Evaluation of the shielding initiative in Wales (EVITE Immunity): protocol for a quasiexperimental study

Abstract

IntroductionShielding aimed to protect those predicted to be at highest risk from COVID-19 and was uniquely implemented in the UK during the COVID-19 pandemic. Clinically extremely vulnerable people identified through algorithms and screening of routine National Health Service (NHS) data were individually and strongly advised to stay at home and strictly self-isolate even from others in their household. This study will generate a logic model of the intervention and evaluate the effects and costs of shielding to inform policy development and delivery during future pandemics.Methods and analysisThis is a quasiexperimental study undertaken in Wales where records for people who were identified for shielding were already anonymously linked into integrated data systems for public health decision-making. We will: interview policy-makers to understand rationale for shielding advice to inform analysis and interpretation of results; use anonymised individual-level data to select people identified for shielding advice in March 2020 and a matched cohort, from routine electronic health data sources, to compare outcomes; survey a stratified random sample of each group about activities and quality of life at 12 months; use routine and newly collected blood data to assess immunity; interview people who were identified for shielding and their carers and NHS staff who delivered healthcare during shielding, to explore compliance and experiences; collect healthcare resource use data to calculate implementation costs and cost–consequences. Our team includes people who were shielding, who used their experience to help design and deliver this study.Ethics and disseminationThe study has received approval from the Newcastle North Tyneside 2 Research Ethics Committee (IRAS 295050). We will disseminate results directly to UK government policy-makers, publish in peer-reviewed journals, present at scientific and policy conferences and share accessible summaries of results online and through public and patient networks.

Working with stakeholders to rapidly identify and prioritise COVID-19 health and social care evidence needs for evidence-informed policy and practice decision making: processes, results, and lessons from the Wales COVID-19 Evidence Centre

“…Some important themes were not covered by our work programme. Questions were submitted about shielding and COVID-19 bereavement, but through our networks we identi ed parallel Wales-based studies that were addressing these issues, (20,21) and so these were excluded to avoid duplication. Further, we received 11 questions relating to pandemic planning and learning, which were not covered by our work programme.…”

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

“…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 In line with the latest MRC guidelines on evaluating complex interventions, 5 the first stage of the EVITE Immunity study aimed to develop a programme theory to explain the intentions of the policy, making explicit all components of the intervention (defined here as being the shielding policy plus support programme), and representing these in a logic model, presented in this paper. Logic models can have a particular value in helping to articulate causality in the evaluation of public health interventions.…”

“…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…”

“… 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 …”

How much did the Covid-19 shielding policy cost in Wales? A Retrospective Cost analysis within the EVITE Immunity study

“…The 'EVITE Immunity' study aims to evaluate the costs and effects of the shielding policy on deaths, hospital and intensive care admissions and COVID-19 infections in the population identi ed for shielding compared to a similarly vulnerable group of non-shielded people using anonymised individual-level, population-scale routinely-collected data sources available within the Secure Anonymised Information Linkage (SAIL) Databank (Lyons et al 2020) trusted research environment (TRE). The study will also investigate the impact of shielding status on immunity, safety, health-related quality of life, anxiety, depression, and loneliness, as well as the NHS and local government costs of the shielding policy (Evans BA, et al 2022). The NHS and local government implementation costs of the shielding policy in Wales, United Kingdom, during the rst wave of shielding (March to June 2020) reported here, are the rst part of the evaluation of the costs and consequences of the shielding support programme in Wales.…”