BMJ Editorial: Managing individual and population risk of Covid-19

An editorial in BMJ (British Medical Journal) online calls for greater clarity over who should be shielding from covid-19. One of the authors is: Dr Stephen Bradley, a Clinical Research Fellow at the University of Leeds. He is also a GP in Leeds. 

Government advice to people who are clinically extremely vulnerable to shield themselves from the coronavirus infection is confusing, according to the editorial.

The authors said the prolonged social isolation recommended for some people at high risk is likely to have an impact on people’s “physical and mental wellbeing” and the official guidance needs to be clearer about who it applies to, the specific steps individuals need to take and the evidence to support those measures.

They write in the editorial: “The prolonged confinement endured by the millions who are shielding is likely to come with significant costs to quality of life and could plausibly engender lasting impairments physical and mental wellbeing.   

“Decisions on shielding should be informed by individuals’ own values and priorities along with the stock they place in the guidance.... Many will make an entirely appropriate judgement that their best interests are served by continuing to venture outdoors.”

There are two clinically vulnerable groups: those at moderate risk, which includes people over 70, pregnant women and individuals who have medical conditions that would mean they would qualify for the flub jab.

The second group is those at high risk of becoming very ill if they were to contract covid-19. They include people with severe respiratory diseases, some cancers and transplant recipients. The advice to this group is to stay at home.  

The editorial argues: “Many people have been placed in this group erroneously and received letters advising them to shield Some of those who were advised to shield have subsequently been informed by text message that they are no longer required to do so leaving them uncertain as to what advice they should follow.

“Separate briefings to clinicians have advised that additional groups, such as patients on renal dialysis or those with a history of splenectomy, should also shield, although these categories are yet to be added to the government’s website"

Evidence is also emerging of the increased risks faced by people from black, Asian and minority ethnic backgrounds who are suffering from hypertension and diabetes.

Given the uncertainty, the authors said maintaining the trust of people "requires clear and consistent communication" and "openness about uncertainty".The full editorial article is attached and can be downloaded here