CMO advice on review of lockdown arrangements: 23 July 2020

First Minister,

I have reviewed the proposed amendments to the Health Protection (Coronavirus Restrictions) (Wales) Regulations 2020 which include:

1. Allowing the reopening of specified premises:

• all remaining self-contained accommodation with shared facilities, such as campsites
• indoor cinemas, museums, galleries and archive services
• close-contact services with the exception of treatments in high risk zones (face and throat). These include: nail and beauty salons; massage parlours; and establishments providing tanning services, body piercings, tattooing, electrolysis or acupuncture, including these services provided in spas
• full opening of housing market
• amusement arcades (adult gaming centres and family entertainment centres)
• underground attractions

  2. Exempting supervised recreation for children and young people under 18 from the Regulations covering outdoor gatherings and removing the provisions on working from home from the Regulations.  

  3.    Amending the Regulations to make the wearing of face coverings mandatory on public transport. 

Overall advice

I recommend that these amendments are adopted.

Specific considerations 

We currently continue to experience a decline in the spread and impact of coronavirus in Wales and we have an established and effective Test, Trace and Protect programme in place.  I note with concern that the rate of decline of infections may be plateauing. I note that our surveillance systems have been strengthened so as to allow us to identify and contain clusters of new cases.  These developments provide scope for the proposed changes to be made without undue risk to the health of the public.

Whilst the direct harm of being infected by COVID-19 continues to fall, I remain concerned that the restrictions in place are leading to significant negative impacts on mental health and wellbeing. These are particularly acute for the young, and those less able to understand the necessity of a change in routine such as young children or people with autism. A continued restoration of economic activity in areas that the public values (for example personal services, the housing market, entertainment and cultural venues and enabling holidays to be taken) could help to alleviate these impacts.

I note the view of our Chief Economist that

it is virtually certain that a very large increase in unemployment is now inevitable. Analysis indicates that those most likely to be adversely affected by long-term unemployment, which is the most damaging form, include young people entering the labour market, those in low paid and low skilled employment, and those with other forms of labour market disadvantage including poor health, disability and/or exposure to discrimination.

These groups are also most at risk of long-term 'scarring' effects which could have lifetime consequences for their health, well-being and life expectancy, over and above the more direct impacts on their future income levels and their risk of recurrent unemployment. It is very likely that a consequence will be to further widen inequalities over the long term. It is very important, therefore, that steps are taken to restore levels of economic activity as rapidly as possible, consistent with short term public safety.

I note that these proposals to ease restrictions are made at a time when the public should be encouraged to spend more time outside where virus transmission is reduced.  I remain concerned that there is a higher risk of transmission in indoor settings and I advise that we continue to recommend the use of face coverings by the public in crowded indoor settings where adequate social distancing cannot be maintained.

Over the coming months I expect us to see clusters, incidents, and outbreaks of coronavirus infection and there is a very real prospect of a significant increase in viral transmission with consequent pressure on the health system and impact on public health towards the later part of the year.  I strongly recommend that we strengthen our public messaging so that Welsh Citizens understand that the risks posed by the coronavirus pandemic have not abated, that social distancing and respiratory hygiene remain as our greatest protection, and that it may be necessary to re-impose restrictions on public life at local or national levels in the event of disease resurgence. 

Dr Frank Atherton

Chief Medical Officer

Welsh Government

23 July 2020