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expert reaction to new advice for people who are clinically extremely vulnerable

The government have released new advice for people who are clinically extremely vulnerable to COVID-19.


Dr David Strain, Senior Clinical Lecturer, University of Exeter, said:

“The suggestion that the extremely clinically vulnerable do not require any additional measures to protect them flies in the face of yesterday’s announcements by both the Chief and Deputy-Chief Medical Officers. Professor Van-Tam described his alarm that transmission rates had apparently increased over the weekend, and how that the virus was already moving into older adults whilst the current “Rule of 6”  was in force. Professor Whitty stated that he was “not confident” that the existing measures in Tier 3 situations were sufficient to get on top of it. If the UK’s top doctors believe that more is required for the general population, surely as a bare minimum those at the greatest risk from adverse outcomes should be offered protection. Suggesting the “rule of 6” and wearing a standard cloth face covering is sufficient, when number continue to climb since their introduction a month ago, is at best a distortion of the truth.

“Failure to offer the additional support for the extremely clinically vulnerable fails to recognise the consequences of the social isolation that many are currently experiencing. In our experience, the majority of people who were previously notified of the need to shield have continued to function with the minimum amount of risk possible rather than the maximum permitted. For these, today’s announcement will have little impact on their behaviour, whether shielding is recommended or not. The most significant conclusion that can be drawn from the announcement is that there is a reluctance to support the physical and mental health of the clinically vulnerable.” 


Dr Stephen Griffin, Associate Professor, School of Medicine, University of Leeds, said:

“Shielding was implemented as a result of the SARS-CoV2 epidemic in the UK getting out of control in the spring and then ended, somewhat arbitrarily, at the start of August. The principle was twofold: to effectively isolate those most at risk from severe COVID-19 from infection, and to provide legislative, practical and financial support to those needing to take this action. The latter ensured that shielders theoretically had no need to fear for their jobs, and could access community resources to help them through lockdown and the period thereafter.

“Shielding was therefore effectively an emergency response, rather than any kind of long term strategy. The psychological, societal and sometimes physical cost of the process was, and is, not to be underestimated. However, balanced with this is the need to protect the vulnerable from COVID, which made it somewhat unclear as to why the programme was paused in August when the virus remained in circulation. Following this, whilst some shielders have been able to maintain this practice at least in part, many have had to return to normal practices, accepting a considerable level of risk as the nation unlocked over the summer.

“As we see cases accelerating back towards the levels last seen in March, a similar story for hospital admissions, and the number of severe and lethal cases also increasing, one might logically question why shielding has not been re-introduced en masse based upon whatever obscure criteria were relevant in August. The report rightly considers the toll shielding takes on people and emphasises that choice remains an important element for people with long term health conditions; this is especially important as chronic illness can remove many of the everyday advantages that the majority of us take for granted.

“Nevertheless, it is impossible not to be genuinely torn in two between the anguish and fear people must face as SARS-CoV2 is in resurgence with the equally powerful frustration that more has not been done to ensure that shielders can return to a version of normality, as can also be argued for the rest of the British population. The ONLY way to achieve such safety is to suppress virus transmission and maintain this through an effective testing and tracing programme, as advised by many prominent public health experts. We have also seen from countries such as Taiwan, South Korea and New Zealand that this strategy ensures economic stability and far less damage to GDP, compared with the constant uncertainty of other incoherent and reactive policies. However, neither of these objectives were achieved in the UK over the summer, which represented our best opportunity to do so, as a result of attempting to achieve a half-way house to satisfy both economic and public health/scientific lobbies. Sadly, by trying to please everyone, it is clearly the case that nobody is happy with the present situation.

“The consequences for inaction in this matter are, put simply, profound when it comes to shielders. It seems that some would have this group “put back in their box” such that the rest of society can continue as normal – apparently avoiding any unpleasant consequences of SARS-CoV2 infection whilst mysteriously achieving the first documented worldwide control of a pandemic via naturally acquired herd immunity. Others dismiss shielders and other victims of COVID as being likely to die anyway, and that the virus merely hastens this process, generating interesting statistical anomalies. This inhumane, selfish and uncaring approach speaks to some of the worst aspects of human behaviour, in my opinion. We are obliged to find a better solution than making the problem disappear from view – this would not be the action of a civilised society.

“Shielders lived lives before this pandemic worth just as much as anybody else’s; they have families, friends and contribute to society. Moreover, the lives of shielders are just as diverse, complex and stressful as anyone else, perhaps more so, and they ought not to be generalised into a convenient group where their health concerns circumvent all others. It may be that the current situation requires shielding to commence once again out of necessity, but I call upon those in responsibility to genuinely consider the costs of doing so, and to prioritise this group as they contemplate their objectives during this dreadful pandemic.”


Sarah MacFadyen, Head of Policy at Asthma UK and the British Lung Foundation, said:

“For the 500,000 people with lung conditions who have previously been shielding and have been anxiously waiting for this news, the lack of detail and timelines as well as the news that those in ‘exceptionally high risk’ areas may still be advised to adopt formal shielding in the future, will be devastating.

“We need urgent clarity from the government as to exactly how and when people with severe lung disease, will be able to access this tailored guidance, particularly those in high and very high alert areas. Crucially, we need answers now for those people who cannot work from home to know how their income will be protected if they are advised not to go into work. More than six months on, people are still being asked to make the impossible choice between health and financial security.

“We are told again today that people who are defined as clinically extremely vulnerable are at very high risk of severe illness from COVID-19.  Yet it’s not clear how they will be able to access the support they need to be able to feed themselves and get access to vital medicines, particularly if help is not coming from local authorities or they are not eligible for benefits.”


Prof Mark Woolhouse, Professor of Infectious Disease Epidemiology, University of Edinburgh, said:

“The new advice to those clinically most vulnerable to COVID-19 indicates that the government is starting to pay attention to those who will suffer most during this second wave of infection. 

“Given that levels of infection are still rising and when they do start to decline are unlikely to go down any faster than they went up. As a result, there is every likelihood that most of those who will be hospitalised or will die during this wave are yet to be infected. Lockdown measures, if successful, can do no more than prevent the burden increasing even further. 

“In my view, there is now a public health imperative to provide additional protection to those at increased risk, and the new advice is a step in this direction. 

“If the government wished to take further steps to save lives it could extend its advice more widely to encompass more of those at increased risk – the elderly, the frail and those with co-morbidities. It could also offer advice and support to those who live with, care for, or are otherwise in regular contact with this group of people. 

“Managing the public health burden of COVID-19 is not just about reducing the R number.”


All our previous output on this subject can be seen at this weblink:


Declared interests

Dr Stephen Griffin: No conflicts

Prof Mark Woolhouse: No CoIs to declare.

None others received.

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