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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.

This brief provides 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.These considerations include: 

• The specific shielding approach taken should reflect the context of the country or locality, taking into account the relative feasibility and likely effectiveness of its implementation, and the ways people are likely to react to the measures.
• Clear and transparent communication should occur with communities through trusted local authorities or interlocutors.
• Shielding will only be feasible and effective if an appropriate model is chosen in consultation with recognised community representatives.