Shielders: how can vulnerable people stay safe as restrictions end?

Ever since COVID-19 entered the UK last year, clinically vulnerable people have been looking for ways to protect themselves from the virus.

Anxiety and easing restrictions

Marcus, 28, has respiratory issues and shielded for a year until last April.

"Honestly I'm quite scared of things opening up," he says. "It's not that I don't want to do things - it's more about getting back and 'relearning' to get used to things again. Shielding made a lot of things difficult and I'll need a period to adjust. It's changed my entire mindset."

Some shielders are angry and frustrated with the lack of support. Chani, 32, plans on staying 'pretty shielded', wearing masks, socially distancing and using hand gel whenever she goes out.

"My partner and I have both been double jabbed for a while now but continued to stay pretty shielded," she says. "This is likely to stay the same for a long time, well beyond whatever the government, which was quite willing to dispose of me for herd immunity, will advise.

"Due to my conditions (compromised immune system, adrenal insufficiency and asthma) I am quite limited in what I can do. I miss going to the cinema. My partner and I would go every month or so as a date night. I know cinemas are open now but I'm worried about crowds."

Louise, 41, shielded because she had had a transplant. She plans to keep shielding until she at least receives the booster jab, and possibly even longer.

"Unless there is firm evidence it is safe for me to do so, I can't risk it," she says. "Immunosuppressed people have just been abandoned by this government so it's down to us to keep ourselves safe. 'Freedom Day' means 'fear day' for so many people, because others refuse to mask up."

Who's at risk?

People who are clinically vulnerable have conditions that make their risk of catching COVID-19, or being hospitalised with it, much higher - people with respiratory diseases, chronic conditions, or high BMI. Some people in this group are classed as 'extremely vulnerable' because their immune system would likely not be strong enough to fight COVID-19. This includes people with blood cancer or HIV, people with Down's syndrome, people who have had organ transplants, and people in chemotherapy.

Charity leaders have spoken out about the disappointment. "The government is going to fall short on protecting clinically extremely vulnerable people, including more than half a million people with lung conditions," said Sarah Woolnough, chief executive of Asthma UK and the British Lung Foundation (AUK-BLF).

"The new guidance means the burden of staying well has fallen squarely on them and many will feel they can't participate in the same daily activities as they did before the pandemic."

AUK-BLF's survey of people with lung conditions found that 93% believed people should continue to wear a face covering when restrictions lift. The charity has published advice on work, mental health and vaccines on its website.

Vaccines are not a silver bullet

For some vulnerable people, getting one or both jabs reduces the risk of catching COVID-19, or facing a serious infection. But for a few thousand, the vaccine is not as effective for them as it is for the majority.

Public Health England recently ran a study of a million people in at-risk groups and reported that the study showed vaccines were 'highly effective in most people in clinical risk groups'. But the agency was forced to update its press statement after experts pointed out that for thousands of immunosuppressed people, that is simply not the case.

For example, Blood Cancer UK warned that people with blood cancer are amongst those for whom immunity stays low even after two jabs, and a survey the charity did of patients found that four in five people with the condition had not been warned of this by the NHS.

In fact, latest data suggest that while one COVID-19 vaccine offers only 4% protection if you're immunosuppressed, double vaccination reduces the risk of infection by 74%. But what we don't yet know if how fast the immunity afforded by the vaccine wanes, particularly for people whose immune system isn't working efficiently.

Abi Howse, the charity's health information manager, warns, "As case rates continue to climb, this summer is not a summer of freedom for many vulnerable people. They are now at more risk rather than less, with restrictions that were protecting them being removed. The vaccines do not protect 100% of people, and for those who have a much higher risk of dying from COVID-19, mixing with others this summer is too risky."

Sam Williams, outreach and advocacy lead at the Aplastic Anaemia Trust (AAT), warns that research is also ongoing for the patients they represent.

"Our official advice is that clinically extremely vulnerable people should be exercising extra caution as restrictions ease," he says. "The fact that research is ongoing means that they should still be more cautious, even if they have received the vaccine. We simply don't know yet what protection it offers." The charity has now commissioned its own research into the issue.

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Will there be booster jabs?

In early July, the creator of the Oxford/AstraZeneca vaccine warned that the most vulnerable may have no choice but to resume shielding. The same week, more than 1,200 leading doctors and scientists signed a letter for The Lancet calling decisions to relax COVID-19 rules this month as 'unscientific and unethical'.

On 13 July, new government advice said vulnerable people 'may wish to think particularly carefully about additional precautions' such as continuing some precautions already in place.

Booster jabs could be available as soon as September, and the JCVI - the body who decides which groups are prioritised for vaccination - recommended that people who are 'severely immunosuppressed' should receive jabs in September.

But while early trials outside the UK show promising results from third vaccines for immunosuppressed people, experts are not yet certain that booster jabs will work. Research is underway at the University of Birmingham to explore the types of immune responses immunosuppressed people might have after a COVID-19 vaccine.

Fiona Loud, policy director at Kidney Care UK warned that many people in the UK were now expected to shield voluntarily until the booster campaign, without statutory funding or even any verbal expressions of support.

"Details have not yet been operationalised for the booster campaign, so even if it begins on 1st September, that still means at least six more weeks of voluntary shielding for vulnerable people," she said.

Dates of the booster campaign haven't been released yet, and last month [June] the Royal College of GPs said information is needed 'urgently'.

"The advice is to stay away from workplaces as much as possible during this time and take extreme care," Loud added, "but not everybody's able to. While employers still have responsibilities for staff safety, the government is no longer instructing people to work from home if they can. That's why we've been pushing all this time for mitigation."

How can vulnerable people stay safe?

While restrictions continue to change or end, leading doctors have recommended vulnerable patients to make personal decisions about staying safe with their GP's advice. The minister for health also encouraged them to contact their GP.

Some charities for vulnerable groups have published specific advice - for example, Cancer Research UK encourages all cancer patients to have both doses of the vaccine when offered, and for vulnerable patients to have the booster jab, if and when it becomes available.

Michelle Mitchell, Cancer Research UK's chief executive, said: "Evidence is still emerging on how effective the vaccines are for people with cancer. We encourage people with cancer to take all the relevant doses of the COVID-19 vaccine to give them the best protection possible."

Sam Williams of the AAT adds that people will have to decide for themselves how to act, but doctors and charities want to support people who are immunocompromised to get the info they need until booster jabs arrive.

"What 'more cautious' means for individuals will depend on their personal circumstances, and is something they should discuss with their clinician," he says. "We are providing tools to help patients set boundaries with people around them, including badges that encourage others to give them more space, advice on how to have difficult conversations and set boundaries with people, and information on employment law for people feeling pressured to return to work when they don't feel it is safe.

"People have the legal right to request reasonable adjustments on the grounds of disability, particularly if they have been working from home effectively during the pandemic."

For thousands of people in the UK stuck shielding at home - and their friends, families, neighbours and colleagues - 'freedom day' is still a long way off.