Evaluation of the UK’s COVID-19 public health policy “shielding: results of a linked data matched cohort study

Snooks, H A, Akbari, A, Bethell, L, Carson-Stevens, A, Dale, J, Dixon, L, Edwards, A ORCID: https://orcid.org/0000-0002-6228-4446, Emery, H, John, A, John, G, Jolles, S, Lyons, J, Lyons, R A, Kingston, M R, Parab, R, Porter, A, Sewell, B, Watkins, A and Williams, V 2025. Evaluation of the UK’s COVID-19 public health policy “shielding: results of a linked data matched cohort study. Public Health 244 , 105736. 10.1016/j.puhe.2025.105736

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Abstract

Abstract Objective: To assess outcomes associated with shielding, introduced during the COVID-19 pandemic across the UK to protect those at highest risk of harm. Study Design: Linked data and questionnaires in matched cohorts from the population of Wales, UK. Methods: We compared individual-level linked routine and self-reported outcomes between people identified for shielding (n = 123,293) and comparators (n = 120,997) matched by age, sex, and previous health service utilization. We sent questionnaires to 1500 randomly sampled people in each cohort. Results: At one year, 6.1% of shielded people had contracted SARS-CoV-2 compared to 6.2% in the matched cohort (Adjusted Odds Ratio [AOR] 0.970; 95% confidence interval [CI] 0.937 to 1.004). Suspected healthcare-associated infections were more likely in shielded people (1.1% vs 0.6%; AOR 1.678; 95% CI 1.529 to 1.842). All-cause and COVID-19 related deaths were higher in the shielded cohort (7.0% vs 3.5%; AOR 2.280; 95% CI 2.190 to 2.374; and 1.1% vs 0.8%; AOR 1.430; 95% CI 1.308 to 1.563, respectively). About one-third completed questionnaires (n = 1015), with linkage possible in 752 cases (shielded: n = 411; matched: n = 341). Shielded respondents reported lower physical and mental health (SF12 PCS difference: −3.752; 95% CI −4.823 to −2.682; SF12 MCS difference: −1.217; 95% CI −2.580 to 0.145). They were more likely to have strictly avoided contact; stayed at home; felt scared to go outside; and were less likely to have gone out for shopping, leisure, or travel. Conclusion: We found no evidence of a protective effect of shielding on SARS-CoV-2 infections or COVID-19 related mortality, an increased rate of hospital-acquired infections, and increased self-isolation. Shielding during a future pandemic should only be considered alongside effective measures to reduce healthcare-associated infections.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Medicine
Publisher:	Elsevier
ISSN:	0033-3506
Funders:	NCSi4P
Date of First Compliant Deposit:	23 May 2025
Date of Acceptance:	17 April 2025
Last Modified:	23 May 2025 14:30
URI:	https://orca.cardiff.ac.uk/id/eprint/178431

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