Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in Wales? Results of EVITE Immunity, a linked data retrospective study

Snooks, Helen; Watkins, Alan; Lyons, Jane; Akbari, Ashley; Bailey, Rowena; Bethell, Lesley; Carson‐Stevens, Andrew; Edwards, Adrian; Emery, Helena; Evans, Bridie; Jolles, Stephen; John, Ann; Kingston, Mark; Porter, Alison; Sewell, Bernadette; Williams, Victoria; Lyons, Ronan A

doi:10.1016/j.puhe.2023.02.008

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…25 To reduce their risk of SARS-CoV-2 infection and severe outcomes, immunocompromised individuals are recommended to continue to self-isolate, 26 , 27 heavily impacting their mental health and health-related quality of life. 28 , 29 …”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study

Evans,

Dube,

et al. 2023

The Lancet Regional Health - Europe

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Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study

Evans,

Dube,

et al. 2023

The Lancet Regional Health - Europe

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“…The changes in the intervention over time noted in our study reflect the evolving nature of the shielding list, and the slippage between guidance and advice in public discourse has been tracked in detail by Herrick 16. Emerging evidence suggests that, despite the shielding intervention, there were still high rates of infection, hospitalisation and mortality in the shielding group3 17 casting doubt on the mechanism proposed. This may in part be due to the impracticality of truly isolating people, particularly those who were in contact with clinical care providers and carers due to their vulnerability.…”

Section: Discussionmentioning

confidence: 62%

“…We undertook an evaluation of shielding in Wales (EVITE Immunity—Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, including those with cancer:quasi-experimental evaluation), where records for the 130 000 people who were identified for shielding are already anonymously linked with other integrated data sources, using the Medical Research Council (MRC)-funded ConCOV ( Controlling COVID19 through enhanced population surveillance and intervention ) project in the Secure Anonymised Information Linkage Databank 2. Initial findings show that people were more likely to have been identified for inclusion in the shielding intervention with increasing age, frailty and residence in deprived areas; and that reported infection rate was higher in the shielded cohort than the non-shielded general population, though testing rates were higher and infection rates among those not tested in each cohort were unknown 3. We will also report how shielding affected deaths, healthcare utilisation, immunity status, National Health Service (NHS) costs and quality of life, and how people complied with guidance 4…”

Section: Introductionmentioning

confidence: 99%

Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study

et al. 2023

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IntroductionShielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the first year of the pandemic from March 2020. As the first stage in the EVITE Immunity evaluation (Effects of shielding for vulnerable people during COVID-19 pandemic on health outcomes, costs and immunity, including those with cancer:quasi-experimental evaluation), we generated a logic model to describe the programme theory underlying the shielding intervention.Design and participantsWe reviewed published documentation on shielding to develop an initial draft of the logic model. We then discussed this draft during interviews with 13 key stakeholders involved in putting shielding into effect in Wales and England. Interviews were recorded, transcribed and analysed thematically to inform a final draft of the logic model.ResultsThe shielding intervention was a complex one, introduced at pace by multiple agencies working together. We identified three core components: agreement on clinical criteria; development of the list of people appropriate for shielding; and communication of shielding advice. In addition, there was a support programme, available as required to shielding people, including food parcels, financial support and social support. The predicted mechanism of change was that people would isolate themselves and so avoid infection, with the primary intended outcome being reduction in mortality in the shielding group. Unintended impacts included negative impact on mental and physical health and well-being. Details of the intervention varied slightly across the home nations of the UK and were subject to minor revisions during the time the intervention was in place.ConclusionsShielding was a largely untested strategy, aiming to mitigate risk by placing a responsibility on individuals to protect themselves. The model of its rationale, components and outcomes (intended and unintended) will inform evaluation of the impact of shielding and help us to understand its effect and limitations.

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The cost of implementing the COVID-19 shielding policy in Wales

Sewell,

Farr,

Akbari

et al. 2023

BMC Public Health

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Background The EVITE Immunity study investigated the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, United Kingdom, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report the cost of implementing shielding in Wales. Methods The number of people shielding was extracted from the Secure Anonymised Information Linkage Databank. Resources supporting shielding between March and June 2020 were mapped using published reports, web pages, freedom of information requests to Welsh Government and personal communications (e.g. with the office of the Chief Medical Officer for Wales). Results At the beginning of shielding, 117,415 people were on the shielding list. The total additional cost to support those advised to stay home during the initial 14 weeks of the pandemic was £13,307,654 (£113 per person shielded). This included the new resources required to compile the shielding list, inform CEV people of the shielding intervention and provide medicine and food deliveries. The list was adjusted weekly over the 3-month period (130,000 people identified by June 2020). Therefore the cost per person shielded lies between £102 and £113 per person. Conclusion This is the first evaluation of the cost of the measures put in place to support those identified to shield in Wales. However, no data on opportunity cost was available. The true costs of shielding including its budget impact and opportunity costs need to be investigated to decide whether shielding is a worthwhile policy for future health emergencies.

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Did the UK's public health shielding policy protect the clinically extremely vulnerable during the COVID-19 pandemic in Wales? Results of EVITE Immunity, a linked data retrospective study

Cited by 3 publications

References 23 publications

Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study

Impact of COVID-19 on immunocompromised populations during the Omicron era: insights from the observational population-based INFORM study

Rationale for the shielding policy for clinically vulnerable people in the UK during the COVID-19 pandemic: a qualitative study

The cost of implementing the COVID-19 shielding policy in Wales

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