain uncharted and incompletely understood.
Regarding experience with Waldenstrom’s macroglobulinaemia patients, although data regarding all COVID-19 cases are being gathered across NHS sites, this is still in the early stage and the data are not robust enough to provide tailored guidance. Discussions with colleagues across the UK have provided experience similar to my own: varied outcomes, not confined to subgroups such as those on chemotherapy or ibrutinib. The influence of other health issues and age is also seemingly variable.
Basing clinical advice on anecdotal evidence is undesirable. The last three months have not provided clarity about how to change the recommendations regarding shielding. We have all become more accustomed to the presence of COVID-19 in our lives and the NHS feels more prepared to handle cases. For many this familiarity eases our anxieties to some extent (the ‘new normal’) but we must bear in mind that there is no treatment yet available and testing is still in an experimental stage. There is more testing available, and the reliability of the tests has improved, but more work is needed before there is a clear blueprint for using testing as a means to ease shielding.
The main role for testing at present is to keep health facilities such as hospitals as COVID-free as possible. Most hospitals have a requirement for testing prior to planned appointments for scans, bone marrow biopsies, visits for chemotherapy and non-urgent surgery. In some cases, the requirement includes a 14-day quarantine and a negative test result. Emergency cases are tested routinely to segregate COVID-19 positive and negative patients in hospitals. Many outpatient clinics remain telephone based with the option of having blood tests quickly (in and out) ahead of a telephone consultation. Face-to-face outpatient visits are carried out with prior verbal screening and a temperature check on entry to the hospital.
So what to do about relaxation of shielding? Based on the context outlined above, I would advise the following principles to be applied:
If you go out, how far can you venture?
- Do you have a garden or a quiet locality in which to step out without encountering other people? If so, it is probably safe for you to venture out for exercise whilst socially distancing. As an additional measure, you could wear a mask and avoid touching objects.
- In general, it is advisable to remain outdoors rather than within a confined space such as shopping malls, where you will undoubtedly encounter other people. Ask yourself if you really need to go! As venues such as restaurants, museums and theatres put social distancing measures in place, it may become safer to visit them whilst employing common sense precautions such as social distancing, wearing masks and use of hand washing hand sanitisers.
- Ideally the use of public transport should be minimised, but if you have to then it is mandatory to use a mask and to employ common sense social distancing and hand sanitising measures. If you can travel by car instead this would be preferable.
Remember that there is no blueprint for behaviour in COVID-19 times. Each of us will need to exercise some judgement in how we proceed.
Above all, make sure to discuss your circumstances with your GP or medical team if you are in doubt.