CMO advice on 21 day review of COVID-19 restrictions: 5 August 2021

Advice presented to First Minister on 21 day review of COVID-19 restrictions.

I support the general direction of travel being proposed, including the move to level zero.

Community transmission remains high in Wales, particularly the North. Most cases are in the younger population, with gradual narrowing of the difference between young and old as transmission spreads through the ages, reflecting the protection provided by vaccination. There has been a small increase in hospitalisations and COVID related cases in hospitals but these remain at much lower levels than in previous waves. Hospitals remain under pressure though, with many other patients seeking and needing care.

There are some positive features. The rate of increase in cases has slowed and over the last few days we have seen a small daily decrease in case rates. It is too early to know if this is temporary, but it is welcome. It may be the consequence of the end of the school term, in which case the decrease might continue, but a recent fall in the rate of testing could indicate a reluctance of the population to seek a test, perhaps before holidays. Other positive features are that schools are closed for the Summer and the warmer weather enables outdoor behaviours.

Vaccination coverage continues to increase with 80% of the adult population now fully vaccinated. While there is some evidence of vaccine hesitancy in younger ages, I am encouraged that, of 18 to 29 year olds, around 75% have had one dose and nearly 50% have had two. Efforts to reach out to achieve even higher coverage remain crucially important.

Preparations are being made for a booster programme in the highest risk to commence in September. Given the relatively low levels of harms being seen from COVID at present, I support the shift from legislation towards a more proportionate emphasis on guidance and behavioural support. It is however important to extend regulations for longer as the situation remains unpredictable.  

The opening of night clubs requires careful consideration. Closed throughout the pandemic, they are crowded and noisy, often not well ventilated, with large numbers of people drinking and not socially distanced. They are high risk settings with super-spreader potential.  However those in the population at highest risk are now protected by vaccination and there are other relatively favourable conditions mentioned above. Whatever the timing of nightclubs opening, there will always be an element of public health risk.

As restrictions are further eased we need to continue strong public health messaging to help people keep themselves and others safe.

·        Good hand and respiratory hygiene remains important

·        Limiting contacts and out door settings are preferable

·        Self isolate when symptomatic and get tested

·        Retain legal requirements for COVID-19 risk assessments and face coverings in enclosed indoor settings

The major risk looking forward remains that of virus variants. The change to remove quarantine and relax testing requirements for fully vaccinated adult arrivals from amber-list countries is not without risk, increasing opportunities for variant infections to arrive in the UK and Wales. Vaccines can help reduce this risk, but only if they are still effective.

A cautious approach is therefore warranted to relaxing border health requirements, because of increasing variant case incidence rates globally and still incomplete vaccine coverage in Wales. Although border health measures go some way to protect against the importation of infection and the introduction of new variants into the UK, we should continue to work with other UK nations to further strengthen our border control arrangements. Continued restrictions on international travel may be warranted if we see case rates begin to increase.

Given the risks linked with importing infection, especially variants of concern, we should continue to advise against all non-essential travel. However, as Wales shares an open border with England, it is ineffective to have separate policy arrangements for Wales. Therefore, at the very least, if UK-wide policies change to relax quarantine requirements, we should maintain consistent and robust testing surveillance and the genomic sequencing of results as one mitigation against importing vaccine escape variants.  

Dr Frank Atherton
Chief Medical Officer