This brief considers the rationale for shielding individuals at high risk of severe disease or death from COVID-19 in low and middle-income countries. It provides an overview of proposed approaches to shielding, discusses the categories of individuals who may be identified for shielding, and outlines the likely difficulties of these measures and ways to mitigate them. It should be noted that the authors are not aware of any precedent for targeted shielding of specific groups in low- and middle-income countries during this or any other outbreak. As such, shielding as an approach is untested.
The authors have attempted to provide considerations regarding the feasibility and challenges of this approach, particularly in low- and middle-income settings. Decisions on shielding will need to pay particular attention to the local socio-economic context, be made in collaboration with local actors, and be continually adapted in light of emerging evidence about the approach’s effectiveness, the characteristics of the COVID-19 and the trajectories of the outbreaks.