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Shielding from covid-19 should be stratified by risk

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2063 (Published 28 May 2020) Cite this as: BMJ 2020;369:m2063

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  1. George Davey Smith, director1,
  2. David Spiegelhalter, chair2
  1. 1MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  2. 2Winton Centre for Risk and Evidence Communication, Centre for Mathematical Sciences, University of Cambridge, Cambridge, UK
  1. Correspondence to: G Davey Smith pa-ieudirector{at}bristol.ac.uk

Lockdown is damaging lives; stratified shielding could help get us out

Protecting those at most risk of dying from covid-19 while relaxing the strictures on others provides a way forward in the SARS-CoV-2 epidemic, given the virus is unlikely to disappear in the foreseeable future.1 Such targeted approaches would, however, require a shift away from the notion that we are all seriously threatened by the disease, which has led to levels of personal fear being strikingly mismatched to objective risk of death.2 Instead, the aim should be to communicate realistic levels of risk as they apply to different groups, not to reassure or frighten but to allow informed personal decisions in a setting of necessary uncertainty.

Several preprints have modelled “stratify and shield” strategies based on enhanced protection of the vulnerable while easing or removing constraints on others.345678 They all aim at identifying groups that are at high risk of dying from covid-19 and are therefore shielded against risk of infection. The models have different views on how such shielding can be ended, however. Some have considered ending shielding when herd immunity levels are reached …

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