CMO advice for 3 June regulatory review of the Coronavirus Regulations

The current public health position for COVID-19 across Wales is stable, with low COVID-19 case rates, hospitalisations and deaths in all parts of Wales and increasing population protection by vaccination. Vaccination milestones continue to be reached ahead of their expected timing. The longer we can maintain low case rates while increasing vaccination coverage, the less the likely magnitude of a third wave, but we are not yet in a position of high confidence that COVID-19 related harms will not increase substantially should transmission increase.

Set against the confidence of this picture are remaining areas of uncertainty. In England the variant first identified in India, recently designated by the World Health Organisation as the 'delta' variant, shows a greater rate of transmission than preceding variants, causing exponentially increasing case rates in some areas despite current restrictions. There is a moderate likelihood that the delta variant will become the dominant variant across England and the wider UK.

At present Wales has only a limited number of known cases of the delta variant, generally in clusters derived from travel related cases.  Our past experience is that variants will spread from England to Wales in time, so this is to be expected, along with an increase in associated transmission and case rates and possibly hospitalisations and deaths. The extent to which our excellent vaccination programme will slow transmission remains unknown. The protection provided by two doses against this variant is much greater than for one dose, and therefore protection from infection remains limited for many in the population at this point.

The Chief Economist notes that the economy in Wales and across the UK is now recovering sharply, which is as expected, given the success of the vaccination programme and the reduction in the level of restrictions. The adverse effects in the labour market, where the economic harms of Covid are felt most acutely, have so proved rather less severe than originally forecast, due mainly to the temporary support schemes put in place by the UK and Welsh Governments. However, there remains a high level of uncertainty about prospects for the labour market over the medium term, as the pandemic evolves and support schemes are removed. The likelihood of longer term socio-economic harm, resulting from 'scarring' in both the labour market and the education system, and affecting disproportionately people from disadvantaged backgrounds, remains high, although its extent will depend on the future path of the recovery and the measures taken to remediate the damage.  

There is pleasingly little evidence so far that increased mixing caused by the previous relaxations from Alert level 4 to 2 has significantly increased transmission, but this remains the expected consequence of more people spending time together, particularly in poorly ventilated indoor settings with inadequate social distancing.   

Thus, while current low case rates allows some further relaxation of restrictions, I continue to advise caution and support a continuation of the graduated, stepped approach we have deployed throughout the pandemic. The risk of transmission in outdoor settings remains significantly less than indoors, so I would support greater freedom for outdoor activities at this time when the weather is improving, but a more cautious approach still to indoor settings, at least until the impact of the delta variant is more clearly known in a few weeks. This phased approach, over a longer period of time, could be linked continued low prevalence and to further vaccination milestones achieved. I am also quite certain that basic protective behaviours remain vitally important, in particular test, trace and protect for those who are symptomatic, regular hand hygiene, the use of face coverings indoors, and social distancing all still have an important place in mitigating the risk of transmission.

Dr Chris Jones
Deputy Chief Medical Officer
4 June 2021