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

H Snooks¹, A Watkins², J Lyons³, A Akbari⁴, R Bailey⁵, L Bethell⁶, A Carson-Stevens⁷, A Edwards⁸, H Emery⁹, B A Evans¹⁰, S Jolles¹¹, A John¹², M Kingston¹³, A Porter¹⁴, B Sewell¹⁵, V Williams¹⁶, R A Lyons¹⁷

Affiliations

¹ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: h.a.snooks@swansea.ac.uk.
² Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: a.watkins@swansea.ac.uk.
³ Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: j.lyons@swansea.ac.uk.
⁴ Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: a.akbari@swansea.ac.uk.
⁵ Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: r.bailey@swansea.ac.uk.
⁶ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: lesleybethell@gmail.com.
⁷ Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK. Electronic address: carson-stevensap@cardiff.ac.uk.
⁸ Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK. Electronic address: edwardsag@cardiff.ac.uk.
⁹ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: Helena.emery@swansea.ac.uk.
¹⁰ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: b.a.evans@swansea.ac.uk.
¹¹ Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Electronic address: jollessr@cardiff.ac.uk.
¹² Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: a.john@swansea.ac.uk.
¹³ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: m.r.kingston@swansea.ac.uk.
¹⁴ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: A.M.Porter@swansea.ac.uk.
¹⁵ Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: b.diethart@swansea.ac.uk.
¹⁶ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: v.a.williams@swansea.ac.uk.
¹⁷ Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: r.a.lyons@swansea.ac.uk.

PMID: 36933354
PMCID: PMC9928733
DOI: 10.1016/j.puhe.2023.02.008

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

H Snooks et al. Public Health. 2023 May.

. 2023 May:218:12-20.

doi: 10.1016/j.puhe.2023.02.008. Epub 2023 Feb 15.

Authors

Affiliations

¹ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: h.a.snooks@swansea.ac.uk.
² Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: a.watkins@swansea.ac.uk.
³ Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: j.lyons@swansea.ac.uk.
⁴ Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: a.akbari@swansea.ac.uk.
⁵ Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: r.bailey@swansea.ac.uk.
⁶ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: lesleybethell@gmail.com.
⁷ Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK. Electronic address: carson-stevensap@cardiff.ac.uk.
⁸ Cardiff University, Division of Population Medicine, Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, UK. Electronic address: edwardsag@cardiff.ac.uk.
⁹ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: Helena.emery@swansea.ac.uk.
¹⁰ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: b.a.evans@swansea.ac.uk.
¹¹ Immunodeficiency Centre for Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. Electronic address: jollessr@cardiff.ac.uk.
¹² Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: a.john@swansea.ac.uk.
¹³ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: m.r.kingston@swansea.ac.uk.
¹⁴ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: A.M.Porter@swansea.ac.uk.
¹⁵ Swansea University, School of Health and Social Care, Vivian Tower, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: b.diethart@swansea.ac.uk.
¹⁶ Swansea University, Medical School, ILS 2, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: v.a.williams@swansea.ac.uk.
¹⁷ Population Data Science, Swansea University, Medical School, Data Science Building, Singleton Park, Swansea, SA2 8PP, UK. Electronic address: r.a.lyons@swansea.ac.uk.

PMID: 36933354
PMCID: PMC9928733
DOI: 10.1016/j.puhe.2023.02.008

Erratum in

Corrigendum to "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 218 (2023) 12-20].
Snooks H, Watkins A, Lyons J, Akbari A, Bailey R, Bethell L, Carson-Stevens A, Dale J, Edwards A, Emery H, Evans BA, Jolles S, John A, Kingston M, Porter A, Sewell B, Williams V, Lyons RA. Snooks H, et al. Public Health. 2023 Sep;222:229. doi: 10.1016/j.puhe.2023.06.001. Epub 2023 Jul 16. Public Health. 2023. PMID: 37463828 Free PMC article. No abstract available.

Abstract

Introduction: The UK shielding policy intended to protect people at the highest risk of harm from COVID-19 infection. We aimed to describe intervention effects in Wales at 1 year.

Methods: Retrospective comparison of linked demographic and clinical data for cohorts comprising people identified for shielding from 23 March to 21 May 2020; and the rest of the population. Health records were extracted with event dates between 23 March 2020 and 22 March 2021 for the comparator cohort and from the date of inclusion until 1 year later for the shielded cohort.

Results: The shielded cohort included 117,415 people, with 3,086,385 in the comparator cohort. The largest clinical categories in the shielded cohort were severe respiratory condition (35.5%), immunosuppressive therapy (25.9%) and cancer (18.6%). People in the shielded cohort were more likely to be female, aged ≥50 years, living in relatively deprived areas, care home residents and frail. The proportion of people tested for COVID-19 was higher in the shielded cohort (odds ratio [OR] 1.616; 95% confidence interval [CI] 1.597-1.637), with lower positivity rate incident rate ratios 0.716 (95% CI 0.697-0.736). The known infection rate was higher in the shielded cohort (5.9% vs 5.7%). People in the shielded cohort were more likely to die (OR 3.683; 95% CI: 3.583-3.786), have a critical care admission (OR 3.339; 95% CI: 3.111-3.583), hospital emergency admission (OR 2.883; 95% CI: 2.837-2.930), emergency department attendance (OR 1.893; 95% CI: 1.867-1.919) and common mental disorder (OR 1.762; 95% CI: 1.735-1.789).

Conclusion: Deaths and healthcare utilisation were higher amongst shielded people than the general population, as would be expected in the sicker population. Differences in testing rates, deprivation and pre-existing health are potential confounders; however, lack of clear impact on infection rates raises questions about the success of shielding and indicates that further research is required to fully evaluate this national policy intervention.

Keywords: COVID-19; Pandemic.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Cohort recruitment flowchart.

See this image and copyright information in PMC

References

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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

Affiliations

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

Authors

Affiliations

Erratum in

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical