by Katherine Runswick-Cole
COVID-19 has led to an explosion in new words and phrases linked to the virus that help us to make sense of the world we are living in now. Linguists have noted the increased use of terms like ‘self-isolating’, ‘pandemic’ and ‘lockdown’ and argue that this new, shared linguistic register ‘unites us’ in a time of crisis (Lawson, 2020). And yet, missing from Lawson’s list of lockdown words is ‘shielding’. ‘Shielding’ is used to describe people who have been required to stay at home and avoid all face-to-face contact at some time during the pandemic; they are, typically, people with long-term health conditions, older people and disabled people.
The focus of this blog is to outline a brief history of shielding in England and to explore the consequence of the appearance, disappearance and reappearance of the language of ‘shielding’ for ‘clinically extremely vulnerable’ people.
Shielding – the timeline
GPs were first asked to identify their ‘most clinically vulnerable patients’ on 21 March, 2020.
The Government originally said NHS England would write to extremely vulnerable patients by 29 March, 2020, but patients began to contact their GPs to say they had not received letters.
The NHS originally wrote to around 1.3million people considered to be at highest clinical risk from coronavirus to inform them that they should stay at home at all times and avoid all face-to-face contact for a period of at least 12 weeks. Over time, shielding figures rose to 2.2 million people.
People were initially allowed to directly refer themselves to the government list of the most clinically vulnerable, but GPs were able to review the list and write to people to say that the GP did not consider that they needed to shield.
All people who received the letter were asked to register with the Government’s website. This was intended to help people to access support with activities such as obtaining food packages or medications, though people who were shielding reported problems with the scheme.
From 1 August 2020, people were advised that shielding has been paused. The support scheme ended and ‘vulnerable’ people were told that they could return to ‘covid secure’ workplaces. This decision led to confusion and lack of trust in the new guidance and, as a result, many people continued to shield.
In September 2020 all pupils and students were told they should continue to attend education settings at all local COVID alert levels unless they were one of the very small number of pupils or students, under specialist care, who were advised by a clinician not to attend an education setting.
In October 2020, the government insisted that, although rates of new Covid cases were going up in most parts of the UK during the autumn, there was still no need to recommend people stay at home and shield, although they were advised to take particular care when outside, and to maintain strict social distancing.
From 13 October 2020, clinically extremely vulnerable people in England received new guidance to help them reduce their risk from coronavirus, tailored to the risk of their local area but even people living in a “Very High COVID-19 alert level” were not required people to shield.
On 31 October 2020, a further set of guidance was published in the light of the new lockdown rules that are effective from 5 November 2020. This guidance refers to “a further group of people who are defined, also on medical grounds, as clinically extremely vulnerable to coronavirus”. This group of people have been advised to work from home, to apply for Statutory Sick Pay or for Employment Support Allowance if they cannot work from home. They have been ‘encouraged to stay at home as much as possible, but are encouraged to go outside for exercise’.
In his statement to the nation, Boris Johnson, prime minister, gave only a brief mention of shielding saying:
I know how tough shielding was, and we will not ask people to shield again in the same way again. However, we are asking those who are clinically extremely vulnerable to minimise their contact with others, and not to go to work if they are unable to work from home.
On 4 November, 2020, updated guidance was published advising children who are ‘extremely clinically vulnerable’ to stay at home, though children, who are not clinically vulnerable, but are living in the same household with a vulnerable person are advised to go to school.
The evening before the second national lockdown began, 4 November, 2020, ‘clinically extremely vulnerable people’ received an alert from the Secretary of State for Health and Social Care, Matt Hancock, to direct them to the revised guidance on shielding. The advice to stay 2 metres away from other members of the household was met with derision by disabled people who rely on people they live with for care and concern that other members of the household were instructed to continue to go to work and children to go to school.
Behind the policy rhetoric
Language unites us, but it can also divide us. Reported deaths of those with underlying health conditions are designed to re-assure ‘us’ that we are not ‘like them’, as Altermark has explained, the function of ‘risk groups’ is ‘”to reassure ‘normal’ people that someone else will die”. Through the language of extreme vulnerability, people who have been shielding have been constructed as disposable.
As the public policy changes, so does the discourse. In the summer months, a (bio)political choice was made to dial down the volume on the language of shielding in order quietly to facilitate the pausing of support, the lack of clarity in public policy guidance and a blatant disregard for the disadvantage and discrimination that people who are shielding have experienced, crucially, both before and during the pandemic.
- Over 60% of disabled people they surveyed said they had struggled to access food, medicine and necessities.
- Over 35% of people talked about increasing levels of psychological distress.
- Nearly half of the people they asked talked about inaccessible information, confusing guidance and lack of advice.
- Disabled people reported social care being cut, reduced and widespread failure to provide protective equipment.
- Disabled people reported feeling abandoned and neglected and fear a rationing of resources and needing to fight for their right to life.
We now know that six in ten covid-related deaths have been of disabled people and that death rates for people with learning disabilities rose by 134% at the height of the first wave. A lack of PPE fuelled the crisis in care homes and the government took five months to produce guidance for supported living settings. And yet, while ‘lockdown’, ‘self-isolating’ and ‘pandemic’ might be experiencing a surge of usage in public discourse, ‘shielding’ has barely punctuated mainstream media. On 31st October, 2020, Frances Ryan, The Guardian Journalist, said:
I think I’m the only British weekly columnist who is shielding – please correct if wrong – and it shows. Millions of people locked in their homes is a massive public policy issue but it’s been remarkable how little attention it’s received. A non-disabled media can’t represent us.
In times past, the lives of disabled people have often been undocumented and, so, difficult to retrieve. And yet, during the pandemic, the experiences of disabled people are being documented, journalists like Frances Ryan (The Guardian) and John Pring (Disability News Service) are leading the way alongside disabled activists and academics (See for example, Disability and Covid-19: the global impacts). No matter how the history of shielding unfolds in public policy discourse, we need to insist that the experiences, concerns and aspirations of ‘clinically extremely vulnerable people’ are not sidelined during the pandemic, and ensure that the histories of disabled people are no longer hidden.