Publication date: May 20, 2025

To assess outcomes associated with shielding, introduced during the COVID-19 pandemic across the UK to protect those at highest risk of harm. Linked data and questionnaires in matched cohorts from the population of Wales, UK. We compared individual-level linked routine and self-reported outcomes between people identified for shielding (n = 123,293) and comparators (n = 120,997) matched by age, sex, and previous health service utilisation. We sent questionnaires to 1500 randomly sampled people in each cohort. At one year 6.1 % of shielded people had contracted SARS-CoV-2 compared to 6.2 % in the matched cohort (Adjusted Odds Ratio [AOR] 0.970; 95 % confidence interval [CI] 0.937 to 1.004). Suspected healthcare associated infections were more likely in shielded people (1.1 % vs 0.6 %; AOR 1.678; 95 % CI 1.529 to 1.842). All-cause and COVID-19 related deaths were higher in the shielded cohort (7.0 % vs 3.5 %; AOR 2.280; 95 % CI 2.190 to 2.374; and 1.1 % vs 0.8 %; AOR 1.430; 95 % CI 1.308 to 1.563, respectively). About 1/3 completed questionnaires (n = 1015), with linkage possible in 752 cases (shielded: n = 411; matched: n = 341). Shielded respondents reported lower physical and mental health (SF12 PCS difference: -3.752; 95 % CI -4.823 to -2.682; SF12 MCS difference: -1.217; 95 % CI -2.580 to 0.145). They were more likely to have strictly avoided contact; stayed at home; felt scared to go outside; and were less likely to have gone out for shopping, leisure or travel. We found no evidence of a protective effect of shielding on SARS-CoV-2 infections or COVID-19 related mortality, an increased rate of hospital acquired infections and increased self-isolation. Shielding during a future pandemic should only be considered alongside effective measures to reduce healthcare associated infections.

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