Government urges people with CF and others with high risk conditions to stay at home plus related advice (Cocooning)

In an announcement yesterday, March 27th, An Taoiseach Leo Varadkar in consultation with the Minister for Health Simon Harris and Chief Medical Officer, Dr. Tony Holohan announced additional measures to help fight the spread of COVID-19.

The new measures include a mandatory order for everyone to stay at home for a two week period and the introduction of shielding or "cocooning" for those over the age of 70 and for specified categories of people who are extremely vulnerable to the coronavirus.

People with cystic fibrosis are included in this category.

Cystic Fibrosis Ireland understand this is an anxious time for the CF Community. To support our members we have put together some key points on what the new measures mean for the CF Community.

Full information on the new measures can be found here.

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

People with CF fall into the category of medically vulnerable and should now be practicing cocooning. This means they should not leave their homes and minimise all non-essential contact with other members in their household.

The full measures of Cocooning include:

• 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
• 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

This advice will be in place for 2 weeks from 27 March 2020.

This period will be kept under review.

Who is classed as vulnerable?

• People with cystic fibrosis and other severe respiratory conditions including severe asthma and severe COPD
• People aged 70 years or over
• Solid organ transplant recipients (including lung, liver and heart transplant recipients)
• People with specific cancers
• 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

Cocooning is for your personal protection.

Home support Visits
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.

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.

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, 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.

The advice from Gov.ie in relation to sharing a house while cocooning is as follows:

• 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.

What you should do if you develop symptoms of COVID-19 (Coronavirus)
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 and CF Centre or using the HSE Live phone line 1850 24 1850.

Do this as soon as you get symptoms.

In an emergency, call 112 or 999 if you are seriously ill.

Do not visit the GP, pharmacy, urgent care centre or a hospital unless you are told to do so.

To help us provide you with the best care if you need to go to hospital as a result of catching COVID-19 (Coronavirus), we ask that you prepare a single hospital bag.

This should include your next of kin or emergency contact, a list of the medications you take (including dose and frequency), any information on your planned care appointments and things you would need for an overnight stay (snacks, pyjamas, toothbrush, medication, and so on). If you have an advanced care plan, please include that.

How you can get assistance with foods and medicines if you are cocooning
There are supports available for the delivery of food and medicines during cocooning.

 An Garda Síochána is in the process of hiring additional vehicles to provide additional mobility to members nationwide to provide increased community support and community engagement across the country.

 An Garda Síochána continue to urge families, neighbours and community groups to engage with people in line with ‘social distancing’ guidelines.

As an organisation, Gardaí across the country are being asked to actively identify those persons most at need, particularly those with limited local family or social support.  In these cases An Garda Síochána will assist.

These ‘contingency’ vehicles will be used to maintain personal interactions and where needed to assist and support people, which may include collecting medical prescriptions, attending hospital appointments and other supports they may need.  They are not ‘primary response vehicles’.

An Garda Síochána will also use these opportunities to link identified people into local, national and state services where appropriate.

You can also contact Cystic Fibrosis Ireland for guidance and information on additional supports.

What you should do if you have hospital and GP appointments during this period
Contact your CF Centre / GP directly in advance of your appointment for guidance.

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.

Cystic Fibrosis Ireland remains operational and CFI staff are available to speak to members who may need support.

Cystic Fibrosis Ireland have online counselling available to members who require additional support. To avail of this service, please contact Samantha Byrne: sbyrne@cfireland.ie

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

• Keep active - 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.
• Fresh air - If you have a garden or backyard, go out and get some fresh air, but please keep away from other people including neighbours. Alternatively 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
• Ty to eat healthy, well-balanced meals, drink enough water, exercise regularly, and try to avoid smoking, alcohol and drugs

These additional measures have been introduced to help

We understand that these measures may be difficult and would remind members that CFI staff are there for you to talk to and online counselling is available for anyone who requires additional support.

Cystic Fibrosis Ireland will continue to update members regularly.