COVID-19 is caused by a virus. People almost always catch COVID-19 by sharing space for 15 minutes or more with a person who is infectious. People are more likely to catch infection indoors or in another enclosed space like a car or a bus. The risk of catching COVID-19 from touching things like groceries, newspapers or clothes delivered to your house is very low. There is a very small chance that this could happen if the person who delivered them has COVID-19. Hand hygiene is the most practical way to manage that risk.

COVID-19 infection does not affect everyone the same way. Some people do not get sick at all (asymptomatic infection), some people get a very minor illness, some people get an illness like a really bad flu and a small number of people get a very serious illness that can mean they need to go to hospital. Some people who catch COVID-19 will die as a result. There is no way to tell any person for sure what will happen to them if they catch COVID- 19. The best that we can do is to give some idea of what the chances are for groups of people of different ages and for people who already have long-term disease.

If 1,000 people aged less than 30 catch COVID-19 we can expect that many of them will get flu like illness but probably very few will need to go to hospital especially if they are in good general health to begin with.

If 1,000 people over 70 catch COVID-19, we can expect that hundreds of them may get seriously ill and many may die even with the best care that the healthcare service can give. Older people who are in good general health are usually less likely to get severe disease. Older people with a lot of health problems are usually more likely to get severe disease. The risk of needing to go to hospital and of death is also higher among groups of people who are very overweight and in people with long-term disease. However, there is no telling up front for any one person of any age how the disease will affect them.

This guide is written to give the best general information on the risk of harm from COVID- 19. It is about the choices people can make to lower the chance of harm to them and to those they care most about in practical and reasonable ways without making life impossible to bear.

For this purpose, your home is your house or apartment and any indoor or outdoor space around it (a yard, garden or fields) that is used only by you and by others in your household. There is almost no chance of you catching COVID-19 at home if people who are infectious with COVID-19 do not come to your home. If you can make your home safe then you have a place where you can relax and move about freely without worrying all the time about the risk of infection. There is no particular COVID-19 risk in going outside and moving around your own yard, garden or fields if you keep away from anyone from outside your household. Keeping active will probably improve your chances of making a good recovery if you do catch COVID-19.

Managing who comes into your home is the most important part of keeping your home as a safe haven.

A very big part of controlling the risk depends on how other people in the household behave. If other household members are very careful to follow all the public health guidance to reduce their risk of infection when they are out of the home this reduces the chance that they become infected and carry the virus home to you.

If there are members of your household that behave in ways that places themselves at high risk of catching COVID-19 that means they are also putting you at higher risk of catching COVID-19. If you own or control your home and if you are concerned that people in your household are behaving in ways that are placing you at high risk you should talk to them about your concerns if you can. If they are not able to or are not willing to change their behaviour to help you to protect yourself, it may be time to think about an alternative to sharing your home with that person(s). If you need help with this there are contact details for services that can help you on the second page of this document.

Even if everyone in the household is careful, someone can catch COVID-19 through no fault of theirs. If this happens, there is a high risk that the infection will spread from one person in the household to others. This makes it especially important that anyone who is a carer for someone who is at high-risk takes many of the precaution followed by the person at high risk.

There are a limited number of things that are practical to do to reduce the risk of spread within a household if someone gets infected.
Everyone should know that they should go straight to a room to self-isolate if they develop symptoms of COVID-19 or if they are identified as a Contact of COVID-19. If they have symptoms, they should call their doctor. There are details on how to self- isolate on www.hse.ie.

All members of the household should clean their hands (soap and water or use hand sanitiser) when they come into the house. It is a good idea to keep some hand sanitiser near the front door and encourage people to use it.
You should avoid sharing toothbrushes, taking a bite from a piece of food someone else has bitten (like an apple) or a drink from a bottle or cup someone else is drinking from. The exception to this is if there are people in the household who you kiss on the mouth or with whom you share a bed. In that case, there is no additional risk in sharing items with them. Using cutlery, dishes and similar items that someone else in the house has used after they have been washed is safe.

If you need care and support from home help the public health nurses or others working in the health service it is safer to keep taking the help than to tell people that they cannot come in. Healthcare workers are told not to come to work if they have symptoms of COVID-19 and they are trained to reduce the risk that they might spread COVID-19 to you. If you have family, friends or neighbours who come to your home to help you, try to make sure they are people you can trust to be responsible and that they know to stay away if they have symptoms. If you depend on friends, family or neighbours try to make a plan for how you will manage if a person you depend on gets COVID-19 or is worried that they might have COVID-19.

If you need people to come into your home to make repairs, try to make sure you are dealing with a reliable and trustworthy person or company who will follow public health advice.
You may also want to have people come to your house just for a social visit. This is a risk you can avoid if you do not need to see people but sometimes we all need company especially if we live alone. If you want to have visitors to your home try to keep the number of people who visit to a few people you trust. It is generally better if you have just 1 or 2 people at a time. There is no reason to believe that a visit from a child is a greater risk than a visit from an adult provided the child has no symptoms and is able to follow some simple rules.

If people deliver groceries or other things to the house ask them to leave them on the door step so that you do not have to meet the person. If they stand back from the door, you can come to the door to speak with them with very little risk especially if it is a door to the outside. You can take the things right away; you do not need to leave them on the doorstep for a period of time. The risk of handling things like this is very low if you clean your hands afterwards.

Keeping the risk low when there are people from outside the household in the house The higher the current level of the Framework for Restrictive Measures nationally or in your area the greater the risk of having additional people in the house.
Check with people if they have symptoms of COVID-19 before they come in.

Ask them to clean their hands (soap and water or hand sanitiser). It is a good idea to keep hand sanitiser near the door.
Ask them to wear a face covering or mask especially when they are in the same room as you are.

If you do not kiss, hug or shake hands and you can keep some distance between you and the other person, this will reduce the risk of catching COVID-19 if they are infectious. If the person is family or a friend that you can trust and that comes to support you or on a social visit, there is very little extra risk in having a cup of tea, a snack or a meal together while they are in the house and talking to you.
If there is a friend or family member that you depend on a lot for support it is a good idea to have a list of people you can call on if that person becomes unwell.

Family Carers Ireland has a range of practical supports and guide available to family carers during the COVID-19 pandemic, including an Emergency Care Plan Booklet.
It is safer not to share towels, dishes cutlery or anything that is put near the eyes nose or mouth with visitors (but dishes and cutlery are OK after they are washed).
If the person is in your home to makes repairs or to do work try to tell them what needs to be done and pay them without being in the same room or at least while keeping distance. You could do this by phone. If you need to talk to them/show them what you need try to be on the other side of an open door or window. Try to arrange to check the work and pay them without being in the same room or being in the same room as little as possible.

You can reduce the risk also if you do not invite people who have come to work to have tea with you or invite them to make use of your kitchen for breaks, as that increases the time spent together and the risk of spread of infection.

There is very little risk in bringing things such as letters, packages and groceries into the house. There is no need to wash or disinfect packages or leave them for a long period before opening things or putting them away. The virus can survive on the surface of things for some time but spread of infection by touching these things is very rare unless there is an infectious person very close to them shortly before you touch them.

It is reasonable to keep the house generally clean to reduce the risk of all sorts of infections but an extra effort on cleaning and disinfection is not especially recommended unless there is someone self-isolating in the house.

If you can control things to make your home safe, the biggest risk is when you are outside of home.

The higher the current level of the Framework for Restrictive Public Health Measures nationally or in your area the greater the risk of being out and about.

If you are working, you may be able to reduce how often you need to leave home if you can work from home all or most of the time. If you need to leave home for work try to organise your work so that you come into contact with people as little as is practical. It may be useful to discuss with your employer how that can be organised.
You may also be able to reduce how often you need to leave home if neighbours, family or friends can do shopping and other jobs for you. How much you can get people to do for you depends on having neighbours, family and friends you can rely on to be fair and honest with you. This is especially true if other people are handling your money or your credit cards. If are concerned that anyone may be taking advantage of your situation or making it difficult for you to keep in touch with other friends or family you can talk to someone at the HSE Safeguarding and Protection Team for your area (see contact details in Appendix II). If you need help from an independent advocate you can contact SAGE (1850 71 94 00 from 8 in the morning until 10 at night). You can also talk to ALONE (0818 222 024 from 8 in the morning until 8 at night) or the HSE confidential recipient at 1890 1000 14.

Talk to your pharmacy about the safest way to make sure you get a supply of any medicines you need.

You may be able to get shopping delivered to your house. It is especially important to try to get help if the shopping or other jobs are likely to involve contact indoors with a lot of people. If you do not have friend, family or neighbours who can help your local community support team may be able to help.

If you need to contact your GP or other services, you may be able to use the phone so that you do not need to leave your home. Plan ahead to make sure you know how to contact your doctor or out of hours service if you feel unwell. If your GP advises that you need to be seen at the surgery it is important that you attend. Remember to attend for your flu vaccine.

You should continue to attend for all your regular healthcare appointments at hospital or clinics. The risk of catching COVID-19 is lower than the risk of missing out on healthcare that you need. Hospitals and clinics have put in place steps to protect you from being in contact with people with COVID-19.

If you are out and about, just as when you are at home, the biggest risk is being close to people. Key measures to reduce your risk when you are out include:

▪ Keeping a safe distance.
▪ Not touching things if you do not need to.
▪ Cleaning your hands and wearing a face covering.

Gloves are not recommended. Gloves get contaminated quickly and can get punctured. You are better to rely on cleaning your hands.
If you want to tell people who provide services that you need to be extra careful to avoid COVID-19 they will usually try to fit you in at a quiet time and be extra careful when providing you with the service.

If you do need to leave home try to avoid public transport if you can. It is especially important to avoid public transport at busy times, as it is very difficult to avoid very close contact with a lot of people on public transport at busy times. It is the law that you should wear a face covering on public transport. If it is possible for you to walk, where you need to go this is likely to be much safer and exercise is good for health and wellbeing.

If you are outdoors and more than 2m away from anyone, there is little additional risk of catching COVID-19 compared to staying at home. However if anything goes wrong and you need to be near other people the risk increases. It is a good plan to have hand sanitiser and a face covering with you in case you do need to be near other people.

If you are out for a drive in a car with members of your household and you have no contact with anyone else there is no additional risk of catching COVID-19 compared to staying at home. It is a good plan to keep hand sanitiser and a face covering in the car in case you do need to be near other people.

If you need other essential services, for example legal or financial advice and it cannot be dealt with by phone or videoconference, check before you travel that the place you need to go to has taken steps to keep people as safe as possible. Bring and use hand sanitiser and a face covering.

If you have to do your own shopping go at time when the place is likely to be quiet or if they have a protected time when there are less people in the shop try to go at that time. Bring and use hand sanitiser and a face covering.

If you decide that you want to visit someone, attend a religious service, go to the hairdresser, go to a café or some other service, think about the risk for you and plan to keep that as low as possible. Try to go to a place that you know is careful about following public health guidance, try to go at a time when it is not busy and keep your distance from other people as much as you can.

If you are out and about and you find yourself near anyone who is coughing or looks feverish or sick move away to a safe distance as quickly as you can.

If you can be very careful all the time, you can protect yourself from catching COVID-19, but we are all human and we all forget sometimes or maybe make a decision to do something that is not very safe. No one can guarantee you that you will not get COVID-19. Most older people who catch COVID-19 will recover. Your chance of recovering is likely to be better if:

• You keep your body active – make a plan for how to get exercise every day.
• You keep your mind active – crosswords, puzzles, music, whatever works for you
• You look after your mental health – plan to keep in touch with people.
• You have a healthy diet and are not overweight.
• You do not smoke.
• You take good care of any long-term illness that you have.

You contact your doctor by phone if you develop symptoms of COVID-19. A lot has been learned about how to take care of people who get very sick with COVID-19. If you do catch COVID-19 you have a good chance of recovery if your doctor knows about it early and can send you for special treatment if you need it.

One of the harms from COVID-19 is the stress caused by all the changes in our lives and the fear of catching infection when you hear the number of cases is increasing. It is natural to feel this way. The good news is that even when infection is very common in your community there is great deal that you can do to keep safe and at the same time stay well and keep connected.

Extremely Medically Vulnerable People
What do we mean by extremely medically vulnerable?*

1. People aged ≥ 70 years.
2. Solid organ transplant recipients.
3. .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 that 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.
4. People with severe respiratory conditions including cystic fibrosis, severe asthma, pulmonary fibrosis/ lung fibrosis/ interstitial lung disease and severe COPD.
5. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
6. People on immunosuppression therapies sufficient to significantly increase risk of infection.
7. Women who are pregnant with significant heart disease, congenital or acquired.