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NEWS

No Evidence That
Shielding the
Vulnerable Reduced
COVID Infections
Sheena Meredith, MB BS, MPhil | Disclosures | 01 May 2023

The previously untested pandemic policy of 'shielding'

vulnerable people to reduce their risk of infection during
the pandemic had no clear impact on infection rates. That
conclusion, drawn from a new study by researchers from
Swansea University, was based on data from Wales, but
"as shielding policy was similar across the UK", the
findings were "of relevance in other countries too", they
said.  

CONTINUE READING BELOW

PI & AE REPORTING

Inclisiran is indicated in adults with primary

hypercholesterolaemia (heterozygous familial and non-familial)
or mixed dyslipidaemia, as an adjunct to diet: in combination
with a statin or statin with other lipid-lowering therapies in
patients unable to reach LDL-C goals with the maximum
tolerated dose of a statin, OR alone or in combination with other
lipid-lowering therapies in patients who are statin-intolerant, or
for whom a statin is contraindicated.1

Leqvio® Summary of Product Characteristics.

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The shielding policy was introduced in March 2020 in an

attempt to protect those thought to be at highest risk of
serious harm should they catch COVID-19. Those targeted
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serious harm should they catch COVID-19. Those targeted

had existing conditions such as cancer, severe respiratory
disorders, or diseases requiring immunosuppressive
treatment. They were sent personal communications by
letter, text, or email strongly advising them to stay at
home and to self-isolate for at least 12 weeks, including
from anyone – even family members – sharing the same
premises.

Policy Introduced 'Without Evidence'

In the new study, published in Public Health, researchers
said the policy was introduced "without prior evidence of
effects on health outcomes, costs or behaviour". So they
conducted a linked data retrospective study using
electronic health records routinely collected for the entire
Welsh population, and compared the 117,415 people told
to shield with the rest of the population (3,086,385) who
were not.

The largest clinical categories in the shielded cohort

were: severe respiratory conditions (35.5%),
immunosuppressive therapy (25.9%) and cancer (18.6%).
People in the shielded cohort were more likely to be
female, aged 50 years and older, living in relatively
deprived areas, care home residents, and frail. The
authors noted that although people living in care homes
were intended to be excluded from shielding, they found
more than 1000 care home residents in the shielded
cohort, almost double the proportion of care home
residents in the general population.

PI & AE REPORTING

Inclisiran is indicated in adults with primary

hypercholesterolaemia (heterozygous familial and non-familial)
or mixed dyslipidaemia, as an adjunct to diet: in combination
with a statin or statin with other lipid-lowering therapies in
patients unable to reach LDL-C goals with the maximum
tolerated dose of a statin, OR alone or in combination with other
lipid-lowering therapies in patients who are statin-intolerant, or
for whom a statin is contraindicated.1

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Leqvio® Summary of Product Characteristics.

ADVERTISEMENT

As expected given that the shielded cohort were sicker

than the general population, they had higher overall rates
of death and of healthcare utilisation. However when the
team examined COVID-19 infections, deaths, and
admissions to hospital and intensive care, the infection
rate was only marginally higher in the shielded cohort
(5.9%) than in the general population (5.7%), even though
the proportion of shielded people tested for COVID-19
was higher (odds ratio 1.616; 95% CI 1.597 to 1.637).

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Study Raises Questions About the

Benefit of Shielding
The authors said: "Lack of clear impact on infection rates
raises questions about the success of shielding." 

Helen Snooks, professor of health services research at

Swansea University Medical School, who led the
research, said: "Our study found no evidence of reduced
COVID-19 infections one year after shielding was
introduced. This raises questions about the benefits of

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shielding for vulnerable people as a policy."  

The authors noted: "Shielding was an untested public

health policy that was introduced in the United Kingdom
early in the pandemic," and "was based on assumptions
rather than evidence of effectiveness".  

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Professor Snooks added: "Work is ongoing to compare

these outcomes, as well as self-reported quality of life,
with a matched group of people who were clinically
vulnerable, but not selected for shielding. 

"Having as much evidence as possible about the effect of

policies is essential if we are to learn lessons for the
future."

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The project, known as EVITE Immunity, was funded

through the National Core Studies Immunity Programme
and commissioned by Birmingham University on behalf of
UKRI. It involves collaborations with Cardiff University,
Warwick University, Welsh Government, and NHS Wales.
The authors declared that they have no competing
interests.

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 References
Snooks H, Watkins A, Lyons J, et al. Did the UK's public health shielding policy
protect the clinically extremely vulnerable during the COVID-19 pandemic in
Wales? Results of EVITE Immunity, a linked data retrospective study. Public Health.
2023;218:12-20.DOI:10.1016/j.puhe.2023.02.008

Lead image credit: iStock/Getty Images

© 2023 WebMD, LLC

Send comments and news tips to uknewsdesk@medscape.co.uk.

Cite this: Sheena Meredith, MB BS, MPhil. No Evidence That Shielding the Vulnerable Reduced
COVID Infections - Medscape - 01 May 2023.

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