CMO advice on pre-festive restrictions

I have reviewed the proposals to retain existing restrictions in the Health Protection (Coronavirus Restrictions) (No. 2) (Wales) Regulations 2020, and impose new restrictions on travel, the hospitality, indoor entertainment and indoor visitor attractions. I have also considered the Scottish, Northern Irish and UK Governments’ four-nation plan for the festive period. 

My advice continues to be informed by the outputs of the UK Scientific Advisory Group on Emergencies (SAGE) and the Welsh Technical Advisory Cell (TAC), and through discussions with Chief Medical Officers in the 4 Nations and the Chief Economic Adviser in Wales.

The Welsh firebreak had the intended impact of a short sharp early intervention to push back the epidemic by approximately three weeks. This period of negative growth is now being overtaken by the rates of transmission increasing across health board areas, with highest rates in Aneurin Bevan and Swansea Bay, as well as affecting people aged 60 and over. On the 29^th November, there were 1,687 patients with confirmed, suspected or recovering COVID-19 in hospital, including 68 COVID-19 related patients in critical care.

Advice from UK Scientific Advisory Group on Emergencies (SAGE) and our Technical Advisory Cell (TAC) is that implementing interventions earlier and before exponential growth is the most effective way of  controlling the pandemic. The Scottish level three system and the English tier three restrictions appear to be having a positive impact on reducing the spread of the Coronavirus. I therefore support the proposed amendments to the Welsh regulations to prohibit the sale of alcohol in and reduce the opening hours for pubs, bars, restaurants and cafes, and to close indoor entertainment venues and attractions. 

These measures are specific and targeted and aim to reduce opportunities to mix and socialise in indoor, crowded and poorly ventilated settings where the virus can easily transmit. These additional restrictions, together with the existing arrangements of extended households will help us to enter the festive period with a lower community prevalence of COVID-19 than would otherwise be the case.

I recognise the adverse socio-economic effects and associated harms that will arise from these measures and which will particularly affect the hospitality sector and its associated supply chains in a period which has traditionally been very important for revenues. I therefore very much welcome the proposed support package that will be implemented by the Welsh Government. I would also note that while it will not be possible to fully mitigate all adverse effects, the harms could be even greater were we to delay action and have to impose even more restrictive and protracted measures in the future.

The four nations approach to the festive period is to be welcomed; it provides clear, understandable rules which should be easier to comprehend and follow. However, whilst it is permitted to bring three households together to form a Christmas bubble between the 23 and 27 Dec, I encourage the Welsh public to think carefully about their plans and opt where they can, for a safe and low-key Christmas. This is particularly the case for any planned face to face meetings with elderly relatives, as safer ways to meet such as virtual ‘get togethers’ could be employed. 

We know that transmission in households happens quickly and that pre and early symptomatic individuals are highly contagious - the best way to protect vulnerable family members is not to expose them to potential infection, no matter how well intended the reason for contact. Where this cannot be avoided, I would advise that in the weeks leading up to Christmas, households should not mix, as a way of lowering the risk of inter-generational infection, and when they do meet together; to practice social distancing, maintain good hygiene, reduce the length of stay indoors and keep environments well ventilated.

There is no doubt that meeting with families and friends over the festive period will lead to increased opportunities for transmission of the disease. The consequences of this brief relaxation will inevitably be an increase in cases, hospitalisations and deaths in January and February. I therefore recommend that we map out and publicise our plans for the post-festive period in a way which allow us to rapidly put in place further restrictions in the new year should these be needed.  

Plans to develop, licence, produce, and deploy a vaccine are well advanced and offer a way for us to move from dealing with the pandemic to living with an endemic disease. In the meantime, until effective vaccines are widely available the Welsh public will need to maintain social distancing and related measures which are needed to avoid catching and spreading COVID-19 and so to preserve public health and save lives. 

Dr Frank Atherton
Chief Medical Officer
2 December 2020