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

Introduction

At the beginning of the Covid pandemic, we identified the people at the highest risk of severe illness from Covid-19. This was drawn up and approved by the four Chief Medical Officers across the UK, based on the list of health conditions thought to put people at the highest risk of severe illness and death if they caught the virus.

The restrictions that applied to the general population were aimed at reducing the spread of the virus, protecting the population and protecting our health service. But shielding, as it became known, is about saving the lives of the people most at risk. We asked those people to take the most stringent steps to protect themselves. We advised you to stay inside and even limit contact with other people in your households to reduce the chance of infection. Since the end of March, about 180,000 people have been asked to shield – over 3% of the Scottish population. We put support measures in place to help you, including, but not limited to, deliveries of food and medication.

Who has been asked to shield?

Shielding is incredibly difficult to do, so only those who were thought to be at the highest risk were advised to do it. If you are in this group you will have received a letter from the Chief Medical Officer advising you to shield and telling you what support was in place for you to do so. Your GP or clinician will also have contacted you to discuss what this means for you and how to minimise the negative impacts it can have on you.

The highest risk group includes the following people:

• Solid organ transplant recipients
• People with specific cancers
• People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe Chronic Obstructive Pulmonary Disease (COPD), severe bronchiectasis and pulmonary hypertension.
• People with rare diseases including all forms if interstitial lung disease/sarcoidosis and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell disease)
• People on immunosuppression therapies sufficient to significantly increase risk of infection or who have had their spleens removed
• People who are pregnant with significant heart disease, congenital or acquired
• People who are receiving renal dialysis treatment

You can find further details on these groups, and how they are identified, online: https://www.gov.scot/publications/covid-shielding/pages/highest-risk-classification/]. You can also find the latest clinical advice on shielding on NHS Inform: https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/coronavirus-covid-19/coronavirus-covid-19-shielding#overview.

We know that following the advice to shield has been extremely difficult. We have been listening to people who are shielding, to understand your experiences, hear what support you need, and gather suggestions. We need to heed this feedback if we are to chart a way forwards.

Most people interviewed describe a negative impact of shielding on their mental health – from social isolation, and feelings of guilt about the impact of their conditions on family. They also describe a profound sense of loss as their quality of life has diminished, as well as disempowerment, anxiety and of course a fear of contracting Covid. But shielding does not just impact on the person who is shielding, everyone around them is affected too. People are having to take life-changing decisions to follow advice which is not easy to comply with, especially if you have dependents, partners in work, if you need physical support or hands-on physio, or if your home does not easily allow you your own separate space.

While shielding has been stressful, many people are feeling very anxious about what happens after the initial 12 weeks, and many are asking 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 whilst maintaining the necessary protections for safety. This document applies to people who have received a letter from the Chief Medical Officer advising them to shield, but does not apply to people currently living in residential care and nursing homes.