What’s happened to shielding?

You’d be forgiven if you missed the update this week.

Shielding and the plight of those who are extremely clinically vulnerable was missing from the Prime Minister’s announcements at the start of this week and only mentioned by Chief Medical Officer Chris Whitty when directly asked.

It continues a trend this group of people have had to endure throughout the pandemic: mixed, confused and delayed communication.

During the first wave of the Covid-19 pandemic extremely clinically vulnerable people were told to shield. Approximately 2.2 million people were advised to remain indoors and, if living with others, sleep and eat separately from the rest of their household. This advice lasted for four months and came at a considerable mental and emotional burden for those asked to shield, many, as Whitty highlighted, experiencing anxiety and extreme loneliness. In fact 35% of shielders reported worsening mental health due to shielding in an ONS Survey. There were also ongoing problems with who exactly was and wasn’t included on the list -- with some people not receiving a letter telling them to shield until early May.

Shielding guidance ended at the end of July. 

Now, with infection rates rising and the very real threat of a second wave of the virus looming on the horizon, the Government finally issued updated advice to those in this extremely vulnerable group yesterday (13th October). As with its wider response to this stage of the pandemic, the Government has taken a more localised approach, with differing guidance dependent on where the person lives and their Local Covid Alert Level tier. 

At this moment in time, the Government is not advising this group of extremely clinically vulnerable people to shield, recognising the strain it caused on individuals and their loved ones last time.

This might change. In areas of very high infection rate, the Government may decide to reintroduce shielding for what it promises would be a time-limited period. Clearly, there is reluctance to do this unless very necessary. Some may argue skeptically that this is to save the Government the financial cost of support triggered by such a move.

So what are those people in this group advised to do? In a nutshell: take care. The detailed guidance (available here), as well as setting out advice for each level of tier, also looks particularly at the areas of socialising, work and school, travel, shopping, and additional care and support.

Certainly, this means those who are extremely clinically vulnerable have more freedom to enjoy the crucial activities in life that give it meaning, including meeting up with friends and family. However, whether, given the strength of messaging during the first wave of the pandemic, people will have the confidence to do this, and whether introducing differing levels of advice to a system that had already been criticised for its poor communication will cause further confusion, is yet to be seen.

Extremely clinically vulnerable people were promised a more nuanced approach in the event of any future waves. Yet a risk stratification tool allowing a more personalised assessment of an individual's risk has yet to appear. This, along with consistent and appropriate communication, is needed so that those at highest risk can take the precautions needed to protect themselves while participating as much as they can in everyday life. It will also be crucial that a localised approach doesn’t lead to inequities, with some local authorities providing support to people who need and others falling short.

The Government has a profound duty of care to this group of people. These people have already endured great emotional toil -- second time round communication and support must be better.