Why can’t we shield the vulnerable?

[Calledyoulastnightfromglasgow]

Can anyone tell me why this wouldn’t work?

It’s been dismissed out of hand by the government as apparently it would still spread. As far as I can see, it’s spreading anyway - maybe restrictions only work for so long and we have non compliance?

But can’t we throw a pile of money at the issue (which would still be less than we currently are spending). Segregated medical appointments/dental etc. Home delivery o iu for shielders. Basically what we did in March but to the vulnerable or vulnerable households.

My mum is elderly and is pretty much shielding until a vaccine anyway. It’s dismal. The sooner the less vulnerable of us get it, then the sooner we can achieve some kind of community immunity.

We would have covid hospitals only - we would actually use them. We would still have restrictions so it didn’t spread so quickly but we wouldn’t paralyse whole sectors.

I appreciate long covid is a thing - but so is most chronic fatigue after a virus (I have had it).

The real issue might be households where the elderly lived with the young. Or the highly vulnerable. My friend is in this category and has spent months shielding. It’s dismal.

If we had adopted this strategy slowly from April we could have avoided hitting flu season.

People go on about antibodies but T cell immunity is repeatedly ignored and the cases where people demonstrate symptoms twice are something like five.

I just can’t believe we are going to save more lives with the current strategy compared to a change of tactic. Thousands will die through other causes as it is.

You can't lock up the elderly and vulnerable. The risk of Covid to them might drop, but their risk from other illneses would go up.
The govt are not going to provide money to support that.

BoJo does need to look at his management in England. Why is it so different than in Scotland Wales and Ireland? It's obvious that the restrictions did not work. Would short lockdowns produce better results?

Money, and logistics.

The government can't even cope with overseeing a three tier lockdown in England.

There are rather more than three extremely vulnerable people in the country, all with their own unique circumstances.

That'd be... fun.

I'd imagine very few of the extremely vulnerable live alone. Yet more variables.

Covid will even itself out, the most successful viruses are the ones that don't kill us. There isn't any need to go mad.

There has got to be close to a 100 threads on MN on this alone. People who would be shielding are people - you need to think about;

• if they need carers
• how to they earn money
• what about about the people that rely on them eg family members and their own patients
• what about their school aged children

These are just a few things to consider.

Money

It's a good idea in theory though.

I agree though apparently it wouldn’t work.

Yes but none of these things are insurmountable are they?

We have spent billions and there is no real end in sight.

Carers are especially problematic but we already have to manage that issue in nursing homes. Something like weekly tests, full PPE would reduce spread. My friend’s child has had this since March - it’s a nightmare but do-able.

It would be like putting the whole country in tier two, and keeping safe those most at risk.

Except that getting it once doesn't guarantee immunity. In fact, recent a US case suggests that second time around it may be more severe. The health service is exhausted. The "break" that lockdown brought about has not been felt on the frontline and frankly the prospect of a winter of this is beyond what most healthcare workers can cope with. Combine that with the prospect that surviving it may not give you the home run to freedom but in fact set you up for long Covid.

It wouldn’t work you couldn’t shield them and let everyone else carry on imo they should be shielded if want to be ( and be allowed off school without fines etc )
But they are more likely to need hospital treatment for other things/ still need house repairs etc so if covid was still flying around and everyone going as normal you can not protect them fully without other restrictions.

There are several ‘vulnerable people’ I know. They are absolutely key members of staff in hospitals, schools and government. They have young children. And FULL and interesting lives.

‘Vulnerable people’ aren’t some sub-species different to ‘us’. And anyone can become vulnerable.

We don’t yet know if you gain immunity so herd immunity might not work.

The hospitals (you know - those places where we ALL could end up if we have an accident or fall I’ll) would be overwhelmed very quickly.

The amount of sick leave required would devastate the economy any way.

I could go on but this thread has been done to death.

If it would work it would have been done by now. We need to trust the science. It’s not perfect. It’s not fail safe. It’s the best we have though in a new and frightening situation.

Reasons we can't:

1. There's a lot of the vulnerable. Approx 12 million people in the UK are of pension age or older. www.pensionspolicyinstitute.org.uk/research/pension-facts/table-1/ 26% of men and 29% of women are obese digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/england-2020. 4.7 million are diabetic www.diabetes.org.uk/about_us/news/new-stats-people-living-with-diabetes. 1.2 million have a diagnosis of COPD, and probably twice as many have it but are undiagnosed; more have asthma statistics.blf.org.uk/copd. Over two million in England were shielding digital.nhs.uk/dashboards/shielded-patient-list-open-data-set. There is significant overlap between these groups, of course, but it's still a lot of people. Could easily be as high as 25% of the population.
2. Many of these people are in work. We do not have a good track record as a society in supporting those who leave the workplace. They need to stay in work to support themselves and their families.
3. Many are keyworkers. Almost by definition, they tend to be the most experienced and thus most valuable in our teams. We need them to stay working. My clinical team would collapse if we sent all the vulnerable home - I'm sure other services would say the same. There would be no segregated medical/dental services, because the senior clinicians we need to lead those services would be at home isolating. This isn't theoretical, these are key individuals in my team that I could name.
4. Many have families. Some of those will also be keyworkers, or the main bread winner, or children in school. Are their households going to shield also? If so, how do we support those individuals, and backfill their roles? Or are we going to remove the vulnerable person from their family and park them in a covid-camp until this is all over? Because that didn't work well in care homes in the spring.
5. Many of the most vulnerable rely on carers. Or frequent contact with medical services. Or live in care homes. Are we going to require all care workers and clinicians to shield to protect their patients? One of my neighbours is profoundly disabled and has 18 different carers coming in a week. If the virus is running free through his care team, then how do we keep him safe?

It sounds great, but society is simply too intertwined for it to work in practice.

There has got to be close to a 100 threads on MN on this alone.
^ this

The vulnerable aren’t one group of frail, elderly people.

Plenty of ‘the vulnerable’ have jobs, families and lives to live. They’re not so unwell that they can’t do those things and if they all stopped doing those things we’d just create more problems.

2 out of the 4 psychiatric nurses in my team are closed as vulnerable - they’re in work with appropriate measures in place. We couldn’t cope if they both stayed at home.

For a start, in order for it to work the definition of vulnerable would have to be expanded a lot in order to prevent the health service from being over run. It would probably include everyone over 50, possibly over 45.
And in order for it to work, those people would absolutely have to stick to it. A lot of people wouldn’t be able to work which would lead to issues with staffing in heath & education and other key sectors. And that’s before you consider that high circulating levels of the virus would lead to staff shortages anyway.

Also, this is a new virus where we are still learning a lot about how it presents and how to treat it. And that’s just in the acute phase. Yes other diseases can have long term affects, but we know a lot more about what they are and their prévenance. In the case of Covid we don’t know what the long term effects are, how prevalent they are or how long lasting. Until we know a bit more, it would be massively irresponsible to let the virus rip through populations.

We didn’t adopt this strategy in April for a reason. Largely that it became clear quite quickly when we started down that route in March that it would turn out to be a fucking disaster. So there was a very rapid change of direction.

A) Very unfair to completely lock up certain people for circumstances that are beyond their control. The vulnerable aren't just very elderly adults, not that I would agree with just locking the elderly away either.

B) Vulnerable people are more likely to need access to medical care. Are you proposing they stay away from hospitals so they don't contract Covid, which may cause them to die from other conditions that need treatment?

Where are these vulnerable people only hospitals that you speak of??! I'd love to know. All made up of staff who are shielding presumably? Completely green with no risk what so ever of asymptomatic transmission? And obviously no one needing any specialist input that only the cardiac hospital in that town does or the oncology specialist centre that the other town has. Or do the 'vulnerable' only get non specialist generic healthcare?

Pie in the sky. You can't have hospitals that do everything across all streams of healthcare but are only for the vulnerable. They don't exist. They can't exist. You sound ridiculous.

Shielding people and older people are two entirely separste groups. The shielding group have a very defined and specific range of conditions of which age is NOT one of them. Many of them are not disabled.
Under normal circumstances, you'd probably have no idea many of them are shielding at all. They are of working age, have families, have full.live and are contributors to society in all ways.
And yet you'd be happy to lock away all these people and condemn them to probable dreadful mental health and loneliness too, for an unspecified period of time?
A decent society does not separate people out like this.

I'm vulnerable. I discussed with my consultant and decided not to shield. I can't think of anything more miserable. I've continued my normal life as far as possible (been on holiday, eaten out, seen family and friends when allowed, go shopping, taken DS to nursery). I don't think there's any amount of money in the world that would have convinced me to give that up. And, like many people, I'm vulnerable not because of my underlying health condition but because of the medication that manages it so, to all intents and purposes, I lead a normal life.

I will never ever go back into shielding. After 16 weeks I was almost a mental case. There's life and a no life. I don't have that much time left and I refuse to be locked up again EVER again😡

Long Covid is not just chronic fatigue. And it is not the only potential negative outcome of an infection of Covid-19:

www.abc.net.au/news/health/2020-09-26/coronavirus-covid-health-effects-can-linger/12705022

www.abc.net.au/news/health/2020-10-23/doctors-with-long-covid-warn-long-term-effects-can-be-serious/12785934

www.abc.net.au/news/2020-09-23/covid-19-may-cause-parkinsons-disease-research-finds/12688384

www.abc.net.au/news/health/2020-10-21/coronavirus-covid-19-effects-on-the-heart/12795726

Who is going to do all the home deliveries for the vulnerable, when the vulnerable make up a large part of the workforce? Who is going to man the hospitals when doctors, nurses, surgeons, and other staff are themselves among the clinically vulnerable? How will trains and buses run and shops operate when the vulnerable stop working?

You have a lot of silly notions.

@Sostenueto we were never locked up it was never the law it was always up to us to follow the advice it even said on the letters ❤️

I appreciate long covid is a thing - but so is most chronic fatigue after a virus (I have had it).

The description of the nature of the fatigue many people with long CoVid are reporting (Long CoVid probably has subgroups, say some with fatigue from organ damage are different to another group under the longcovid term) sounds v similar to people with ME. I have had ME now for many years. It is too soon to know whether this group of longcovid will turn out to have ME but the similarities in many symptoms, particularly the activity intolerance, are being noted by some scientists including Fauci of the US CDC.

Chronic fatigue does not characterise the fatigue sufficiently in ME, nor is fatigue the only symptom. There is now extensive evidence to show that people with M.E. have abnormal responses to exercise/activity. Such abnormalities in people with ME include reduced maximum heart rate, reduced maximum oxygen consumption, reduced cardiac output, insufficient blood pressure increase on exertion and decreased capacity to use oxygen. Anaerobic threshold and maximum exercise are reached at much lower oxygen capacity, exhaustion reached more rapidly and accompanied by relatively reduced intracellular concentrations of ATP, increased intracellular acidosis in exercising muscles and reduced post-exercise recovery from acidosis. Also, activation and worsening of symptoms which can be immediate. There is also but not limited to tachycardia, muscle pain, head pain, insomnia and poor concentration and word recall.

Its a bit of a cuntish attitude really. Lock up the 'vulnerable' so all the ' non vulnerable' can get their freedom back? What makes you so special? How can anyone be so selfish as to blanket demand that the vulnerable stay home so the rest of us carry on whooping it up? Why don't we all take our turns with restrictions so we can all get our lives back?

Because when you say shield the vulnerable what you actually mean is lock people out of society completely so that you don’t experience any loss of freedom at all. It’s monumentally selfish, utterly offensive and quite honestly you can just fuck of with your othering and discrimination.

Further, it wouldn’t work. Lots of reasons, educate yourself. So not only is it a selfish and offensive concept, it’s stupid.

OP, please answer me this. I'm very vulnerable. I'm also pregnant. What do you suggest I do about my care and birth? Currently I see or speak to several specialists weekly. I will be induced. High risk birth so need to be in hospital. I rely on the whole bloody hospital (specialists, nurses, cleaners, food-bring-people, receptionists) to try not to get ill. Plus they tend to have families as well, so they shouldn't get ill either otherwise they infect the people that care for me. Plus some have school going children and they can't get ill or they'll infect the people that care for me.

So how are we going to shield that many people? And that's just me, other patients might rely on public transport to get to said hospitals. The vulnerable are exactly the people that come into contact with others BECAUSE they are vulnerable and need care.

A Professor on this subject on Twitter talked about this specifically.
Points From that I can remember :
-The shielders category you are talking about consists of the vulnerable ( young and older people) including their WHOLE household will have to shield and these account to quarter of the population.

-Then comes the big question of who do you class as vulnerable? I have two immune suppressed friends that aren’t classed as vulnerable but they would be severely ill if they catch it. Same goes to asthmatics.

-Then you have the ethical question of locking them up.

-Then you get the next issue with the fact that the virus will find its way around as no one lives in isolation even if one is shielding.
There has been few instances where people reported catching the virus even when they haven’t left the house.
Deliveries can be one way for the virus to come into the house once the virus is prevalent.

-And another issue is the ethical question of letting it rip through the community and play Russian roulette of death or long term issues with the virus.

We have seen what happened to the hospitals when they refused to lockdown. It was full of covid patients. Now if we let open up the doors again, the same will happen on a bigger scale. Once Hospitals get overwhelmed, there will be much more deaths as there won’t be beds for simpler covid cases that are suffering breathing problems and could have been helped with oxygen, but therefore end up with a complication and dying.
I wish it were that simple.