Chief Medical Officer advice on a firebreak lockdown

I have reviewed the proposals to:

1. introduce new national restrictions (a firebreak lockdown) for a two week period coinciding with the forthcoming school half-term break
2. work on a post firebreak position and a new set of national rules 

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.

I am concerned that transmission of coronavirus has increased substantially in Wales over the past two months and is increasingly shifting back into older, frailer people. It is a near certainty that the cases we are currently identifying in the community will translate into increased pressure on the NHS over the coming weeks. The Local Health Protection Area arrangements we have established in many parts of Wales have led to some short term stabilisation but have not arrested the exponential growth in viral transmission. With an estimated Rt of 1.4, growth rate of 5% per day, and current doubling time of 10-14 days we have a short window of time to act if we are to prevent our NHS capacity becoming stressed and potentially overwhelmed. To prevent direct COVID-19 deaths and deaths related to the non-availability of NHS services, I therefore recommend a 'firebreak' return to some of the earlier lockdown measures. 

Modelling is imprecise but the factors which should guide our decisions on the nature of a 'firebreak' are:

• it should be implemented as soon as possible while recognising the need for some consultation and the necessary communication to prepare sectors and the public
• a two week period is the minimum duration which is likely to have an impact; the longer the duration the greater the effect
• simple message of staying at home  is likely to be more easily understood and monitored than more complex restrictions on geographical travel
• we should maintain suitable exemptions which allow the public to maintain physical activity, engage in low-risk outdoor activities, and support single person households and single parents
• enabling younger children and vulnerable children of secondary school age to remain in the classroom is advisable to support parents who are key workers.  In secondary and independent schools enabling our youngest and most vulnerable children to continue to receive face to face learning is advisable. For older children in secondary school and further education, continuity of teaching via on line platforms will minimise disruption for learning and at the same time minimise social interaction, in line with the purpose of the firebreak  
• universities remaining open will also prevent the adverse consequences of mass migration of students to different parts of the UK and Wales  

I am acutely aware of the indirect harms which will result from the proposed restrictions. Our Chief Economic Adviser estimates that over £300 million of output (GDP) and the associated income could be lost, before taking account of all supply chain effects.  Payments under the UK government job support schemes will not fully offset this lost output and income.  The adverse economic and social effects are likely to last beyond the period of the circuit-break, worsening labour market prospects for those who lose employment or who have entered the labour market in the recent past.  Evidence from previous recessions suggests that young people who enter the labour market in such circumstances suffer long term adverse consequences, affecting economic outcomes, health and well-being, and have an increased risk of premature mortality. These, and other, effects will tend to exacerbate socio-economic inequalities. However, the indirect harms could be much greater if the proposed firebreak was not introduced, the NHS becomes overwhelmed, and a longer or more stringent national lockdown is subsequently judged to be necessary.

I intend to communicate with those individuals who are in the 'shielding group' to advise them on the measures that they can take to protect themselves and the support mechanisms that are available to them.

A firebreak lockdown at the current time will not, of itself, end the pandemic; we may need to institute similar restrictions during the forthcoming winter months. Prospects for vaccines against the virus are improving and our approach in Wales should continue to be to reduce deaths and avoid harm as much as possible until such a time as they can be deployed.

Finally, I agree that we should make best use of the firebreak period to carefully monitor the impact on viral transmission, to further strengthen our NHS preparations for the winter months, to regroup our TTP programme, and to re-engage with the welsh public on the essential actions that we all need to take to protect ourselves: by reducing all forms of social mixing; in our homes, restaurants, shops, leisure centres and workplaces for a short period of time, we can avoid catching or spreading the virus, we can prevent hospitalisations, and we can reduce the number of COVID-19 related deaths that will be seen over the winter months. 

Dr Frank Atherton
Chief Medical Officer
19 October 2020