Coronavirus (COVID-19): shielding - a way forward for Scotland

Summary

The aim of shielding is to protect people who are at greatest risk of severe illness if they catch COVID-19. But asking people to stay at home and minimise all contact with others for a long period of time can significantly impact on quality of life as well as mental and physical health. Having shielded for almost 12 weeks, many people are feeling very anxious about what will happen next. They are eager to resume their lives but unsure how shielding can end while the virus continues to exist in our communities.

The purpose of this document is to start answering those questions, and chart a possible route out of shielding that allows more freedom while keeping those most at risk safe.

The future of shielding is closely linked to the success in our broader strategy of controlling the virus through the route map and Test and Protect. As the virus is brought under control it will become safer for those who have been shielding to gradually get back to day to day life.

We have promised that our advice on shielding must be right for Scotland and evidence-based. We are therefore making two changes to the shielding advice, both of which have been agreed on the recommendation of our clinical and scientific advisory groups. Firstly, we are extending the shielding advice to 31 July. Secondly, if infection rates are low enough, we will advise that people shielding can go outside for exercise from 18 June.

The original advice was to shield for at least 12 weeks, which comes to an end on 18 June. The levels of infection in the community are now significantly lower than they were in March, but the evidence suggests that it is advisable that people with the highest clinical risk should continue to shield. Having set out to save lives it does not feel right to prematurely end shielding until we are confident the evidence supports it.

However, we are very aware that shielding is difficult and it is not sustainable in the long term. The longer people are advised to shield, the greater impact it will have on their physical and mental health, on their relationships with their families and loved ones and on their quality of life. We are monitoring these impacts and constantly weighing up these harms against the benefits of shielding.

Moving to a new approach for shielding

We are learning about the virus all the time, and in particular about the factors that increase or reduce the risk to particular people. Because different things matter to different people, we need to move towards the idea of enabling those who are shielding to make choices about how to do it. In the course of the summer, once the evidence base has been developed, we will:

• Provide people with updated clinical evidence about their conditions and what that means for their risk from Covid,
• Help those shielding understand the changing levels of infection in the community and how to reduce the chance of catching the virus
• Provide that information in a way that is accessible, understandable and helpful,
• Give people who are shielding access to support that can help them make informed choices about their lives,
• Support people shielding to put their choices into practice.

These choices have a tremendous impact on the lives of people shielding and also on the lives of their loved ones. That's why it's important that we do everything we can to make sure they have the chance to consider what matters to them.

We will continue to advise people shielding in an honest and open way, and we promise that advice will always be based on the best evidence we have.

This approach is dependent on us understanding as much as possible about the chances of people shielding catching the virus and the risk to them if they do. The evidence to support this is growing but we need to be sure it is robust enough before we start using it to change our approach. There is coordinated work being carried out across the four nations to gather this evidence and we hope that we will start to see the benefits of that over the course of
the summer.

Extension to shielding

We are advising people to continue to shield until at least 31st July. That is because, although infection rates are much lower than they were at the start of lockdown, we are not yet confident that it is safe enough to change our advice.

During this time we will continually review this advice and monitor Covid infection levels to make sure it remains the correct decision. We will continue to balance this against the harms caused by shielding. People who are shielding will continue to receive the support they have been getting, whether that be free weekly food boxes, access to priority supermarket delivery slots, pharmacy deliveries, or other support through Local Authorities.

However, we understand that it is not fair to continue to ask people to stay at home all the times, especially as restrictions are eased for everyone else. This is why we will be looking
for ways to gradually ease the guidance for shielding people if clinicians and scientists advise it is safe.

Outdoor Exercise

We will start by making a change to the advice on going outdoors for exercise.

We anticipate that people shielding will be able to take exercise outdoors from 18 June.

However, we will confirm this on 18 June based on the evidence. This also will not apply to people living in nursing or residential care homes – we are not yet confident this
is safe.

If you have been advised to shield and wish to go outside for exercise after 18 June, you should take the following precautions:

Go outdoors for a walk, wheel, run or cycle. We do not recommend that you take part in outdoor activities such as golf, hiking, canoeing, outdoor swimming, angling, etc. in the same way as the rest of the population can just now. You:

• Can go out on your own or with someone you live with
• Should maintain strict physical distancing, also known as social distancing, at all times, even if you live with the person you're out with. This means keeping 2 metres (or three steps) away from other people at all times
• Should not meet with anyone you do not live with
• Should choose times and areas that are quiet, if you can
• Should wash your hands for at least 20 seconds as soon as you get back home

Future Changes to Advice

We do not intend to advise you to shield completely for any longer than necessary without further changes. We will set out updated guidance for you by 31 July at the latest. However, between now and then – and in addition to the changes we are signalling now on outdoor exercise – we will make further changes if it is safe to do so.

We want to gradually provide advice on how you can increase your freedoms, as we have done for those who are not shielding. We are continually monitoring the virus and as soon as we think it is safe for you to do something, we will update our advice. And as soon as we can provide you with information that will allow you to understand your own risk and make decisions about what is right for you, we will do so.

As we progress through the route map there will increasingly be need that the wider public recognises their role in keeping those shielding safe, in particular in supporting people shielding to regain some normality in their life, just as the wider public have been able to.