Chief Medical Officer for Wales statement on 21 day COVID-19 review: 9 December 2021
The COVID-19 pandemic in Wales continues to be dominated by the delta variant. Community transmission appears to be stabilising with case rates declining slowly and direct pressures on the NHS easing. It is not yet clear whether the wave of delta variant infection which is sweeping across Europe from East to West will lead to a reversal of this improving trend in Wales and other UK nations.
The identification of the Omicron variant is a matter of significant concern and there is considerable uncertainty as to its likely impact; intelligence from South Africa together with rapid global dissemination strongly suggest a transmissibility advantage. There is insufficient information at present to make a judgment about potential for vaccine escape and both the symptomatology and the degree of clinical severity in infected individuals remain uncertain.
In this context I support the adoption of appropriate precautionary actions to limit transmission while further epidemiological and clinical assessments are conducted. The border controls which have been enacted on a UK basis are likely to reduce the number of seeding events and to delay establishment of the variant although they will not prevent it and will be less effective when wide scale community transmission of the variant is established in the UK. I anticipate rapid growth in community transmission in coming days/weeks. The initial focus of our TTP programme on testing, identification, isolation and intensive contact tracing of the early cases should continue but experience with the delta wave again suggests that this approach will delay rather than prevent establishment of the variant in Wales. When widespread community transmission is established we will need to consider a refocussing of our TTP resource towards the protection of vulnerable individuals/settings, and the management of complex cases and outbreaks.
The Omicron variant may prove to be less responsive to vaccination in terms of both transmission and serious illness but it is highly likely that some protective effect will remain and it is therefore imperative that we rapidly implement the JCVI advice to extend booster doses to younger cohorts.
In addition to these measures, non-pharmaceutical interventions continue to play a crucial role in limiting wide-scale community transmission. Social distancing, limiting the number of personal contacts, wearing face coverings in crowded places, and practising good respiratory hygiene all work in combination to reduce the spread of COVID-19, influenza and other respiratory viral infections. Greater use and availability of Lateral Flow Devices (LFD) in the community will also help to identify positive cases quickly and prevent people from unknowingly spreading the virus.
The transmissibility advantage of the Omicron variant makes it liable to cause outbreaks in closed settings environments and I recommend a review of the protective arrangements in these places. Care homes should ensure systematic use of LFD testing by visitors, high booster coverage for residents and staff, and restrictions on staff working in multiple locations. Health care facilities should review arrangements for regular LFD use by staff and ensure full compliance with up to date IPC guidance.
It is not yet possible to predict the potential for infection and harm in the most clinically vulnerable and it would be premature to re-consider a reinstatement of shielding for these groups; any change to this advice should be considered on a UK-wide bases but we should maintain our list of shielded patients in case of need.
As the situation regarding the Omicron variant unfolds over the coming days/weeks there may be a need to intensify community interventions aimed at reducing person to person contact in households and in public spaces. We should be ready to escalate to our 'COVID urgent' arrangements if we see a significant rise in community infection rates leading to serious illness and threats to the capacity in our health and care system.
Dr Frank Atherton