At the beginning of the covid-19 pandemic over two million people in the UK with underlying health conditions were labelled as “clinically extremely vulnerable” and “clinically vulnerable”. For a significant proportion of these individuals, although they were labelled as “vulnerable,” this vulnerability is not easily visible to society. They have “invisible” illnesses that they have managed while continuing with their everyday lives and being contributing members of society. Many were advised to “shield” and were left in a frustratingly foreign situation far from their usual lives and now sit contemplating what the new normal means for them.

Disempowerment through labels has led to social isolation, anxiety, and fear. Plans to de-escalate the shielding programme have been announced, social distancing has been decreased in England from 2m to “1m plus”, and all of a sudden people who have been shielding are expected just to integrate back into day to day life. The messages are mixed, support is not sufficient, and people are scared. Seeing a major incident declared as people flock to beaches before these new measures even come into play has hardly reassured anyone that their social space will be respected. 

In a previous BMJ opinion piece we proposed the idea of a “safer at 2m” lapel badge for shielding individuals during the upcoming transition period. Feedback from a number of charities, as well as shielding and non-shielding individuals, has been overwhelmingly positive. This has led us to further explore the concept and its ability to scale. The initial idea carried its own flaws. To roll something out on a national basis is complex. Literacy, font size, language, and overall impression all need to be carefully considered so text isn’t favoured. Therefore, symbolism is preferred.

Symbolism has its own downsides. To be effective it needs instant recognition which requires exposure. If used incorrectly it can become a label with which individuals are reluctant to self-identify, and limits the effectiveness. But symbolism, if carefully considered, well publicised, and easily recognised can be incredibly powerful. Look at road signs and logos where text is not required.

However, asking those who have been disempowered by an initial label, to wear another one and self-identify as “vulnerable” or “at risk” could likely lead to further retraction from human interactions and worsening mental health. The other option is to empower society. 

Engagement with people in shielding and non-shielding groups has shown us there is wide understanding of personal responsibility, and need to respect other people’s personal and social space. This is a substantial change from what we would previously have classed as “normal”. While ongoing social distancing can be encouraged through initiatives like working from home and online meetings, there will always be human interactions. People need and want to go back to work, or do their shopping, and see friends for their physical, financial, and mental wellbeing. 

To maintain a culture of no handshakes, hugs, or high-fives, will need positive prompts. A simple action such as introducing a symbol with a strong well-communicated message has the potential to empower society to change. Instead of asking shielded people to identify themselves when returning to social or workspaces, they can instead be welcomed with a visual that indicates “I understand others would like their social space respected, please respect mine also.” The power of a shared message and belief cannot be underestimated; just look at examples like PRIDE and Black Lives Matter—huge open non-exclusive movements that empower people with their message.

Motivation to self-identify varies. Many choose to and many choose not to, decisions that should be equally respected. Change is possible, and at minimal cost. This self-identification could happen through consistent branding of any number of things—a lapel badge, lanyard, t-shirt, mask or hat. 

The risk to those emerging from shielding increases as others drop social distancing and a second peak remains likely. Instantly recognisable symbolism can promote a caring integrated society, encourage people to respect physical distancing rules, and lower the risk to all.  

Helen Iliff, Anaesthetics Core Trainee; Department of Anaesthesia and Critical Care, Prince Charles Hospital, Cwm Taf Morgannwg UHB and Bevan exemplar, Wales. Twitter: @iliff_helen

Ilora Finlay, Baroness Finlay of Llandaff, House of Lords, Westminster and Bevan Commissioner Wales.

Competing interests: None declared.