Shielding and COVID-19. June 2021

BETTER HEALTH PROGRAMME SOUTH AFRICA

FACT SHEET

JUNE 2021

Shielding and COVID-19

This fact sheet is based on a webinar co-hosted in April 2021 by the South African National Department of Health (NDoH) and the World Health Organization Africa (WHO Africa) and supported by the Better Health Programme, South Africa. The recording of the webinar is available at: https://youtu.be/Hz5a33J-NcA

WHAT IS SHIELDING?

Shielding is a term used to describe the protection of individuals at high risk of severe COVID-19 illness by separating them from the general population. Shielding is most important when infection rates in a community are high.

Shielding has been interpreted in different ways. In some countries, shielding means helping vulnerable people to live safely and separately from their families and neighbours until COVID-19 can be controlled, or vaccine and treatment options become available. In the South African context, it may include the separation of individuals at high risk in a designated space within the same household.

Key messages on shielding

Key messages on shielding for vulnerable people cover ideal behavior. For example

1. Stay at home and do not have visitors to the house.

2. Adopt safe behaviours inside and outside the home. These include:

■ Keep a physical distance from others; ■ Avoid crowds, close contact and confined spaces; ■ Wear an appropriate face mask; ■ Sit outside, when convenient; ■ Ensure good ventilation, keep windows and doors open; ■ Wash hands frequently; ■ Use sanitisers, if available; ■ Seek medical assistance, if unwell; and ■ Continue to take your medications as directed.

A comprehensive approach to shielding may not be practical or possible in most South African communities, but vulnerable people should still be able to practice physical distancing, wear facemasks and wash hands frequently.

BHPSA BETTER HEALTH PROGRAMME SOUTH AFRICA WHO SHOULD BE SHIELDED? Research in South Africa has identified the most vulnerable groups for severe COVID-19 disease and death according to the following risk factors: 1. Age is the most important risk factor for severe COVID19, with the probability of death increasing strongly for those over the age of 59 years.

SUMMARY REPORTAPPROACHES TO SHIELDING

Shielding is not always practical or possible, for FEBRUARY 2021 example where people live in crowded conditions, and other approaches should be used.

1. Information, Education and Communication (IEC) campaigns on shielding

25%

Probability of death

20%

15%

10%

5%

Females Males

0%

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59

Age

60-64 65-69 ≥70 People with vulnerabilities, and their families, carers and communities need correct information and advice about their COVID-19 risk, and the strategies they can use to minimise it. IEC campaigns could be conducted in all communities.

Booklets on shielding and COVID-19 are widely available. For example, the Knowledge Translation Unit of the University of Cape Town have produced a series of pamphlets, which are available in English, Afrikaans and isiXhosa, and can be downloaded from their website at https://www.coronawise.org.za/

Figure 1: Probability of death by 30 days since COVID19 diagnosis by age(adjusted for comorbidities) 2. Review of the NSP Source: SA hospital data 2. People with uncontrolled diabetes and hypertension are extremely vulnerable to poor COVID-19 outcomes. 3. (May 2020 version) Other comorbidities also increase the risk of severe death and disease. The most important of these are obesity, uncontrolled HIV and TB, and kidney disease.

Proportion of comorbidities

0% 10% 20% 30% 40% 50%

the indicators in the NIDS are not prescribed by the WHO GMF, they are voluntary indicators. Of greater The report identifies some key constraints regarding the successful implementation of the draft NSP. Many of these constraints are due to a significant proportion of the planned activities not being concern is that none of the 25 WHO-prescribed (mandatory) NCD indicators are currently defined in the NIDS. This implies that NDoH is non-compliant with the WHO GMF standard. adequate to achieve the expected outputs. The In conclusion, the national NCD surveillance system review found that 36% of the expected outputs is currently rudimentary and does not support are unlikely to be achieved due to a misalignment the collection of data for the 25 recommended

Ischemic heart disease Heart disease

2

Hypertension

Diabetes HIV Chronic Renal Disease TB

Comorbidities Obesity Asthma Lung Disease None Unknown

Figure 2: Proportion of comorbidities and deaths at Groote Schuur Hospital

Source: NDoH presentation, 2020 2. Community shielding programmes

The NGO Médecins Sans Frontieres (MSF) has implemented a pilot community-based shielding programme in two areas of KwaZulu Natal. The programme involves community leaders including isindunas, and is implemented by community health workers (CHWs) who identify those who are at risk. CHWs provide education, including pamphlets on COVID-19, and help affected families identify green or safe zones for the vulnerable person in their homestead. They also identify a trusted person who will collect grants, medication and shopping so that the vulnerable person does not have to go out. A COVID-19 champion is appointed who continues educating the community on COVID-19.

3. Health system strategies

Alongside shielding there are several strategies that are necessary to protect vulnerable groups from COVID-19. These include: ■ Promoting early health seeking behaviours and intensifying screening and point-of-care diagnosis for noncommunicable diseases. ■ Increasing COVID-19 testing. ■ Providing vaccinations for people most at risk.

BHPSA BETTER HEALTH PROGRAMME SOUTH AFRICA Shielding may be harmful Shielding can protect the vulnerable against COVID19 but it can also have negative effects for vulnerable people. These are: ■ Decreased physical activity; ■ Social isolation and loneliness; ■ Mental health problems such as anxiety; ■ Impaired care and health-seeking; and ■ Loss of income.

SUMMARY REPORTADDITIONAL RESOURCES

FEBRUARY 2021 Social Science in Humanitarian Action Platform: ■ Key considerations: emerging evidence on shielding vulnerable groups during COVID-19.

SA pilot and training materials, MSF

■ Shielding programme for vulnerable community members during the COVID-19 epidemic

■ Shielding programme, induction and training

Shielding after vaccination

Once a vulnerable person has been vaccinated it is still important for them to protect themselves. This is because no vaccination can be guaranteed to give 100% protection to every person.

Many countries recommend that fully vaccinated people should continue to wear masks outside the home and avoid crowded or high-risk settings, particularly when COVID transmission is high.

World Health Organization

■ Technical guidance on coronavirus disease (COVID-19)

■ Maintaining essential health services: operational guidance for the COVID-19 context interim guidance

UK government

■ Guidance on shielding and protecting who are clinically extremely vulnerable to COVID-19

2. Review of the NSP (May 2020 version)

the indicators in the NIDS are not prescribed by the WHO GMF, they are voluntary indicators. Of greater concern is that none of the 25 WHO-prescribed (mandatory) NCD indicators are currently defined in the NIDS. This implies that NDoH is non-compliant with the WHO GMF standard. The report identifies some key constraints regarding the successful implementation of the draft NSP. Many of these constraints are due to a significant proportion of the planned activities not being The Better Health Programme, South Africa (BHPSA) is a health system strengthening programme funded by the UK government through the British High Commission in Pretoria and managed by Mott MacDonald. adequate to achieve the expected outputs. The In conclusion, the national NCD surveillance system review found that 36% of the expected outputs 3 is currently rudimentary and does not support are unlikely to be achieved due to a misalignment the collection of data for the 25 recommended

More guidance is available on the annotated resource list provided in the webinar.