From John in Brighton: Shielding – To be or not to be?

20 June

How do you link “shielding”, a packet of biscuits and a sharp rebuke? The obvious answer is too much comfort eating but you’d be wrong. My daughter spotted gluten-free biscuits on the shopping list I gave her last week and leaving no stone unturned a third degree ensued on why (I’m not gluten-intolerant), who was coming over, indoors or out, how many people…? Definitely won’t be in the house I reassured her but had to hedge a bit that there might be two people. Cue for a reprimand and brief homily on safest option being total abstinence of any social contact. Floundering on the ropes I point out that since 5 June shielders can spend time outside with someone from another household. A bit of Socratic irony from my son “Do you trust everything the government says?” “Well no actually” and that’s as good as a knockout punch. Case won in favour of the prosecution.
Strictly speaking they are right and what is clear is that their sentiments are entirely well-meaning and out of concern for my health and welfare. But equally after nearly three months the shielding does take its toll and that’s despite my going out on my bike (with social distancing) to maintain my sanity. I’m blessed with a garden but even so the glorious weather exacerbates the frustration. And to rub a bit of salt into the wounds we see progressive relaxation of lockdown for swathes of people up and down the land. But perhaps that reinforces the importance of ongoing shielding – a second wave is always potentially waiting to pounce like an angry cat.
Some shielders and indeed some support groups talk of an increasing two-tier society and the shielders’ desire to return to some sort of normal life. There is speculation this week that imminent changes could include the abolition of the need for shielders to isolate at home from the end of July and based entirely on clinical evidence.. But let’s remind ourselves we are the “extremely vulnerable” (sic). I’m a pensioner with additional health risks and an article in The Guardian a month ago starkly demonstrated how age was a key risk factor. The over-65’s are 34 times more likely to die from Covid than those of working age and 88% of the deaths were in the over-65s. 
So I acknowledge my offspring’s concern and that extreme vigilance is still the only guarantee of safety. The down-tick of cases and deaths should not induce any feelings of security and the case is made for ongoing shielding – short term pain for long term gain one hopes. I haven’t claimed the food parcels nor the prioritisation at supermarkets – it’s much more fundamental than the “perks”, it’s trying to minimise risk and maximise survival. Prolonged isolation can impact mood and mental health and if I were following Socrates I might be seeking out the hemlock by now. Instead I’ll turn to the meditations of Marcus (Aurelius not Rashford although the latter is clearly wiser and more proactive than BJ) and I think his advice would be similar to the offspring. Better to be the also-rans in a two tier society and it’s the utmost caution for the foreseeable future – “Carry on Shielding” is the one they never made so where’s Kenneth Williams when you need him?

from David Vincent in Shrewsbury, UK: unshielding

June 1.So, a new month, the beginning of meteorological Summer, and the un-lockdown begins. 

There is a special concession for the ‘shielded’, who, like me, have not been out of their house and garden since the last week of March (except for a medical check-up).  My thanks to David Maughan Brown for pointing out the irritating misuse of the verb ‘shield.’  On the other hand, ‘extremely vulnerable’ would appear to be a phrase with meaning.  Now we appear to be slightly less so.

The advice on the government website, updated yesterday, is as follows:

“People who are shielding remain vulnerable and should continue to take precautions but can now leave their home if they wish, as long as they are able to maintain strict social distancing. If you choose to spend time outdoors, this can be with members of your own household. If you live alone, you can spend time outdoors with one person from another household. Ideally, this should be the same person each time. If you do go out, you should take extra care to minimise contact with others by keeping 2 metres apart. This guidance will be kept under regular review.”

This is of course just for England.  Over the border, shielded or not, I can still be arrested if I drive more than five miles into Wales.  The change is scarcely a revolution, but it has raised two profound concerns. 

The first, which has been immanent throughout the crisis, is that the category of ‘extremely vulnerable’ covers a whole host of conditions. It places in the same situation those with only a marginal extra risk and those who should not be out of their home under any circumstances – coronavirus scarcely the only threat to those whose immune system is completely shot.  Without detailed medical advice, which is generally not available (as I know myself), it is next to impossible to make the judgment call about going out of doors.

The second is that the change, and the broader relaxation for the unshielded, is driven more by political convenience or economic urgency than by medical reality.  The ‘R’ rate is still perilously close to 1, and the improvements in the infection rate are at best patchy across England.  No one was convinced when the Number 10 briefing came out with the tortured explanation that the country, whilst at level 4 of risk (where everyone should be in lockdown) is ‘transitioning’ towards level 3.  Further, whilst London may be getting safer, the rest of the country is not necessarily doing so.  Over the last ten days, the infection rate for Shropshire has increased from 233.2 to 253.2.  The scores have also risen from 275.6 to 301.8 in nearby Stoke-on-Trent, and from 267.0 to 288.2 in Manchester. 

As critics have pointed out, we need a much more nuanced approach to the vulnerable, and we need in place an effective track and trace system before we make any significant change to the lockdown.  This was argued in an excellent article on Saturday by Devi Sridhar, chair of global public health at Edinburgh University, and her colleague Yasmin Rafiei:

“What we suggest instead is a general strategy of suppression, where governments make a commitment to keeping daily new cases as low as possible through an active testing-and-tracing programme and real-time monitoring of transmission. At the same time, the government should advise those in “shielded groups” about their individual risk, as well as provide them with data about transmission within their communities, and then leave these individuals to make an informed decision about how and when they would like to engage in society.”

Just so.

In the meantime, the changes are bringing some joy.

My five-year-old grandson was so pleased about the prospect of going back to school (four days a week from this Thursday) that during the hour-long family Zoom meeting on Sunday he insisted on wearing his school uniform throughout.

And I have a Finnish friend who tells me that in her country the relaxation of the two-metre rule has been welcomed, as it enables people to go back to their natural distancing of five metres.