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Evaluation of the UK's COVID-19 public health policy “Shielding: Results of a linked data matched cohort study

Helen Snooks Orcid Logo, Ashley Akbari Orcid Logo, L. Bethell, A. Carson-Stevens, J. Dale Orcid Logo, L. Dixon, A. Edwards Orcid Logo, Helena Emery, Ann John Orcid Logo, G. John, S. Jolles, Jane Lyons, Ronan Lyons, Mark Kingston Orcid Logo, R. Parab Orcid Logo, Alison Porter Orcid Logo, Berni Sewell, Alan Watkins Orcid Logo, Victoria Williams

Public Health, Volume: 244, Start page: 105736

Swansea University Authors: Helen Snooks Orcid Logo, Ashley Akbari Orcid Logo, Helena Emery, Ann John Orcid Logo, Jane Lyons, Ronan Lyons, Mark Kingston Orcid Logo, Alison Porter Orcid Logo, Berni Sewell, Alan Watkins Orcid Logo, Victoria Williams

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DOI (Published version): 10.1016/j.puhe.2025.105736

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 rout...

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Published in: Public Health
ISSN: 0033-3506 1476-5616
Published: Elsevier Ltd 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69548
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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 utilisation. We sent questionnaires to 1500 randomly sampled people in each cohort. Results: At one year 6&#xB7;1 % of shielded people had contracted SARS-CoV-2 compared to 6&#xB7;2 % in the matched cohort (Adjusted Odds Ratio [AOR] 0&#xB7;970; 95 % confidence interval [CI] 0&#xB7;937 to 1&#xB7;004). Suspected healthcare associated infections were more likely in shielded people (1&#xB7;1 % vs 0&#xB7;6 %; AOR 1&#xB7;678; 95 % CI 1&#xB7;529 to 1&#xB7;842). All-cause and COVID-19 related deaths were higher in the shielded cohort (7&#xB7;0 % vs 3&#xB7;5 %; AOR 2&#xB7;280; 95 % CI 2&#xB7;190 to 2&#xB7;374; and 1&#xB7;1 % vs 0&#xB7;8 %; AOR 1&#xB7;430; 95 % CI 1&#xB7;308 to 1&#xB7;563, respectively). About 1/3 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: &#x2212;3&#xB7;752; 95 % CI -4&#xB7;823 to &#x2212;2&#xB7;682; SF12 MCS difference: &#x2212;1&#xB7;217; 95 % CI -2&#xB7;580 to 0&#xB7;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.</abstract><type>Journal Article</type><journal>Public Health</journal><volume>244</volume><journalNumber/><paginationStart>105736</paginationStart><paginationEnd/><publisher>Elsevier Ltd</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0033-3506</issnPrint><issnElectronic>1476-5616</issnElectronic><keywords>COVID-19; Pandemic; Shielding; Routine linked data; Self-reported outcomes</keywords><publishedDay>1</publishedDay><publishedMonth>7</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-07-01</publishedDate><doi>10.1016/j.puhe.2025.105736</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>This study was funded through the National Core Studies Immunity programme (led from Birmingham University), in turn funded by the Medical Research Council [MR/V028367/1]; Health Data Research UK [HDR-9006], which receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust; and Administrative Data Research UK, which is funded by the Economic and Social Research Council [grant ES/S007393/1]. This work was also supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales. Swansea University sponsored the study.</funders><projectreference/><lastEdited>2025-06-17T13:44:10.5027010</lastEdited><Created>2025-05-21T09:19:19.9704466</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Helen</firstname><surname>Snooks</surname><orcid>0000-0003-0173-8843</orcid><order>1</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>2</order></author><author><firstname>L.</firstname><surname>Bethell</surname><order>3</order></author><author><firstname>A.</firstname><surname>Carson-Stevens</surname><order>4</order></author><author><firstname>J.</firstname><surname>Dale</surname><orcid>0000-0001-9256-3553</orcid><order>5</order></author><author><firstname>L.</firstname><surname>Dixon</surname><order>6</order></author><author><firstname>A.</firstname><surname>Edwards</surname><orcid>0000-0002-6228-4446</orcid><order>7</order></author><author><firstname>Helena</firstname><surname>Emery</surname><order>8</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>9</order></author><author><firstname>G.</firstname><surname>John</surname><order>10</order></author><author><firstname>S.</firstname><surname>Jolles</surname><order>11</order></author><author><firstname>Jane</firstname><surname>Lyons</surname><orcid/><order>12</order></author><author><firstname>Ronan</firstname><surname>Lyons</surname><order>13</order></author><author><firstname>Mark</firstname><surname>Kingston</surname><orcid>0000-0003-2242-4210</orcid><order>14</order></author><author><firstname>R.</firstname><surname>Parab</surname><orcid>0000-0003-1822-657x</orcid><order>15</order></author><author><firstname>Alison</firstname><surname>Porter</surname><orcid>0000-0002-3408-7007</orcid><order>16</order></author><author><firstname>Berni</firstname><surname>Sewell</surname><order>17</order></author><author><firstname>Alan</firstname><surname>Watkins</surname><orcid>0000-0003-3804-1943</orcid><order>18</order></author><author><firstname>Victoria</firstname><surname>Williams</surname><orcid/><order>19</order></author></authors><documents><document><filename>69548__34325__17de2cb6bf064b348bded036bbcb9119.pdf</filename><originalFilename>69548.VOR.pdf</originalFilename><uploaded>2025-05-21T09:26:56.0707351</uploaded><type>Output</type><contentLength>962710</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2025 The Author(s). 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spelling 2025-06-17T13:44:10.5027010 v2 69548 2025-05-21 Evaluation of the UK's COVID-19 public health policy “Shielding: Results of a linked data matched cohort study ab23c5e0111b88427a155a1f495861d9 0000-0003-0173-8843 Helen Snooks Helen Snooks true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false ddcdeaa3de5b3256ab5832a9a7377f1b Helena Emery Helena Emery true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 1b74fa5125a88451c52c45bcf20e0b47 Jane Lyons Jane Lyons true false 83efcf2a9dfcf8b55586999d3d152ac6 Ronan Lyons Ronan Lyons true false 3442763d6ff0467963e0792d2b5404fa 0000-0003-2242-4210 Mark Kingston Mark Kingston true false fcc861ec479a79f7fb9befb13192238b 0000-0002-3408-7007 Alison Porter Alison Porter true false f6a4af2cfa4275d2a8ebba292fa14421 Berni Sewell Berni Sewell true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false e9bb438bfaaf693c0376c20c9e4529d2 Victoria Williams Victoria Williams true false 2025-05-21 MEDS 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 utilisation. 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 1/3 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. Journal Article Public Health 244 105736 Elsevier Ltd 0033-3506 1476-5616 COVID-19; Pandemic; Shielding; Routine linked data; Self-reported outcomes 1 7 2025 2025-07-01 10.1016/j.puhe.2025.105736 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) This study was funded through the National Core Studies Immunity programme (led from Birmingham University), in turn funded by the Medical Research Council [MR/V028367/1]; Health Data Research UK [HDR-9006], which receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust; and Administrative Data Research UK, which is funded by the Economic and Social Research Council [grant ES/S007393/1]. This work was also supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales. Swansea University sponsored the study. 2025-06-17T13:44:10.5027010 2025-05-21T09:19:19.9704466 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Helen Snooks 0000-0003-0173-8843 1 Ashley Akbari 0000-0003-0814-0801 2 L. Bethell 3 A. Carson-Stevens 4 J. Dale 0000-0001-9256-3553 5 L. Dixon 6 A. Edwards 0000-0002-6228-4446 7 Helena Emery 8 Ann John 0000-0002-5657-6995 9 G. John 10 S. Jolles 11 Jane Lyons 12 Ronan Lyons 13 Mark Kingston 0000-0003-2242-4210 14 R. Parab 0000-0003-1822-657x 15 Alison Porter 0000-0002-3408-7007 16 Berni Sewell 17 Alan Watkins 0000-0003-3804-1943 18 Victoria Williams 19 69548__34325__17de2cb6bf064b348bded036bbcb9119.pdf 69548.VOR.pdf 2025-05-21T09:26:56.0707351 Output 962710 application/pdf Version of Record true © 2025 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article distributed under the terms of the Creative Commons CC-BY license. true eng http://creativecommons.org/licenses/by/4.0/
title Evaluation of the UK's COVID-19 public health policy “Shielding: Results of a linked data matched cohort study
spellingShingle Evaluation of the UK's COVID-19 public health policy “Shielding: Results of a linked data matched cohort study
Helen Snooks
Ashley Akbari
Helena Emery
Ann John
Jane Lyons
Ronan Lyons
Mark Kingston
Alison Porter
Berni Sewell
Alan Watkins
Victoria Williams
title_short Evaluation of the UK's COVID-19 public health policy “Shielding: Results of a linked data matched cohort study
title_full Evaluation of the UK's COVID-19 public health policy “Shielding: Results of a linked data matched cohort study
title_fullStr Evaluation of the UK's COVID-19 public health policy “Shielding: Results of a linked data matched cohort study
title_full_unstemmed Evaluation of the UK's COVID-19 public health policy “Shielding: Results of a linked data matched cohort study
title_sort Evaluation of the UK's COVID-19 public health policy “Shielding: Results of a linked data matched cohort study
author_id_str_mv ab23c5e0111b88427a155a1f495861d9
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author_id_fullname_str_mv ab23c5e0111b88427a155a1f495861d9_***_Helen Snooks
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
ddcdeaa3de5b3256ab5832a9a7377f1b_***_Helena Emery
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
1b74fa5125a88451c52c45bcf20e0b47_***_Jane Lyons
83efcf2a9dfcf8b55586999d3d152ac6_***_Ronan Lyons
3442763d6ff0467963e0792d2b5404fa_***_Mark Kingston
fcc861ec479a79f7fb9befb13192238b_***_Alison Porter
f6a4af2cfa4275d2a8ebba292fa14421_***_Berni Sewell
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
e9bb438bfaaf693c0376c20c9e4529d2_***_Victoria Williams
author Helen Snooks
Ashley Akbari
Helena Emery
Ann John
Jane Lyons
Ronan Lyons
Mark Kingston
Alison Porter
Berni Sewell
Alan Watkins
Victoria Williams
author2 Helen Snooks
Ashley Akbari
L. Bethell
A. Carson-Stevens
J. Dale
L. Dixon
A. Edwards
Helena Emery
Ann John
G. John
S. Jolles
Jane Lyons
Ronan Lyons
Mark Kingston
R. Parab
Alison Porter
Berni Sewell
Alan Watkins
Victoria Williams
format Journal article
container_title Public Health
container_volume 244
container_start_page 105736
publishDate 2025
institution Swansea University
issn 0033-3506
1476-5616
doi_str_mv 10.1016/j.puhe.2025.105736
publisher Elsevier Ltd
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description 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 utilisation. 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 1/3 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.
published_date 2025-07-01T05:28:29Z
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