By Alex Dabek, Head of the Spinal Injury team at Bolt Burdon Kemp

As we enter the next stage of the Covid 19 lockdown with safety measures being relaxed, it is important to discuss the challenges faced by those whose health is most at risk. There has been much uncertainty and confusion over the recent guidance easing the lockdown, especially for those in the “high risk” group. In this article we discuss the concerns shared by those in the ‘high risk’ group and where they can turn to receive much needed support in these difficult times.

Alex Dabek, Head of the Spinal Injury team at Bolt Burdon Kemp

Current advice on shielding

The government’s updated advice on shielding in England and Wales is that those in the high risk category should continue to shield until the end of June 2020 but they can now venture outdoors once a day (unlimited in Wales), either with members of their household or with someone from another household, if they live alone, provided they still observe social distancing rules. They should not leave their homes to go to work, go shopping or visit friends in their homes.

Whilst this new guidance will continue to be reviewed by the Government, other parts of UK have taken a more cautious approach and at the time of writing, the rules have not yet been relaxed.


As a solicitor who specialises in spinal injury claims, I am acutely aware of the additional challenges faced by many of my clients. Many of my spinal cord injury (SCI) clients are amongst the 80,000 plus people who received letters advising them to shield for an extended period of time to safeguard against the virus.

Whilst there is no indication that people with SCI are more likely to catch the virus, many of them will have respiratory issues or compromised immune systems which means that the impact of becoming infected with coronavirus may be more significant for them.

In view of the recent announcements, there is an understandable concern amongst the SCI community and others in the ‘high risk’ group about relaxing the safety measures too soon and without sufficient scientific evidence showing it is safe to do so. In fact, some scientists have expressed concerns about relaxing measures when infection rates still remain high (at around 8,000 per day as at 31 May 2020).

Even more worryingly, there have been recent reports of people being removed from the ‘high risk’ category and losing vital additional support with food provision and medication. Such reports and the uncertainty surrounding the exit strategies for those in the high risk category will inevitably cause further anxiety. Their mental well-being must not be overlooked and better mental health support in these particularly challenging times is called for.

After weeks of mentally and physically draining isolation and many personal sacrifices, those shielding feel frustrated that all their efforts have been for nothing and all that hard work to reduce the number of infections is at risk of being undone. Many of my SCI clients have decided to continue with full isolation for the foreseeable future as the risk of infection is still too high. Charities supporting those at risk have urged the government to provide a clear exit plan with detailed guidance addressing the often complex health and social needs of those shielding.

Advice and Support

Charities supporting those with spinal cord injuries and their families have been working very hard to ensure they can still provide the advice and support to those in need and their role has never been more vital. Spinal Injuries Association (SIA) and Back Up have been working in partnership to ensure that a wide range of services can be available to those with SCI. I have listed below some of the services and ways in which these charities have been supporting those with SCI.

  • SIA’s website is an invaluable source of advice and information on the effect of Covid 19 on the SCI community including advice and assistance with preparing personal care plans and emergency care plans in the event of a hospital admission as well as detailed fact sheets for carers.
  • People with SCI can access a wide range of podcasts and online cafes put together by SIA in collaboration with Back UP and ‘This is Spinal Crap’, a podcast service about living well with SCI. This is a great opportunity to share experiences in a fun and positive environment and have that much needed social interaction.  
  • Thanks to SIA’s Support Network, those with SCI can receive one-to-one virtual support (by telephone, email or skype) where they can discuss any concerns and seek guidance from someone who has been through similar experiences. This is a really helpful service, whether you are newly injured or suffered your spinal cord injury some time ago but need some guidance or simply a listening ear. I have recommended this service to many of my clients who have all found it hugely beneficial.  Back Up also offers a similar service.
  • Those with SCI can discuss any health concerns and seek clinical guidance from one of SIA’s specialist nurses. This assistance is particularly important now when many SCI individuals are shielding but need clinical/nursing advice to manage their condition and any complications that may arise.
  • In collaboration with SIA, Dr Jane Duff consultant Clinical Psychologist who heads up the National Spinal Injuries Centre Clinical Psychology Service has produced a really helpful advice on looking after one’s psychological well-being during these challenging times. You can read this article by following this link.
  • The SIA’s advocacy service can be particularly relevant in the current situation where many SCI people are experiencing problems with their usual care arrangements or medical treatment. The advocacy team can assist with a number of issues including making representations on behalf of high-level injury SCI people to be automatically registered as high risk, advocating the importance of PPE, prioritising SCI people in acute medical settings and ensuring their carers can still support them in hospitals given their often complex needs.
  • Maintaining good levels of physical activity when shielding or self-isolating may be difficult. Helpfully, there are now some great resources available online for adults and children including workouts put together by Neurokinex or check their Twitter feed @neurokinex, a charity which offers specialised neurological rehabilitation for various forms of paralysis. Another great initiative is a collaboration between Rooprai Spinal Trust and Gym Possible, where high risk wheelchair users can receive free exercise bands to help keep in shape along with weekly instruction videos (#ProjectBandTogether). You can check out these videos by going onto their Twitter and Instagram page.

Lessons to be learnt

It is important to learn from and build on these recent experiences. I hope that as a society we can find ways to better protect those at risk in times of crisis such as this one. Appropriate provisions and contingencies have to be put in place by the Government to ensure that those with specialist needs receive the support they require and are well safeguarded. This crisis has also highlighted the important role played by many charities supporting those in need. Their ability to provide such support in the future has to be maintained.

Alex Dabek is an Associate and Head of the Spinal Injury team at Bolt Burdon Kemp.