Shielding should be kept in reserve, NI’s chief medical officer says

Northern Ireland’s chief medical officer said it had been a very difficult to strike the right balance during the coronavirus pandemic.

Northern Ireland chief medical officer Sir Michael McBride gives evidence to the UK Covid-19 Inquiry in London (Covid-19 Inquiry/PA) (PA Media)

Shielding for vulnerable people should be kept in reserve in the event of a future pandemic, Northern Ireland’s chief medical officer has said.

Sir Michael McBride said asking those considered to be clinically extremely vulnerable to stay at home to protect themselves during the earliest stage of the pandemic had been a very difficult decision.

He said it was taken on balance, in the context of a new virus that was causing serious illness in some, no immunity and no treatment or vaccine.

The vulnerable shielded from March to the end of July 2020, when Covid-19 infection rates and the number of people admitted to hospital had tumbled.

Sir Michael said a report he commissioned in May 2020 showed those affected were left afraid and anxious by the experience.

He told the UK Covid-19 Inquiry on Tuesday that in a future pandemic he felt the focus should be on suppressing the transmission of the virus and keeping shielding in reserve and, if necessary, used for as short a time as possible.

Sir Michael, who is  still Northern Ireland’s chief medical officer (CMO) was questioned throughout the day about the impact of the pandemic on the health service in the region.

Sir Michael was asked, with the benefit of hindsight, whether he felt he had got all the decisions right.

He said ultimately that would be for the inquiry to determine.

“I think there were some issues because of the pace of events, I think there were certainly some issues in relation to communications, for instance, to those shielding, in terms of how we conveyed information, how we conveyed information in a balanced way, which allowed people to make choices about what was important to them, to empower them,” he said.

It became very difficult later on, when the harm-and-benefit analysis changed, to provide them with assurance, to the population of people who had been shielding who were clinically extremely vulnerable, and, looking back, I think some of the initial messaging around that could have been more nuanced

Northern Ireland CMO Sir Michael McBride

“It became very difficult later on, when the harm-and-benefit analysis changed, to provide them with assurance, to the population of people who had been shielding who were clinically extremely vulnerable, and, looking back, I think some of the initial messaging around that could have been more nuanced.

“That was something which I was concerned about, and was concerned really from May 2020, when I had commissioned some research to seek the views of people who had been shielding, in terms of the impact it was having on them.”

Sir Michael said that in the early stages of the pandemic, with a new pathogen, no existing immunity, no treatment and no vaccines, with uncertain timelines, it was felt it was the only course of action.

“I think we were all aware of the significant negative impacts of it (shielding).

“I recall saying during some of the media briefing at the time, this was about protecting the vulnerable from the virus, but it was not about removing the vulnerable from society,” he said.

“It was a very, very difficult judgment in terms of trying to strike that right balance, but the consequences with no immunity, and a new virus that was clearly causing very severe disease in some people, it was the only course of action that was available to us at that time.

“But clearly the best approach to protecting those who are clinically extremely vulnerable is to suppress the transmission of the virus in the community, and we had that two-headed approach.”

Asked about lessons learned, Sir Michael said: “While we endeavoured to ensure that we communicated the advice clearly, as honestly as we could, based on the information that we had, and tried to keep that updated in a variety of ways, I think the net result of the advice on shielding was we engendered a significant degree of fear in those who were shielding, fear and anxiety.

“I think the population also communicated in that survey that at times they felt ignored, and they asked for clearer guidance on a more regular basis, and a clear rationale for why the guidance was being provided.

“I think that given the profound consequences that shielding had, I think the primary approach to future pandemics should be suppressing the transmission of the virus and only keeping shielding in reserve if indeed it is necessary and, if it is necessary, then, for as short a time as is possible.

“I think the approach that was taken in good faith, initially, did not fully think through the loss of agency and loss of control that people would experience, and the real fear that people had about re-entering society.”

Sir Michael also said the health service “must do better” in terms of bereavement care and support.

He said they went on to establish a bereavement network and, later, the Northern Ireland Bereavement Network.

“I think that was a direct consequence of some of the experiences in the pandemic and the fact that we need to enhance arrangements in that area,” he said.

Sir Michael, with some of Northern Ireland’s past and present leaders and ministers, previously gave evidence to the last module of the inquiry looking at governance.

The inquiry is currently examining the impact of the pandemic on the health and social care system in Northern Ireland as well as the NHS in Great Britain.