COVID-19 HIGH RISK LETTER REVISED 3.4.20

Directorate for Chief Medical Officer

Catherine Calderwood MA Cantab. FRCOG Hon FRCP Edin, FRCP (Glas), FRCS (Ed), HonFFPH

Chief Medical Officer



[Patient Name Patient address Line 1 Patient address Line 2

Patient address Line 3]

Date

IMPORTANT: PERSONAL

Dear [Patient],

Your CHI number: [CHI NUMBER]

IMPORTANT ADVICE TO KEEP YOU SAFE FROM CORONAVIRUS

The NHS has identified you, or the named person you care for, as someone at risk of severe illness if you catch Coronavirus (also known as COVID-19). This is because you have an underlying disease or health condition that means if you catch the virus, you are more likely to be at risk of serious illness than others.

The government will be offering support to help you self-isolate, including the delivery of food packs and medications. It would be helpful for us to have your mobile phone number, so that we can get in touch with you through an SMS service to offer you this support.

If you have a mobile phone, please text <CHI Number> to 0786 006 4525. This will help us match your phone number to your details in our system. Do not include any other information in your text, as it is an automated service. You will receive an automatic reply to confirm you are connected to the text message service.

This service is for you as someone at higher risk of severe illness from COVID-19. This will help you to make sure you have the food and medicines you need while you stay at home. It will let us keep you up to date with the latest information. You can see more details at www.nhsinform.scot . If you need urgent support with groceries you should phone your local assistance centre. Their contact details will be available at www.nhsinform.scot .

If you do not have a mobile phone, you will still be able to access support with daily living by calling your local assistance centre. Their contact details will be available at www.nhsinform.scot .

We know that this is a very worrying time, especially for patients with significant underlying illnesses. Your safety and the continued provision of the care and treatment you need is a

priority for the Scottish Government and the NHS in Scotland. This letter gives you practical and detailed advice on how to protect yourself and access the care and treatment you need.

The safest course of action is for you to stay at home at all times and avoid all face-to- face contact for at least twelve weeks from today, except from carers and healthcare workers who you must see as part of your medical care.

We recognise this is difficult, and it may feel like a big step, but by doing this it will help to protect you from coming into contact with the virus, which could be very dangerous for you.

If you are in touch with friends, family or a support network in your community who can support you to get food and medicine, follow the advice in this letter. If you do not have contacts who can help support you, more advice is given at Section 5 in this letter.

Over the coming days, councils and health professionals will be working together to keep in contact with you to make sure you have access to food supplies and any medicines you need.

If, at any point, you think you have developed symptoms of coronavirus, such as a new, continuous cough and/or high temperature (above 37.8 °C), seek clinical advice by phoning the NHS on 111. Do this as soon as you get symptoms.

This is different to the advice that we are giving people who do not fall into the very high risk group, who are only being asked to contact the NHS if they feel very unwell. We are asking you to get in touch sooner than we are advising everyone else.

Patients in the ‘highest risk’ groups are all currently receiving this same letter. There is specific advice below for those patients reading this letter who know they have cancer. If you do not have cancer, please follow the advice in the rest of this letter (but not the paragraph which follows):

If you, or the person you care for, is currently within 6 weeks of having received chemotherapy or radiotherapy for a cancer (including a blood cancer), and feel unwell, whether or not you think it might be the coronavirus infection, then you should phone the emergency Scottish Cancer Treatment Helpline number 0800 917 7711, or the emergency number given to you by your consultant or specialist nurse. You should do this whether you think you have Covid-19 or are unwell in any other way, just as you would have done before this Covid-19 epidemic.

Things you should be doing to stay safe.

You, or the person you care for, should:

DO STRICTLY AVOID contact with anyone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature (above 37.8 °C) and/or a new and continuous cough. You might want to have a thermometer at home to check your temperature if you are worried that you may have a
DON’T leave your

DON’T attend any gatherings. This includes gatherings of friends and families in private spaces e.g. family homes, weddings and religious

DON’T go out for shopping, leisure or travel. When arranging food or medication deliveries, these should be left at the door to minimise
DO keep in touch using remote technology such as phone, internet, and social

DO use telephone or online services to contact your GP (for non-coronavirus issues) or other essential
- DO regularly wash your hands with soap and water for 20 seconds. Ask carers or support workers who visit your home to do the same.

The rest of your household need to support you to stay safe and must stringently follow guidance on social distancing, reducing their contact outside the home. In your home, you should:

minimise the time you spend with others in shared spaces (kitchen, bathroom and sitting areas) and keep any shared spaces well ventilated

aim to keep 2 metres away from others and encourage them to sleep in a different bed where possible
use separate towels and, if possible, use a separate bathroom from the rest of the household, or clean the bathroom with cleaning products after every use
avoid using the kitchen when others are present, take your meals back to your room to eat where possible, and ensure all kitchenware is cleaned thoroughly using a dishwasher at the 60 degrees setting if possible, otherwise in very warm soapy

If the rest of your household are able to follow this guidance to help keep you safe, there is no need for them to wear any special medical clothing or equipment.

We want to reassure you that you will still get the usual medical care you need during this period. Due to the situation, demand for all health services is very high and your GP practice will be in touch with you as soon as they can to arrange with you how best to ensure that. Please only get in touch with them if you have any significant concerns.

Other advice you may find helpful:

1. Carers and support workers who come to your home

Any essential carers or visitors who support you with your everyday needs can continue to visit, unless they have any of the symptoms of coronavirus. All visitors should wash their hands with soap and water for 20 seconds when they arrive, before and after preparing food and frequently during their visit.

It is also a good idea to speak to your carers about what happens if one of them becomes unwell. If you need help with care but you’re not sure who to contact please visit https://careinfoscotland.scot/topics/how-to-get-care-services

2. Medicines that you routinely take

The government is helping pharmacies to deliver prescriptions, prioritising those who are not currently able to leave the house. Prescriptions will continue to cover the same length of time as usual. If you do not currently have your prescriptions collected or delivered, you can arrange this by:

Asking someone who can pick up your prescription from the local pharmacy, and leave them at your door for you (this is the best option, if possible).

Contacting your local assistance centre to ask them to help you find someone (who will have been ID checked) to deliver it to

If you get medicines or equipment from your hospital care team, they will make arrangements to have them delivered to you.

3. Planned GP practice appointments

Wherever possible, we will provide care by phone, email or online. But if we decide you need to be seen in person, we will contact you to arrange a visit.

4. Planned hospital appointments

NHS Scotland has written to your hospital to ask them to review any ongoing care that you have with them. It is possible that some clinics and appointments will be cancelled or postponed. Your hospital or clinic will contact you by phone or letter if any changes need to be made to your care or treatment. Otherwise you should assume your care or treatment is taking place as planned. Please contact your hospital or clinic directly if you have any questions about a specific appointment or the care you usually get from hospital.

5. Support with daily living

If you have a mobile phone, please text <CHI Number> to 0786 006 4525. This will help us match your phone number to your other details in our system. Do not include any other information in your text, as it is an automated service. You will receive an automatic reply to confirm you are connected to the text message service.

If you do not have a mobile phone, you will still be able to access support with daily living by calling your local assistance centre.

If you do not have anyone who can help you, here is a selection of organisations who can advise you and can signpost you to other services:

Young Scot: https://young.scot/ https://www.readyscotland.org/coronavirus/where-to-find-additional-support/ Age Scotland: Freephone 0800-12-44-222

And for support in dealing with anxiety around impacts of Coronavirus: https://breathingspace.scot/

https://www.samh.org.uk/

https://www.supportinmindscotland.org.uk/

6. Financial assistance

This letter is evidence for your employer, to show that you cannot work outside the home. You do not need to get a separate fit note from your GP.

If you’ve been financially affected by coronavirus, and if you’re eligible, you should apply for Statutory Sick Pay, Universal Credit or Employment and Support Allowance. The UK Government has introduced some temporary changes to make this process easier. Find out more at https://www.understandinguniversalcredit.gov.uk/coronavirus/

Money Talk Team, from the Citizens Advice network in Scotland, can help you see what benefits you might be entitled to, and offer you advice to help make your money go further. You can call the team on 0800 085 7145 or visit the Money Talk Team website at https://financialhealthcheck.scot/home.

7. Urgent medical attention

If you have an urgent medical question relating to your existing medical condition (ie not Coronavirus), or the condition of the person you are caring for please contact your GP practice, or your specialist hospital care team, directly. Where possible, you will be supported by phone or online. If your doctor decides you need to be seen in person, we will arrange to visit you in your home, or where necessary, see you in a hospital.

To help the NHS provide you with the best care if you need to go to hospital as a result of catching coronavirus, we ask that you have ready a single hospital bag. This should include your emergency contact, a list of the medications you take (including dose and frequency), any information on planned appointments and essential things you would need for an overnight stay (snacks, pyjamas, toothbrush, medication etc). If you have an anticipatory care plan, please include that.

8. Looking after your mental well-being

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, jigsaws 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 or 6 feet from

You can find additional advice and support at www.nhsinform.scot .

Yours sincerely,

DR CATHERINE CALDERWOOD

CHIEF MEDICAL OFFICER

ANNEX

List of diseases and conditions considered to be very high risk:

Solid organ transplant recipients

People with specific cancers
- People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer

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

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

People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD

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

People on immunosuppression therapies sufficient to significantly increase risk of infection

People who are pregnant with significant heart disease, congenital or acquired

You may have received this letter, even if the above conditions are not relevant to you, if your GP or Hospital Specialist thinks that you would benefit from following the advice in this

Data Protection Statement

We would like to reassure you that while you have been identified from either your GP practice, local Health Board or securely stored national data, in order that we could write to you, this information has been shared appropriately within the NHS in Scotland and did not include your medical record. During this outbreak we will maintain your contact details in case we need to contact you again. We will also notify your GP and your Health Board that you have been contacted in order that they can provide appropriate support. Should we need to, in order to provide some of the additional support noted above, we will share your contact details only with your local authority (your council) in order that they can support you during this difficult time. We would highlight that this action is only being taken due to the current Covid-19 outbreak, and would assure you that your local authority would not receive any details of your medical condition or health record.