Coronavirus (COVID-19) advice for people on the Highest Risk List: evidence review

This report presents key evidence underpinning our advice to people on Scotland's highest risk (formerly shielding) list.


11. The pandemic context is very different now to when the Shielding or Highest Risk List was first introduced. The factors that now identify someone as being at highest risk from COVID-19 have changed.

11.1 Furthermore, as the number of people who have been vaccinated rises, the population overall benefits from greater protection against the serious effects of the virus, including those on the Highest Risk List, and the very small number of people who cannot be vaccinated due to allergy to ingredients or previous serious reaction to the vaccine.

11.2 For some time now, we have advised people on the Highest Risk List to follow the same advice and guidance as the rest of the population unless advised otherwise by their GP and clinician.

11.3 We do not intend to advise those who may be at highest risk to return to shielding in the future given the strong evidence of the detrimental impact of isolation on physical and mental health and wellbeing. Therefore the Highest Risk List no longer serves the purpose it was created for. For that reason we are now in a position to retire the Highest Risk List.

11.4 Following the roll out of Scotland's Vaccination Programme the decision to retire the Highest Risk List has been reached by consensus across all Scottish Government clinical advisors. The evidence shows that clinical risk of serious outcomes from COVID-19 is reduced thanks to the vaccination programme and new treatments.

11.5 Given the wide range of circumstances and health conditions of people on the Highest Risk List, ensuring personalised advice and support is available to each individual on the list is an important part of this transitional period. GPs and clinicians who best know the circumstances of people at highest risk will continue to be the first port of call for individual clinical advice.

11.6 It is recognised there are some people on the Highest Risk List who currently have conditions that prevent a robust vaccination response, or who take medication that has a similar immune-suppressing effect. These individuals have always been at risk and, pre-pandemic, would have had to make individual risk assessments in consultation with their clinician.

11.7 As we transition beyond the current Highest Risk List we will adopt an identification process to be able to rapidly and accurately identify people who should be prioritised for vaccination, for treatments and, if the threat level increases, for additional protective advice.

11.8 The retirement of the Highest Risk List applies to all groups previously identified as being at highest risk as we return to the pre-pandemic approach of individual clinical advice for those who may need to take extra precautions (for example people who are immuno-suppressed), just as they would have done before the pandemic to keep themselves safe from other viruses and disease.

11.9 Our overall strategic approach going forward is to support and protect people who are at higher risk from COVID-19. While the threat from COVID-19 is currently waning and we lift legal restrictions as a result, we know that many people at highest risk may be anxious.

11.10 Clear communication is required to support the transition of those on the Highest Risk List to fully participate in society again. This will include;

  • The Scottish Chief Medical Officer writing out to all individuals on the Highest Risk List to inform them their risk of severe illness or death from COVID-19 is now reduced following vaccination and treatments and explaining the clinical context behind that decision, with confirmation of the retirement of the Highest Risk List
  • Clear guidance to key stakeholders of the Highest Risk List such as health charities, local councils and voluntary sector organisations setting out what factors may make an individual more vulnerable, and signposting to available evidence



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