Cocooning: Looking after our over 70s..Here's what you need to know

What cocooning is
Cocooning is a measure to protect those over 70 years or those extremely medically vulnerable by minimising interaction between them and others. This means that these people should not leave their homes. Even within their homes should minimise all non-essential contact with other members of their household.

This is to protect those who are at very high risk of severe illness from COVID-19 from coming into contact with the virus.

If you are over 70 years of age or have a condition which makes you extremely medically vulnerable you are strongly advised to cocoon, to reduce the chance of getting COVID-19 and follow the face-to-face distancing measures below.

The measures are:

strictly avoid contact with someone who is displaying symptoms of COVID-19. These symptoms include high temperature and/or new and continuous cough
do not leave your house
do not attend any gatherings. This includes gatherings of friends and families in private spaces for example family homes, weddings and religious services
do not go out for shopping and, when arranging food or medication deliveries, these should be left at the door to minimise contact
keep in touch using remote technology such as phone, internet, and social media
do use telephone or online services to contact your GP or other essential services
ensure you keep phones/devices charged, and have credit on your phone so that you can stay connected
We know that stopping these activities will be difficult. You should try to identify ways of staying in touch with others and participating in your normal activities remotely from your home.

However, you must not participate in alternative activities if they involve any contact with other people.

This advice will be in place for 2 weeks from 27 March 2020. This period will be kept under review.

What we mean by extremely medically vulnerable*
people aged 70 years or over
solid organ transplant recipients
people with specific cancers
(a) people with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer

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

(c) people having immunotherapy or other continuing antibody treatments for cancer

(d) people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

(e) 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 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
women who are pregnant with significant heart disease, congenital or acquired
*or any essential/key worker advice should be sought from Occupational Health who can give specific advice on individual conditions.

Cocooning is for your personal protection and if you are unsure whether or not you fall into one of the categories of extremely medically vulnerable people listed above, you should discuss your concerns with your GP or hospital clinician.

All other people should stringently follow public health guidance on physical distancing.

What you need to know
If you are over 70 years of age or have an underlying medical condition listed above, you are at very high risk of severe illness as a result of COVID-19.

Cocooning is a practice used to protect those over 70 or those extremely medically vulnerable people from coming into contact with COVID-19 (Coronavirus).

You are strongly advised to stay at home at all times and avoid any face-to-face contact for a period of 2 weeks from today (27 March). This period is being kept under review.

Visits from people who provide essential support to you such as healthcare, personal support with your daily needs or social care should continue, but carers and care workers must stay away if they have any of the symptoms of COVID-19. They may find this guidance for Health and Social care workers who visit homes useful. All people coming to your home should wash their hands with soap and water for at least 20 seconds on arrival to your house and often whilst they are there.

You should have an alternative list of people who can help you with your care if your main carer becomes unwell.

If you have someone else living with you, they are not required to adopt these protective cocooning measures for themselves. They should do what they can to support you in cocooning and they should stringently follow guidance on physical distancing, reducing their contact outside the home. They should wash their hands thoroughly and regularly, especially upon arrival home and observe good respiratory etiquette at all times.

If you care for but don’t actually live with someone who is extremely medically vulnerable you should still stringently follow the public health guidance on physical distancing.

What you should do if you have someone else living with you
Whilst the rest of your household are not required to adopt these protective cocooning measures for themselves, we would expect them to do what they can to support you in cocooning and to stringently follow guidance on physical distancing.

you should stay away from other people in your home most of the time in a well-ventilated room with a window to the outside that you can open
if you have to go into the same room with other people at home you should try to keep at least 1 metre (3 ft) and where possible 2 metres away from them
you should clean your hands regularly and practice good respiratory etiquette
if you can, you should use a toilet and bathroom that no one else in the house uses
if you cannot have your own toilet and bathroom, the toilet and bathroom you use needs to be kept clean (see advice below). Another tip is to consider drawing up a rota for bathing, with you using the facilities first
make sure you use separate towels from the other people in your house, both for drying themselves after bathing or showering and for hand-hygiene purposes
if you share a kitchen with others, avoid using it while they are present. If you can, you should take your meals back to your room to eat. If you have one, use a dishwasher to clean and dry the family’s used crockery and cutlery. If this is not possible, wash them using your usual washing-up liquid and warm water and dry them thoroughly. Do not share cutlery and utensils. When using your own utensils, remember to use a separate tea towel for drying these
clean all surfaces, such as counters, table-tops, doorknobs, bathroom fixtures, toilets and toilet handles, phones, keyboards, tablets, and bedside tables, every day with a cleaning product
when cleaning you should use your usual household products like detergents and bleach as these will be very effective at getting rid of the virus. Follow the instructions on the manufacturer’s label and check they can be used on the surface you are cleaning
we understand that it will be difficult for some people to separate themselves from others at home. You should do your very best to follow this guidance and everyone in your household should regularly wash their hands, avoid touching their face, and clean frequently touched surfaces such as door handles and table tops
If the rest of your household stringently follow advice on physical distancing and minimise the risk of spreading the virus within the home by following the advice above, there is no need for them to also cocoon alongside you.

Handwashing and respiratory hygiene
There are general principles you should follow to help prevent the spread of airway and chest infections caused by respiratory viruses, including:

clean your hands regularly - This is one of the most important things you can do. Do this after you blow your nose, sneeze or cough, and after you eat or handle food
try not to touch your face or anyone else’s face
cover your mouth and nose with a paper tissue when you cough or sneeze
place used tissues into a plastic waste bag and immediately clean your hands with alcohol hand rub or wash your hands with soap and water for at least 20 seconds
avoid close contact with people who have symptoms
What you should do if you develop symptoms of COVID-19 (Coronavirus)
Symptoms
The most common symptoms of COVID-19 (Coronavirus) are recent onset of:

fever (high temperature) and cough
shortness of breath or difficulty breathing
If you develop the symptoms of COVID-19, seek clinical advice by phoning your GP or using the HSE Live phoneline 1850 24 1850. In an emergency, call 112 or 999 if you are seriously ill. Do this as soon as you get symptoms. Do not visit the GP, pharmacy, urgent care centre or a hospital unless you are told to do so.

ALONE is providing a telephone support line, seven days a week from 8am – 8pm, for all older people and their families to contact if they would like any advice, reassurance or additional support: 0818222024. This support line is also open to extremely medically vulnerable people.

The support line complements the clinical advice being provided by the HSE through its website and helpline.

If you receive support from health and social care organisations, for example, if you have care provided for you through the local authority or health care system, this will continue as normal. Your health or social care provider will be asked to take additional precautions to make sure that you are protected. The advice for formal carers is included here.

What you should do if you have hospital and GP appointments during this period
We advise everyone to access medical assistance remotely, wherever possible. However, if you have a scheduled hospital or other medical appointment during this period, talk to your GP or specialist to ensure you continue to receive the care you need and determine which of these are absolutely essential.

It is possible that your hospital may need to cancel or postpone some clinics and appointments. You should contact your hospital or clinic to confirm appointments.

Advice for visitors, including those who are providing care for you
Contact regular visitors to your home, such as friends and family to let them know that you are cocooning and that they should not visit you during this time unless they are providing essential care for you. Essential care includes things like help with washing, dressing, or feeding.

If you receive regular health or social care from an organisation, either through your local authority or paid for by yourself, inform your care providers that you are cocooning and agree a plan for continuing your care.

If you receive essential care from friends or family members, speak to your carers about extra precautions they can take to keep you safe. Speak to your carers about backup plans for your care in case your main carer is unwell and needs to self-isolate.

Advice for informal carers
If you are caring for someone who is over 70 or extremely medically vulnerable to severe illness from COVID-19, there are some simple steps that you can take to protect them and to reduce their risk at the current time. Ensure you follow advice on good hand hygiene and respiratory etiquette.

only care that is essential should be provided
wash your hands on arrival and often, especially before and after being in contact with the person you are caring for. Use soap and water for at least 20 seconds or use hand sanitiser
avoid touching your face
cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
put used tissues in the bin immediately and wash your hands afterwards
do not visit or provide care if you are unwell and make alternative arrangements for their care
provide information on who they should call if they feel unwell, write out the phone number of their GP and GP out-of-hours service and the HSE website and HSELive phone number (1850 24 1850) and leave these prominently displayed
if it is an emergency, call the emergency services at 112 or 999 and remember to tell them that the person may have or has been diagnosed with COVID-19
find out about different sources of support that are available
look after your own wellbeing and physical health during this time

How to look after your mental wellbeing
Social isolation, reduction in physical activity, unpredictability and changes in routine can all contribute to increasing stress. Many people including those without existing mental health needs may feel anxious about this impact, including support with daily living, ongoing care arrangements with health providers, support with medication and changes in their daily routines.

If you are receiving services for your mental health, learning disability or autism and are worried about the impact of isolation please contact your keyworker/care coordinator or provider to review your care plan. If you have additional needs please contact your key worker or care coordinator to develop a safety or contingency plan.

It is very easy to become anxious and lonely when you have to spend time on your own but remember, you can always pick up the phone and call a friend. For more information on minding your mental health during the COVID-19 outbreak go to www.hse.ie. You can also call the Samaritans on Ph: 116 123.

At times like these, it can be easy to fall into unhealthy patterns of behaviour which in turn can make you feel worse.

There are simple things you can do that may help to stay mentally and physically active during this time such as:

although you have been asked to stay at home it is important you keep yourself mobile by getting up and moving around as much as possible. If you have a garden or backyard, go out and get some fresh air but please keep away from other people including neighbours. Keeping a distance of at least 1 metre but where possible 2 metres (or 6.5 feet) from other people is recommended
try spending time with the windows open to let in the fresh air, arranging space to sit and see a nice view (if possible) and get some natural sunlight
spend time doing things you enjoy – this might include reading, cooking, other indoor hobbies or listening to favourite radio programmes or watching TV
try to eat healthy, well-balanced meals, drink enough water, exercise regularly, and try to avoid smoking, alcohol and drugs
Steps you can take to stay connected with family and friends during this time
Draw on support you might have through your friends, family and other networks during this time. Try to stay in touch with those around you over the phone or online. Let people know how you would like to stay in touch and build that into your routine. This is also important in looking after your mental wellbeing and you may find it helpful to talk to them about how you are feeling, if you want to.

Advice for people living in long-term care facilities, either for the elderly or persons with special needs
The advice also applies to those over 70 years of age or extremely medically vulnerable persons living in long-term care facilities. Care providers should carefully discuss this advice with the families, carers and specialist doctors caring for such persons to ensure this guidance is strictly adhered to.