Immune mechanisms of childhood asthma
Authors: C. E Donovan, P. W Finn
Journal: Thorax (1999)

<h3>Introduction</h3> In March 2020 the government introduced the concept of shielding with a new description of ‘clinically extremely vulnerable’ (CEV) individuals. The British Society of Gastroenterology (BSG) developed ‘The Grid’ stratifying patients into low, moderate and high-risk groups. We explored the experiences of patients classified as high risk who were advised to shield and patients who chose to shield. <h3>Methods</h3> Participants were recruited from Crohn’s and Colitis UK website, facebook page and newsletter, and were eligible if they shielded during any lock down period. Semi-structured interviews, held via MS Teams, Zoom or telephone between February and May 2021, were audio-recorded and transcribed professionally. Data were analysed using thematic analysis (Spencer et al.2003). <h3>Results</h3> 27 shielding pts took part, median age 35yrs, 17 females, median disease duration 13yrs, 16 pts with CD, 9 pts with UC, 2 pts with IBDU. Ethnic group: White British 25; British Asian/Indian 2. BSG grid: High risk 10 pts; Moderate 16pts, Low 1 pts. 2pts shielded due to own perception of risk to self and or family member. Four main themes emerged: Becoming CEV; IBD Preparedness; Troubled and Troublesome, and Exit strategy. Becoming CEV patients felt ‘labelled’ - one day they were a normal person, the next labelled, which changed their identity. Whilst protective for some, i.e getting medication delivered, feeling ‘looked after’, for others this instilled fear. Conflicting information at the start of the pandemic around the need to shield caused great confusion. IBD preparedness some patients felt that having IBD, being unwell and living through periods of isolation due to illness prepared them for shielding, having greater resilience than they thought. Many developed coping strategies, such as yoga. The positive impact of shielding was family bonding, spending unexpected time with loved ones, not needing to restrict diet on Sunday to travel to work Monday, not needing to find a toilet and overall, less stress. Troubled and Troublesome patients reported the negative side to shielding, the loss of control, loss of identity and no separation between work and private life. Family members shielded with the patient which caused feelings of guilt and being a burden. Loss of human contact and missed life opportunities added to the anxiety. There was fear of relapse, of needing hospital appointments, and attending for infusions, and a need for more contact with their clinical team. Exit strategy the sudden overnight end to shielding left patients feeling vulnerable, confused, and scared. Some participants have continued to shield and need further support to reconnect with normality. <h3>Conclusion</h3> Shielding had positive and negative effects: those who had led constrained lives pre-pandemic felt prepared for shielding, others bonded with family members again, whilst some lost themselves to loneliness, overwhelming fear and anxiety. The communication around risk classification, shielding and exiting shielding could have been improved. Patients wanted more contact with healthcare professionals via a blend of remote and face to face monitoring. These lessons could inform IBD care delivery in the future.