Managing individual and population risk from covid-19

Bradley, Stephen H; Kirby, Elizabeth Ann; Wheatstone, Pete

doi:10.1136/bmj.m2098

Cited by 8 publications

(7 citation statements)

References 3 publications

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“…Conversely, it has also been reported that some patients initially advised to shield were later informed by text message of no longer needing to do so, fueling uncertainty on what advice to follow. The positive association with increasing age reflects widespread misunderstanding about who shielding advice applied to, with some headlines calling on the government to “set free” healthy individuals aged over 70 years [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study

Bachtiger¹,

Adamson²,

Maclean³

et al. 2021

JMIR Public Health Surveill

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Background The UK National Health Service (NHS) classified 2.2 million people as clinically extremely vulnerable (CEV) during the first wave of the 2020 COVID-19 pandemic, advising them to “shield” (to not leave home for any reason). Objective The aim of this study was to measure the determinants of shielding behavior and associations with well-being in a large NHS patient population for informing future health policy. Methods Patients contributing to an ongoing longitudinal participatory epidemiology study (Longitudinal Effects on Wellbeing of the COVID-19 Pandemic [LoC-19], n=42,924) received weekly email invitations to complete questionnaires (17-week shielding period starting April 9, 2020) within their NHS personal electronic health record. Question items focused on well-being. Participants were stratified into four groups by self-reported CEV status (qualifying condition) and adoption of shielding behavior (baselined at week 1 or 2). The distribution of CEV criteria was reported alongside situational variables and univariable and multivariable logistic regression. Longitudinal trends in physical and mental well-being were displayed graphically. Free-text responses reporting variables impacting well-being were semiquantified using natural language processing. In the lead up to a second national lockdown (October 23, 2020), a follow-up questionnaire evaluated subjective concern if further shielding was advised. Results The study included 7240 participants. In the CEV group (n=2391), 1133 (47.3%) assumed shielding behavior at baseline, compared with 633 (13.0%) in the non-CEV group (n=4849). CEV participants who shielded were more likely to be Asian (odds ratio [OR] 2.02, 95% CI 1.49-2.76), female (OR 1.24, 95% CI 1.05-1.45), older (OR per year increase 1.01, 95% CI 1.00-1.02), living in a home with an outdoor space (OR 1.34, 95% CI 1.06-1.70) or three to four other inhabitants (three: OR 1.49, 95% CI 1.15-1.94; four: OR 1.49, 95% CI 1.10-2.01), or solid organ transplant recipients (OR 2.85, 95% CI 2.18-3.77), or have severe chronic lung disease (OR 1.63, 95% CI 1.30-2.04). Receipt of a government letter advising shielding was reported in 1115 (46.6%) CEV participants and 180 (3.7%) non-CEV participants, and was associated with adopting shielding behavior (OR 3.34, 95% CI 2.82-3.95 and OR 2.88, 95% CI 2.04-3.99, respectively). In CEV participants, shielding at baseline was associated with a lower rating of mental well-being and physical well-being. Similar results were found for non-CEV participants. Concern for well-being if future shielding was required was most prevalent among CEV participants who had originally shielded. Conclusions Future health policy must balance the potential protection from COVID-19 against our findings that shielding negatively impacted well-being and was adopted in many in whom it was not indicated and variably in whom it was indicated. This therefore also requires clearer public health messaging and support for well-being if shielding is to be advised in future pandemic scenarios.

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Section: Discussionmentioning

confidence: 99%

Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study

Bachtiger¹,

Adamson²,

Maclean³

et al. 2021

JMIR Public Health Surveill

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“…While the use of this terminology might be dismissed as a minor semantic difference in an ocean of Covid neologisms, these words have nevertheless had a profound effect on how people have imagined and constructed their own sense of vulnerability and, in turn, self. Indeed, as Bradley et al have argued and returning to the question of agency raised earlier in this paper, “NHS correspondence that refers to people ‘being shielded’ rather than who ‘are shielding’ understates the autonomy of individuals in choosing how they wish to reduce their risk of infection” ( 2020 , p. 2). These linguistic choices also then place responsibility for the protection of those ‘being shielded’ on family, friends, the NHS, government and, often, the kindness of strangers.…”

Section: Creating Biosociality Ensuring Compliancementioning

confidence: 81%

“…This is more so because, despite now being a mainstreamed term in the UK, it has never been a commonly used public health or epidemiological term in the context of viral containment or pandemic response. Rather ‘shielding’—or more precisely the passive ‘being shielded’ that is most common in government guidance (Bradley et al 2020 )—is a political construct that cannot be considered apart from the rampant use of military metaphors by politicians and the media in talking and writing about Covid-19. As a letter to the British Medical Journal notes, “the UK shielding policy is unique internationally” (Evans 2021 ), even if it was arguably far from unique in its effectiveness.…”

Section: Creating Biosociality Ensuring Compliancementioning

confidence: 99%

‘We thank you for your sacrifice’: Clinical vulnerability, shielding and biosociality in the UK’s Covid-19 response

Herrick

2022

BioSocieties

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The UK response to Covid-19 has been unusually complex in its ever-shifting classifications of clinical vulnerability. By May 2020, 2.2 million people had been identified as ‘clinically extremely vulnerable’ (CEV) and were asked to ‘shield’ at home for over four months. To adhere to this strict guidance, they were enfolded within the patchy infrastructure of the ‘shielding programme’. However, membership of the ‘shielded list’ has changed—often without warning or explanation—through time and across space. Drawing on policy and evidentiary documents, government speeches, reports, press conferences and media analysis of Covid-19 coverage between March 2020 and April 1, 2021, this paper traces the shifting delineations of clinical vulnerability in the UK response across three lockdowns. It argues that the complexities and confusions generated by the transience of the CEV category have fed into forms of biosociality that have been as much about making practical sense of government guidance as a form of mutual support amid crisis. This uncertainty has not eased as restrictions have been relaxed and vaccines rolled out. Instead, tracing individual immune response has become a burgeoning industry as ‘the shielded’ navigate the uneasy demands of taking ‘personal responsibility’ rather than being protected by ‘the rules’.

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“…7 Further confusion has resulted from the chaotic process of identifying children who need to shield from COVID-19. 8 In our experience, many parents have felt compelled to keep their children at home as a means of regaining control during a time of uncertainty.…”

Section: What Are the Concerns Of Parents Children And Young People?mentioning

confidence: 98%

Working with communities to mitigate the collateral impact of COVID-19 on children and young people

Coughlan

Soni

Ghouneim

et al. 2020

bmjpo

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Managing individual and population risk from covid-19

Cited by 8 publications

References 3 publications

Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study

Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study

‘We thank you for your sacrifice’: Clinical vulnerability, shielding and biosociality in the UK’s Covid-19 response

Working with communities to mitigate the collateral impact of COVID-19 on children and young people

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