After a brief respite, Covid-19 cases are rising. A second wave? Or, as I have warned, just a bump in the road?
If we keep distancing, washing our hands, and wearing masks (I’m loath to say ‘following the rules’, as the rules are getting increasingly impossible to fathom), I am confident there will be no need to panic, let alone lock down the country again.
But for the two million Britons with high-risk health problems who were advised to shield from March to August, I know the figures are more alarming.
A few weeks back, I asked people who fall within this group – who adhered to the strictest of lockdowns, not venturing out of the house at all – to get in touch.
Many of my own patients had been asking if they need to isolate again, if it is too dangerous to return to life as they knew it.
DR ELLIE CANNON: I’ve received hundreds of emails from high-risk patients – and the verdict was that people want to be able to make up their own minds about shielding (stock)
And, of course, some never stopped shielding, despite the official advice saying it was safe to go out again.
Having seen calls from fellow medics for shielding to start again, I wanted to hear how you were feeling and what you thought should happen as we deal with the continuing threat from Covid-19.
I’ve since received hundreds of emails – and the verdict was, almost universally, that people want to be able to make up their own minds.
One wrote: ‘Having type 2 diabetes and heart failure, I shielded till August. But I won’t do it again.’
Rather than get another letter instructing them to lock the doors and not venture out for the foreseeable future, most said that they were happier making their own risk assessments.
The 12 weeks in total isolation had been incredibly challenging, was the general consensus – but at least finite.
Now, rather than simply trying to stay alive by avoiding the virus, people were thinking about what made their life worth living.
One wrote: ‘The thought of another period of shielding fills me with total dread.
‘I have two granddaughters and drop them off at school two days a week. This time is so precious to me and I can’t bear the thought of not being able to see them again.’
This sentiment was particularly acute in those with life-shortening illnesses. One, who lives with muscle-wasting motor neurone disease, said: ‘I understand the reason behind shielding but I want the chance to enjoy what time I have. I feel risking my health should be my choice.’
Of course, shielding was always voluntary. If vulnerable people had wanted to follow normal lockdown rules – even going back to work when everyone else did – they could have.
And from the letters I received, it seemed many did, taking exercise at safe times of day.
‘I was advised to shield but I continued to go out for walks with my wife, usually later in the afternoon or evening to avoid crowds,’ explained one man.
‘People should take responsibility for their own health. I fully accept that some people may feel that they need to stay indoors but I am not one of them.’
There was also a sizeable group who said they’d keep on shielding regardless of what health chiefs recommended – that they’d carry on until there was a vaccine, or longer if needed. One such reader wrote: ‘I’ve had cancer treatment this year. Prior to this I was active – shopping, walking the dog, looking after my grandchildren.
‘Now I go nowhere. My only outings are hospital visits. I don’t feel confident with the thought of going out and I can’t see this changing any time soon, although I do miss my old life desperately.’
We GPs will keep doing everything we can to support this kind of choice – our huge, collective shift toward remote and digital services means we can keep in touch with patients, even with those who are staying at home. But I worry when reading these emails that tell of patients’ crippling fear of the outside world, that something may have gone awry.
Public health campaigns need to get across risk but they shouldn’t be terrifying. It’s no good saving people from infection, only to send them spiralling into a pit of depression because they’re scared to leave the house.
This is a serious problem. Last week, University College London published a study of 5,800 Britons aged 70. Shockingly, a third of those who’d been shielding were suffering symptoms of depression and anxiety – double the number found in non-shielders.
They were far less physically active, which is also increasingly damaging as we age, increasing the risk of some of the UK’s biggest killers.
The study author, Professor Andrew Steptoe, pointed out: ‘The advice [to shield] saved lives… but it came at a cost.’
More broadly I feel, as this goes on, fewer and fewer people will be told what to do.
Instead, they’ll be left to inform themselves of the risks and make their minds up about whether they want to take that risk, themselves.
It’s like the boy who cried wolf: if you keep piling on rules that, scientifically speaking, are perhaps not necessary, you lose trust. Then, when you ask them to do something that really is vital… well, we all know how that story goes.
We know that, in England, at least eight in ten people don’t isolate fully when told to.
Patients have told me they’re unable or unwilling to keep small children inside the entire time.
Other countries’ governments have said, even when instructed to quarantine, that their children are allowed to go outside to exercise if they stay away from others.
A reasoned, or subjective, approach by the Government could make us more likely to stick to the rules, and therefore could even be safer for everyone.
To doctors calling for a return to mass shielding, I’d suggest a better approach would be a personalised risk assessment. A patient’s age, sex, background health and other factors are important.
We do this daily in general practice with heart health and it would be an easy computer program for someone to develop quickly.
It would give people what they need to make an informed choice – rather than putting in place a blanket policy that seems unlikely to work again anyway.