Novel Coronavirus (COVID-19) - 02/04/2020 Updated 02/04/2020. This page is currently up-to-date, based on the most recent guidance available and is the best advice we have for people with Addison's and Adrenal Insufficiency at this time. This advice is for people living in the UK and ROI. Our trustee medics and Clinical Advisory Panel alongside Society for Endocrinology, have been keeping an eye on the emerging situation and the current view is as follows. We hope you find it useful and it answers some of your questions. Stay at Home Everyone must now stay at home except in exceptional circumstances. However if you have Addison's disease or adrenal insufficiency you are considered to be within the group of vulnerable individuals, who are at an increased risk of severe illness from coronavirus (COVID-19). According to current government guidance and the Summary Advice Statement released by Society for Endocrinology, you should be particularly stringent in following social distancing measures. Please see '6. Getting out and about safety' in our coronavirus precautions below for more information. Shielding advice Shielding is a way of protecting extremely vulnerable people who are at a very high risk of severe illness from coronavirus. It means staying at home and avoiding all face-to-face contact for at least 12 weeks. So who is at a very high risk and what does that mean? Right now, most people with Addison's or adrenal insufficiency – but do not fall into any other categories defined as extremely vulnerable – are not considered at very high risk as confirmed by the Society of Endocrinology and so are not being advised to shield. The rules for stringent social distancing should be followed however, as those with Addison's are considered to be at an increased risk/ vulnerable - similar to those in the over 70's category. There may be some people with Addison's or adrenal insufficiency who need to shield based on other conditions, for example those who have had organ transplants, have certain types of cancers, or have significant respiratory conditions. The full list of people who should be shielding can be found on the gov.uk website. If you are being advised to shield, the NHS will contact you directly by Sunday 29 March 2020. If you think you or a loved one are in this highest risk category and have not received a letter from the NHS by Sunday 29 March or been contacted by your GP, get in touch with your GP or hospital doctor by phone or online. Here are our six COVID-19 (coronavirus) precautions for people who have Addison's Disease or Adrenal Insufficiency. 1. Protecting yourself: If you're in the UK, follow the advice from the NHS on avoiding catching or spreading coronavirus. You may be caring for a person in an at-risk group. If you are, take extra care to protect yourself and the person you care for from coronavirus. Make sure your vaccinations are up to date. Note that our medics have confirmed that the pneumonia vaccine protects against pneumococcal bacterium and would not protect against the type of Pneumonia caused by COVID-19. This is confirmed on the WHO website on their coronavirus myth-busters page. Think about ways to keep your stress levels down. Being prepared can be a great help. Talk to someone if you are feeling stressed or anxious. Read our advice on coping with psychological stress. If you are an ADSHG member, go into our online forum and talk about how you feel. Others can then support you. The World Health Organisation has published advice here about managing your mental wellbeing during the coronavirus outbreak. 2. Preparing for emergencies: Get your Emergency kit and Emergency Letter ready. Make sure you have an Emergency Injection Kit containing hydrocortisone vials available from your GP or Endocrinologist, syringes, injection instructions, and plastic vial snaps. Make sure it is up to date, that you have the instructions and practice a self-injection using our videos. Make sure you have a completed Emergency Letter and it is up to date. Keep a copy of both the NHS Steroid Emergency Card and ADSHG charity Adrenal Crisis Emergency wallet card, filled in with your details, in your wallet or purse. If living in the UK, register with your local ambulance trust. Prepare a hospital bag with a change of clothes, a hospital folder with your key information in and/or ADSHG leaflets, spare medication, a recent prescription, a small amount of money. This can then be picked up and taken there easily. Make sure you have plenty of non-alcoholic drinks, salty snacks and rehydration fluids (available in most chemists) or salts available in your home. Familiarise yourself with the NHS advice on self-isolation or the HSE self-isolation and limited social interaction so that you are prepared in case you are told to self-isolate. Ensure your medical team is aware of your condition and the importance of timing of medication. Liaise with your hospital endocrinology team. If you are too unwell enlist the support of a persuasive family advocate and keep hold of your own supply of medication at all times. Some Trusts have medication self-administration policies that allow patients to self medicate so do ask about this. If you need to use the NHS 111 service please use the NHS 111 website in the first instance so that the service can handle more urgent cases over the phone. If you need to contact NHS 111 or call 999 in an emergency, be sure to mention 'steroid-dependent' and 'adrenal insufficiency' when explaining your health status. Or in ROI: the HSE contact details are: Callsave: 1850 24 1850, Phone: 041 6850300 or Tweet: @HSELive 3. Managing your Medication: Keep taking your tablets as normally prescribed unless you are ill! Steroids taken for adrenal insufficiency are replacement doses and increasing the dose during illness is to try and mimic your body's natural physiological response. In the correctly tailored dosages, they should not suppress your immune system. Make sure you have a good supply of medication that cover you, in the event, you have to self isolate and fall ill enough to increase your dosing as per our Sick Day Rules. Please read our Sick Day Rules before increasing your dosing and make sure you have enough medication for in case you are asked to self-isolate for up to a 14 day period. In our latest video, ADSHG Trustee and Professor or Endocrinology explains how to manage your medication should you get ill in the coming weeks. If your GP or Endocrinologist does not wish to provide additional prescriptions to provide the above cover, please print and provide them with the below documents as a guide and politely ask again: The advice from the Society for Endocrinologists for people with adrenal insufficiency. The ADSHG Caring For the Addison's Patient leaflet The Pituitary Foundations's Letter to GPs - Digital Template If you or UK or ROI based, please also provide details of this refusal to us and we will ensure that the surgery or endocrine unit receive some of our advice and materials ls to help raise awareness. Please note: The ADSHG cannot become involved in individual disputes, but our resources can be downloaded to raise awareness amongst medics. 4. Keeping Informed: Make sure you have useful ADSHG publications printed, filled in and stored in an easy to find location. Talk to your family about the support and/or treatment you need - make a plan. You could use our Personal Emergency Plan to think everything through together. Our Sick Day Rules are an excellent set of principles to follow if you become ill. Print them and share them with those who are likely to be looking after you if you become ill. The Government and NHS are providing regular updates so follow them online or keep an eye on the media for their latest updates. UK Department of Health and Social Care On Facebook On Twitter UK NHS On Facebook On Twitter ROI HSEOn Facebook On Twitter Tailored information for people living in Wales, Scotland and Northern Ireland can also be found at: • Public Health Wales • Health Protection Scotland • Public Health Agency (NI) Tailored information for British Sign Language users Read the advice from the Society for Endocrinologists for people with adrenal insufficiency. Read the advice from the Society for Endocrinologists regarding adrenal crisis. Please familiarise yourself with the NHS advice on self-isolation in case you are asked to self-isolate. Follow the ADSHG on Twitter, Facebook or if you are a member all our updates will also feature on our forum. We'll also include advice on our ADSHG website. Misinformation can be troubling and misleading. Please review the WHO's Mythbusters to verify the things you are hearing, reading or sharing. 5. Managing employment and finances If you are employed, talk to your employer about their plans and your needs. Ask if it's possible for you to work from home or make other arrangements. Read the UK Government's Health and Safety Executive latest advice for employees. You can now receive an isolation note to give to your employer. Click here to visit the NHS website to find out more. Find the latest advice from the Citizens Advice bureau here, if you are concerned about any sick pay or any benefits you receive. 6. Getting out and about safely: The Society for Endocrinology have confirmed it is considered patients with adrenal insufficiency are part of the group of vulnerable individuals who should be particular stringent in following social distancing measures during the COVID-19 (Coronavirus) crisis. In line with their Summary Advice statement which you can read on their website - the following updated advice is recommended: "On this basis, and aligning to UK Government advice, we therefore deem that patients with adrenal insufficiency are within the higher risk group. Patients with adrenal insufficiency are: Strongly advised against social mixing in the community Strongly advised against having friends and family to the house Strongly advised to use remote access to NHS and essential services Strongly advised to vary daily commute and use less public transport Strongly advised to work from home" If you are planning to travel, please check the travel advice from the UK Government about the countries you'll be travelling to and from. We have advice on our website about managing your Addison's when travelling. If you have plans coming up that include being in crowded spaces, especially indoors, consider if it's essential or can be postponed. Indoor spaces are less well ventilated. The virus is more likely to spread in smaller and more crowded spaces. Read more about this in the advice, here, from the ROI HSE for at-risk groups. If you have a medical appointment, check the current advice at the medical centre in question and discuss any concerns with them when considering if you will attend or not. If you have been travelling abroad, and you think you may have been exposed to Coronavirus, the most up-to-date advice on what to do can be found on the NHS, HSE or UK Government websites.