Coronavirus (COVID-19): framework for decision making - overview of public engagement

6. Changes to advice about visiting other households

Footnote^[12]

This chapter covers the specific proposal to allow households to visit each other within a defined group - a 'bubble'. Discussions centred on the following:

• Allowing meetings with other households
• Most 'at-risk' groups
• 'Shielded' groups

Allowing meetings with other households

There was clear desire expressed by many respondents to be able to meet with people outside their households. There were seen to be many benefits, in terms of mental health, morale, a sense of greater freedom and contact with friends and family. These were particularly acute in a number of circumstances:

• People in relationships, e.g. partners who lived in separate households and are not permitted to mix
• Grandparents having contact with grandchildren. This was seen as beneficial on a number of levels: mental health, reduced isolation for older people, potential childcare
• Children, particularly where they are the only child in a household or live with only one parent, as having interaction with peers would improve mental health and development
• Single-person households, including older people, who are currently isolated
• Those with poor mental health who may be particularly harmed by isolation

"Family contact is a must. Most people could happily endure the restrictions longer with this small change. I have a family member with severe and enduring mental health issues hurtling towards the point of no return. I have not broken the lockdown yet, but every day I consider it."

"Every time we come off FaceTime all 3 kids are upset and so [are] the grandparents. Seeing them over camera is totally different to seeing them in person and having small contact such as hug."

It was also argued that two single-person households should be allowed to 'buddy up' during lockdown to prevent isolation.

However there were mixed views on whether social contact between households should ultimately be permitted as there were concerns with how the intricacies of physical distancing within 'a bubble' could be communicated, and who is permitted to be in a bubble. Many thought policing bubbles would be difficult.

There was divergence in views about how many could be in a bubble, and whether they should be selected on the basis of individuals or households. Many correspondents argued that the decision on who to include in a bubble might be particularly stressful if people with larger social networks need to choose between different friends and family members. Furthermore, clarity was required on how far away bubble members can live from each other.

Once a bubble is established, there were many suggestions about what they could be permitted to do together, whether they should still be required to maintain physical distancing from each other, and whether multi-household bubbles could meet up if distant from each other. In addition there were questions about length and frequency of visits and how long bubbles could interact. Children would benefit from social interaction, but might find it more difficult to maintain physical distancing. The location of where bubbles could meet was discussed, whether this was only permissible in public spaces like parks, or could take place in gardens or driveways, which were argued to be equivalent in safety and could help limit overcrowding.

Concern was expressed that opportunities to meet up would be an excuse for wider-scale socialising, in defiance of the rules and increasing risk.

"It's for the greater good, and in fact it's to protect the older people that they are being shielded […] It's hard not to see your loved ones except on a screen but it's better than falling seriously ill or perhaps dying. And it won't be forever. Just please be so grateful if you and your loved ones are lucky enough to remain in good health. Then you will be able to spend time together in the future."

Still others may be completely excluded from bubbles and be further isolated. It was argued that socially distanced befriending schemes should be supported.

While many would welcome the increased flexibility of being able to interact with other households, others were concerned about the impact on most 'at-risk' and 'shielded' groups. This was in terms of their vulnerability if greater social interaction caused more circulation of the virus, but also their need to rely on services from strangers.

A number of respondents suggested that easing social contact restrictions should be combined with measures to make compliance more effective, such as communicating graphical presentations of how social contact is linked to transmission rates. An effective contact tracing strategy would also help control risk.

Most 'at-risk' groups

However, a significant strain of concern, evident in both responses to the platform and email communication to the Scottish Government, was the separation of most 'at-risk' groups from the rest of the society, perhaps until such time as a vaccine is widely available. People were worried that society might be opened up while restrictions remain for "the vulnerable". However, as noted in comments on the Scottish Government approach above, members of the most 'at-risk' group were not all the same. Groups identified by demographic, for example older people, contain a variety of healthy people well able to look after themselves, as well as more frail people requiring help. Similarly many people with underlying health conditions live active lives, especially if their condition is controlled.

In terms of who might have to stay under restrictions, there was a perceived lack of clarity as to what applied to the most 'at-risk' group and the 'shielded' group - who had been given more specific guidance to keep themselves completely isolated and not venture out. There were examples of people who believed themselves to be vulnerable, and therefore required to live in isolation, but who had not received letters from the NHS, and thus did not have evidence to show their employers.

Other respondents who were more recognisably most 'at-risk', e.g. over 80s, felt that they required support from health services which they weren't getting at this time. At the same time, as noted above, those in the wider most 'at-risk' group wanted more guidance on the actual level of risk associated with their conditions - and how it may apply cumulatively if they have multiple risk factors - so that they could make decisions about how to look after themselves.

'Shielded' groups

For those definitively in the 'shielded' group, there was still a desire to be able to go out and interact with others, and concern that the lockdown would continue for them while others resumed greater freedom.

"We need to find a way to 'take the shielded' with 'us' as we move tentatively out of complete lock down. Don't leave us behind in the cupboard shouting at us from a safe social distance 'that it is all for our own good'. Let us be the judge of that. To be clear, I don't want the government or agencies to focus on redoubling efforts to support our being shielded (locked in a cupboard)."

Many 'shielded' people wished to be allowed out to exercise, if necessary at set times, or with obvious ways of signalling they need to keep their distance (e.g. high-visibility vests). Other respondents worried about whether they would have to choose between isolating and being able to access other services, such as health, important to their wellbeing.

'Shielded' people were keen to be valued by society, and not "discarded" as other groups got on with life. In terms of the support available, many groups were concerned about their ongoing financial position, and whether a furlough scheme would continue for them, or other measures, such as a universal basic income.

Official ceremonies^[13]

A number of respondents called for wedding ceremonies to be resumed, with restrictions on guest numbers and clear social distancing advice. People emphasised the pain caused to couples who have been forced to delay their wedding, in particular couples who have decided not to live together or have children until they are married. Some suggested that marriage registration should be possible online, to limit physical interactions with staff.

"I am due to get married next month and I agree that introducing an alternative system for processing marriage applications would make such a huge difference. My fiancé is an NHS doctor working on one of the COVID-19 wards and the prohibition of new marriages has added even more strain during these already difficult times. We have chosen not to live together before marriage on the grounds of our religious beliefs, and not being able to see each other has made lockdown an even more painful experience. I am sure that as well as bringing lots of joy to couples currently waiting to marry, introducing an online system would also help to ease the load on registry offices who will have an enormous backlog to deal with once this pandemic is over."

A number of respondents also spoke about the pain caused by limitations on funeral numbers, and expressed concerns that people have been unable to properly grieve for loved ones. They argued that more people should be allowed to attend funerals as long as social distancing is adhered to. People felt that this would support grieving families, that crematoriums are big enough to allow for this, and people can take personal responsibility for adhering to physical distancing rules. Counter arguments were also made that, when grieving, people may not be able to take "personal responsibility" and that the virus won't respect the sanctity of a funeral.

"One of the cruellest restrictions in my opinion. Crematoriums etc. are big enough to allow social distancing and same household members can sit together."