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Information and rational decision-making: explanations to patients and citizens about personal risk of COVID-19
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  1. Margaret McCartney1,1,
  2. Frank Sullivan2,
  3. Carl Heneghan3
  1. 1School of Medicine, Medicine and Biological Sciences, North Haugh, University of St Andrews, St Andrews, UK
  2. 2Schol of Medicine, Medicine and Biological Sciences, North Haugh, University of St Andrews, St Andrews, Fife, UK
  3. 3Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Margaret McCartney, University of St Andrews, School of Medicine, Medical and Biological Sciences, North Haugh, St Andrews, UK; margaret{at}margaretmccartney.com

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Introduction

On 16th March 2020, the UK government published “Guidance on social distancing for everyone in the UK”,1 which asked people in particular groups to be “particularly stringent in following social distancing measures”. These groups included all people over the age of 70, and under the age of 70 with particular health conditions. People offered influenza vaccines were part of this cohort (which includes people with heart disease, chronic respiratory disease, obesity and major mental illness) as well as people with chronic kidney disease, multiple sclerosis and learning disabilities.2 Subsequently, on the 21st March 2020, a subgroup were identified as recommended to ‘shield’, which entitled them to food deliveries, priority for supermarket deliveries and social care support, if necessary.3

Testing for the presence of COVID-19 in the UK was initially limited and was undertaken only in hospital settings for patients with suspected disease. Subsequently government expanded this to include any symptomatic person in the UK over the age of 5. On 2nd April 2020, the government set a target of 100 000 tests per day.4 Patients booked appointments online at a drive-through centre and the result was communicated by text message.5

Strikingly, communications from government to patients and citizens in these scenarios contained several definitive statements. Patients identified as being in the high risk group were informed they were at ‘very high risk of severe illness’6 from COVID-19. For symptomatic patients having a test for current infection with COVID-19, the result by text for negative test results read “A negative result means you did not have coronavirus when the test was done”.7

These claims were examined as they came to attention during routine work in general practice in the early stages of the pandemic. The shielding information caused distress and confusion in …

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