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Dear Editor

Shielding and ‘wanting others to keep their distance’ – an online survey

As COVID-19 lockdown measures are eased, there is significant anxiety among some groups about decreasing adherence to social distancing. The initial clear ‘2 m rule’ has now been reduced to ‘1 m plus’ in England, with increasing confusion about the guidance. One of the authors, who is shielding, has particular concerns about respect for personal space. A recent publication proposed a ‘Safer at 2 m’ lapel badge to prompt effective social distancing [1], and the overwhelmingly positive response led us to perform a national survey around self-identification with a recognisable symbol on a badge/ pin.

We circulated a questionnaire using Google Poll® between 25 June and 5 July, with eight questions exploring views on concept, design and application. This was shared widely on social media, and 1765 responses were received (Table 1).

None of the proposed designs were favoured outright, but the NHS branded shield design was marginally the most popular of those put forward by 485/1725 (28%). Free-text feedback around the design identified that the symbol needed to be a contrasting colour combination to be easily noticeable, with concerns that modification of an already existing symbol could lead to confusion. There were also concerns relating to the presence of text that might encourage people to come close in order to read it.

The high number indicating that they would respect a badge is one of the most important results of the survey as it showed a willingness to engage from both shielding and non-shielding groups, although the results are open to considerable response bias.

Overall the ability to self-identify with a consistent, recognisable symbol was welcomed. Whilst the need for ongoing social distancing is well known, there is a willingness from the public to engage in the use of polite prompts to maintain this behaviour. With this in mind, the authors have taken the data to local and national governments for consideration of a national scheme. To date the Welsh Government has endorsed an NHS initiative, supported by registered charities and discussions are ongoing with other governments. The ‘Distance aware’ shield (Figure 1) is now being adopted by individuals and organisations nationwide as a positive symbol for ongoing social distancing.

Helen A. Iliff
Anaesthetics Core Trainee
Department of Anaesthesia and Critical Care, Cwm Taf Morgannwg UHB
Bevan Exemplar, Wales

Baroness Ilora Finlay of Llandaff
House of Lords
Bevan Commissioner, Wales

Malcolm G. Semple
Professor of Outbreak Medicine
Institute of Infection Veterinary and Ecological Sciences, University of Liverpool

Twitter: @iliff_helen; @TweedieChap

References

1. The bmjopinion. How can “shielding” be safely lowered as lockdown is eased?, 22 June 2020. https://blogs.bmj.com/bmj/2020/06/22/how-can-shielding-be-safely-lowered-as-lockdown-is-eased/ (accessed 29/7/2020).

Table 1

Figure 1

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Congratulations to Helen A. Iliff for winning October's Letter of the Month prize.

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Dear Editor

Resurgence in use of the facemask hook ring during COVID-19 – just like the good old days

Figure 1. Demonstration of the attachment of tourniquets to ring in an awake subject

There has been extensive correspondence in Anaesthesia News calling for the discontinuation of plastic hook rings provoked by Rattenberry and Shinde’s article [1].

During the COVID-19 pandemic, aerosol generating procedures, including intubation with a tracheal tube or supraglottic airway, have necessitated a 20 min delay before cleaning the operating theatre to allow for aerosol clearance. Increasingly, we have been managing patients’ airways with a facemask for short procedures to ensure smooth running of high volume lists. This was, of course, standard fare ‘back in the day’, and the Clausen harness was available to relieve the aching hands; not so any more. We have found, however, that the mask can be securely applied using two disposable tourniquets applied to the face mask hook ring [Figure 1]. While this does not imitate Clausen’s original design with 3-point application of strapping, it is effective at maintaining a seal, thus allowing concentration on maintaining a patent airway (with or without an oropharyngeal airway).

We loudly applaud the aim to reduce plastic waste, but it may be that we need to keep the ring for a little while longer.

Vanessa Skelton
Consultant Anaesthetist

Joe Carter
Operating Department Practitioner
King’s College Hospital NHS Foundation Trust, London

Reference

1. Rattenberry W, Shinde S. Let’s get hooked on reducing plastic waste. Anaesthesia News 2019; Issue 379: 20-1.

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