Clinically extremely vulnerable people in Tier 4 areas are being told not to go to work even if they are unable to work from home in new guidance published on shielding.

People across London, the South East and the East of England received further guidance online on Monday after the areas moved into Tier 4 restrictions over the weekend.

Those who are at very high risk of severe illness from coronavirus, including people with specific cancers and severe respiratory conditions, are being urged to stay at home and only leave to exercise or attend health appointments.

People who cannot work from home are being told they should not attend work, while children on the shielded patient list should not attend school during term times.

They are advised to avoid all non-essential travel unless they are heading to hospital and GP appointments, and to avoid going into any shops and pharmacies.

The guidance states people who live with someone who is clinically extremely vulnerable, but are not themselves, should still attend work and school.

A 49-year-old woman in London who has been diagnosed with Lupus, who did not want to be named, said she was glad the guidance has been updated but felt she had been “forgotten” over the past couple of months.

Speaking to the PA news agency, she said: “I know that a lot of people who were told to shield felt this way.

“I live with my boyfriend and we are lucky enough to be able to keep distanced at home. Many others aren’t so lucky.”

She described her plans for a “low-key” Christmas, adding: “I’m naturally quite a positive person so will get through this, and I have something to put this is perspective.

“When I first became very ill with Lupus I was unable to walk for a while, I became housebound and in an enormous amount of pain.

“When I was able to get about I wasn’t strong enough to pick up a kettle to make me a tea, now every time I start to feel a little down about shielding, I remind myself that I’ve been through worse and at least I can make a cuppa.”

The updated guidance follows the same rules that were in place during the second national lockdown in England during November.

The Government said those who are clinically extremely vulnerable but living in Tiers 1 to 3 should follow existing guidance, and that there is no formal shielding advice currently in place in areas outside of Tier 4.

Letters are being sent out to all those affected by the new rules later this week, although they will be delayed due to the Christmas period.