Written Statement: COVID-19 Update

This statement provides an update for members on recent developments including face coverings, the NHS Wales Test, Trace and Protect service (TTP), mortality rates across UK nations and screening services.

Face coverings

On Friday 6 June NHS England made an announcement updating their guidance on face coverings for hospital based staff. Later on the same Friday the WHO updated their guidance advising that face coverings should be considered in settings where maintaining social distancing is difficult. We were not sighted on the detail of either announcement.

To be crystal clear, wearing a face covering does not replace the need for social distancing or washing your hands regularly. These together with the advice of the TTP service remain the best way of stopping the spread of the virus.

Further scientific evidence is needed on the benefits to the wider public of wearing face coverings. However, observational findings suggest that homemade or purchased three-layer face-coverings might reduce transmission from one person to another if made, worn, handled and disposed of properly.

Following advice from our Chief Medical Officer the Welsh Government has recommended that three-layer face-coverings should be used in situations where social distancing measures can be more difficult to achieve. It means for example that we have recommended the use of three layer face coverings on public transport.

Social distancing and hygiene measures are by far the most effective ways to protect yourself and others from COVID-19. Public transport providers across Wales have introduced measures to ensure a 2m distance between passengers is possible most of the time, but we realise this is not always possible to maintain. Face coverings are one of a range of measures that bus operators are taking to make travel safe.

The wearing of face coverings are not a silver bullet for COVID-19. Wearing face coverings will not be mandatory, but we will encourage people to do for the benefit of themselves and others. We are not recommending the use of face coverings outdoors.

This advice only applies to people who are not showing symptoms of coronavirus. Anyone who has a high temperature, a new, continuous cough or a loss or change to their sense of smell or taste must self-isolate for a minimum of seven days and get a test as quickly as possible. Unless the test shows a negative result, people must not go out during this time, even with a face covering or mask.

This is an ever changing situation with scientific advice being regularly updated. As with every choice we make as the evidence changes I expect the advice to ministers to change as we move through the different stages. As I have regularly stated that means the decisions of ministers may change on any aspect of our response in Wales to COVID-19.

NHS Wales Test, Trace and Protect service

In relation to Test, Trace and Protect, our population-wide contact tracing operation has made a very positive and successful start.

We now have some 700 staff working in contact tracing teams across Wales and plans are in place to rapidly increase this number should the situation require it. Additionally, a new national digital system has been rolled out across all regions and this will help to underpin an even more effective and robust operation going forward.

Up until the close of play on 14 June, some 1,309 positive cases were referred to the teams for contact tracing and this has resulted in 1,752 follow-up contacts being identified, of which nearly 90% have been successfully contacted and advised accordingly. Furthermore, the available data indicates that fewer than 10 individuals who have tested positive have refused to share details of their contacts. 

We have also identified a number of workplace clusters. Our regional teams have successfully contact traced and worked with staff and employers to identify if the transmission occurred inside or outside the workplace and intervened as appropriate with public health advice.

The early performance endorses the approach we have taken in Wales of working in partnership with local authorities and health boards to build our local contact tracing capacity. All the signs are that the public are engaging positively with our contact tracing operation and our efforts are focused on ensuring this continues.

On daily lab testing capacity in Wales, Public Health Wales currently report this stands at 12,374. A new Mass Testing Centre (MTC) become operational in Deeside on 11 June and plans for an additional MTC in Abergavenny are being finalised. Officials are in discussions with UK Government and LHBs about switching Carmarthen, Cardiff, Newport and Llandudno to lighthouse lab capacity.

This could produce greater flexibility in the Welsh system to develop regular testing priorities and enable LHBs to develop greater access opportunities for testing. Officials are in discussions with PHW and LHBs regarding the options available for utilising Mobile Testing Units (MTUs) across Wales and considering the additional capacity on offer from UK Gov.

On 8 June our Task Group that is made up of representatives from all partner organisations, agreed the minimum level of support that each local authority should provide to help people self-isolate as a result of being contact traced. The support identified is broadly in line with support already provided to people shielding/non-shielded vulnerable people. The Task Group also discussed the additional support that may be required, including how to best help the contacted individual with financial support. This included information on how we understand the financial consequences of not going to work, the level of difficulty this may pose to individuals and how government might with this and when that would be appropriate.

Mortality rates across U.K. countries

We have now have clear evidence of the scale of the terrible impact the pandemic has had on mortality here in Wales.

On 16 June ONS reported that up to and including 5 June, 2,317 deaths had occurred in Wales where COVID-19 was a contributory factor. Each and every death is a tragic loss to the family and friends of those taken from us.

However there are clear signs, from Public Health Wales surveillance data and the ONS published data that we are now well past the initial peak. The ONS have reported a fall in weekly deaths for 6 successive weeks.

ONS statistics refer to excess deaths. This is calculated by taking a 5 year average to give us a usual or expected death figure for each point in the year. Anything above that average is described as the excess death figure. It’s a cold but important way to understand the harm that COVID-19 has caused. On a weekly basis this remained 90 (or 15%)  more than the usual number of deaths for the week ending 5 June. This compares with an excess of 508 (or 77%) deaths at our peak in mid-April.

As we are now past the first peak of the pandemic it is an appropriate time to consider what the figures for Wales tell us about the course of this pandemic and how this has compared with the rest of the UK. This is important as it will help us to understand what has happened in Wales. That learning can be applied to decisions that I will have to make with ministerial colleagues for any potential second peak.

Using the figures published by ONS we have seen that:

• Wales has seen a relatively lower rate of COVID-19 related deaths per head of the population than England and Scotland. 
• We have seen a lower rate of deaths from all causes in Wales when compared with England and Scotland.
• A lower percentage of deaths in Wales are COVID-19 related when compared with the UK average.
• Our rate of excess deaths over this period, that is comparing our mortality with a 5 year average, is lower than England and Scotland.
• Looking at in another way: if Wales had seen the same excess death rate as England for the period March until early June, that would be around an extra 1,600 deaths in Wales; if England had seen the same excess death rate as Wales, that would be almost 24,000 fewer deaths in England.

This is also true if we consider Wales in comparison to regions of England. ONS data published on Friday showed that on an age standardised basis only the South West and, marginally, the South East had lower COVID-19 mortality rates than Wales over March to May. Again, other than in the South West, Wales had the lowest percentage of deaths that were related to COVID-19.

Given our demographic, health and socio-economic profile, this is not what we would have expected to see at the start of the pandemic.

This is not a cause for celebration. It remains a fact that we have seen 2,187 excess registered deaths in Wales from 29 February to 5 June due to the spread of this virus to all corners of our nation. But it is important to put our figures into context and to try and understand why two areas – Wales and the South West - with a traditionally older population have seen lower levels of excess mortality than other parts of mainland Britain.

This will include an understanding of many factors - including age, deprivation, population density, and ethnicity. We know that rates of death involving COVID are higher in our least well off communities. The mortality rate in our least well off communities is almost twice as high as the most well off areas of Wales. I have asked officials to consider what further analysis can take place to help develop our evidence base and understanding. This will include for example looking at the interaction between risk factors like occupation, housing and comorbidities like heart and lung disease.

I will publish an interim report before the summer recess. I expect to issue a final report over the summer to ensure we have considered these issues in preparation for any further peak arising from this pandemic over the Autumn and Winter.

Screening services

Finally, I want to talk about cancer screening. I understand people’s concern’s around rebooting essential cancer screening programmes. The cancer screening programmes which were temporarily paused will recommence this summer in a phased manner starting with the cervical screening programme. Cervical Screening Wales will be inviting individuals who are overdue for an early repeat test from the end of June.

From July, Breast Test Wales plans to start to send out screening invitations to women at higher risk and Bowel Screening Wales will start sending out testing kits. Those who are due to be screened will be contacted by the screening programmes as usual. Of course the programmes will only restart if it remains safe for them to do so.

I will of course continue to keep members and the public updated about the action we are taking to Keep Wales Safe.