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

I support the general direction of travel being proposed. This approach will retain measures designed to reduce the number of infectious people circulating, continue to support core elements of the TTP system and retain a more limited set of restrictions only where appropriate. The broad shift from legislation to guidance will be appropriate when we are secure in our understanding that vaccination weakens the link between community transmission and harms.

Community transmission is high; case numbers and rates are increasing; mostly among younger, less vaccinated people; rates in over 60s are increasing but more slowly.

Hospitalisations are likely to increase but, if we follow a similar pattern to England and Scotland the conversion rates between cases; hospitalisations; ITU admissions and deaths are likely to be much less than in previous waves. We can anticipate that people requiring hospital treatment will be younger and less ill with the current wave but the numbers may be high and some harm will be inevitable. NHS bodies should anticipate the need to care for this expanding group as restrictions ease.

Vaccination coverage in the over 40s is high; this appears to have altered the relationship between community transmission and harms. We need to encourage greater uptake in 18-40 year olds and in groups with lower uptake levels such as those in under-served or vaccine hesitant communities.

The current epidemiological picture changes the balance between direct and indirect COVID-19 harms and makes it increasingly difficult to justify the use of public health powers to continue restricting economic, social, and cultural activities. I agree that it is appropriate to move from legislation and sanctions towards guidance and behavioural support. I support the move to level 1 restrictions and a cautious progression towards relaxing residual restrictions. 

Removal of some restrictions in the summer months would allow us to benefit from four factors, all of which may be less favourable in the autumn/winter months.

• warmer, drier weather is less conducive to Covid-19 transmission and more social mixing occurs outdoors
• there are high levels of natural and acquired immunity in the population (particularly in people with increased vulnerability) 
• school and Higher Education holidays are about to provide a natural break in chains of transmission
• low levels of flu/other respiratory pathogens are currently circulating in the community

As restrictions are further eased we need to continue to support healthy behaviours which limit the spread of COVID-19. Strong public health messaging and policy reinforcement are needed in order that people can better judge how to keep themselves and others safe.

• retaining messaging of caution and ongoing education about good hand and respiratory hygiene
• limiting contacts and not mixing when symptomatic (even mild symptoms) with respiratory diseases, as means of restricting spread of the virus
• continue with COVID-19 specific risk assessments, and work towards embedding wider health and safety measures to prevent spread of infection. 

We should consider a comprehensive review of the TTP programme as the context and epidemiology has changed since the strategy was implemented in June 2020. TTP could potentially move to a ‘warn and inform’ process.

Robust border health measures are still needed to help prevent importing infections (especially Variants of Concern (VoC)). The UK Government proposal to remove quarantine and relax testing requirements for fully vaccinated adult arrivals from amber-list countries is not without risk. While there are residual uncertainties and risks associated with importing VoCs it is acknowledged that it would be difficult for Wales to adopt a different border health policy to UKG. If the policy position is to align with UKG, then the following matters need careful consideration:

• Where appropriate, there should be consistencies across international travel quarantine and domestic self-isolation regimes (for fully vaccinated adult contacts of cases). 
• Given the risks associated with international travel, it may be prudent to advise all arrivals who meet the criteria for this exemption against visiting hospitals, care homes or other sensitive settings where vulnerable or at-risk individuals and groups may be present.
• The proposed removal of the quarantine requirement may serve as an incentive to some to become vaccinated. However, this is unlikely to redress the current vaccine inequality across socio-economic groups.
• Planned technological updates to the Passenger Locator Form should be expedited to improve vaccine status verification of travellers (by carriers and Home Office Border Force) and help the Wales Arriving Travellers Team to prioritise follow-up of those arrivals who do not meet criteria for this exemption.

Dr Frank Atherton
Chief Medical Officer