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The analysis found that the proportion of the population that would be shielded under the policy would be no more than 15%. However, even if a classifier based on data from medical records performed only slightly better than one based on age and gender alone, it should be possible to refer at least 80% of those who would die without shielding to the shielding group. The importance of the population-wide fatality ratio
The average risk of infection among shielded individuals and the overall number of deaths while shielding is implemented would completely depend on the fatality ratio across the entire population.
“Although the proportion of deaths that would be prevented by effective shielding does not vary much with the infection fatality ratio, the absolute number of deaths in the unshielded varies from less than 10,000 if the infection fatality rate is 0.1% to more than 50,000 if the infection fatality rate is as high as 0.4%,” writes the team.
If the ratio were at the higher end of the values now considered viable (0.4%), even a well-performing classifier would be unable to ensure deaths would be kept to less than 30,000 or to keep the risk of death among unshielded people to lower than 1 in 2000, although this would still be manageable by expanded critical care services
However, the researchers note that the mortality risk predictions for unshielded individuals are averaged across the group and that a risk classifier “could, of course, output not simply a dichotomous classification, but a continuous risk score that would be the basis for individual choice.”
“Any shielding strategy involves issues of ethics and equity in that those in the unshielded group are asked to accept a low risk so that not just they, but those shielded from infection, can emerge from isolation sooner,” write McKeigue and Colhoun.
The team says researchers currently conducting studies that should help to answer important questions about applying the stratify-and-shield approach. Areas of uncertainty include the prevalence of immunity, the degree to which infection results in immunity, the fatality ratio, and how a classifier based on medical history performs. “This policy option should not be dismissed”
The researchers say the time has come to seriously consider a stratify-and-shield policy that could hasten the ending of the COVID-19 epidemic.
“A stratify-and-shield policy using a classifier based on medical records has the potential to save lives, restore economic activity and end the epidemic long before a vaccine is expected to be available,” they write. “This policy option should not be dismissed but seriously evaluated as an alternative to adaptive social distancing.” Important Notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information. Journal reference: McKeigue P and Colhoun H. Evaluation of "stratify and shield" as a policy option for ending the COVID-19 lockdown in the UK. medRxiv 2020. doi: https://doi.org/10.1101/2020.04.25.20079913
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