Advice presented to First Minister on changes to the Health Protection Regulations.
Health Protection regulations imposing restrictions on public life in Wales have been successful in controlling the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There has been a decline in the spread and impact of the virus, the vaccination roll out continues at pace, and the intention to gradually ease restrictions would be viewed as a proportionate response to the relative risk to public health. However, the decision to pause and wait for more detailed analysis of the B.1.617.2 variant of concern from India is prudent. Case numbers and clusters are being closely monitored and data will be interrogated to assess transmissibility, period of infection and evasion of immune defences; information which can be used to determine the nature, timing and sequencing of on-going relaxations.
If public health conditions are such that we are able to move away from legislative controls, we will be increasingly reliant on sectors putting in place measures to make environments ‘covid secure’ and on civil society becoming risk literate, so that each and every one of us can assess our risks and adopt appropriate protective behaviours. The risks of transmission in indoor, poorly ventilated, crowded settings remain high.
At this point in time, with the threat of a troubling variant and modelling predictions suggesting the likelihood of some increase in viral transmission later in the year, the potential for adverse impact on population health or health system resources is difficult to quantify. It is therefore essential that we maintain an effective TTP system and maintain local public health surveillance/action to detect and contain incidences and outbreaks; this will help to limit the size and impact of any further wave of infection.
Other risks that I am particularly concerned about include:
- the reintroduction of non-essential international travel which poses additional risks of re-seeding of infections into Wales and the introduction of more new variants with the ability to escape the protection afforded by our vaccination programme
- the too rapid removal of non-pharmaceutical interventions (NPIs), particularly social distancing and face coverings in crowded public indoor settings. Without these measures in place, there is a risk that long chains of transmission in our communities will lead to rapid viral resurgence
- any vaccine resistance among younger adults or waning of immunity in the immunised population will reduce the protection which has been afforded by our successful immunisation programme
I strongly recommend that these risks are considered as part of the longer term management of the pandemic and that a sustainable way forward is communicated to the public; including the measures that everyone needs to take in order to prevent disease resurgence and avoid wherever possible, a re-imposition of societal restrictions on public life.
Finally, our preparation for next winter should consider the potential impact of other seasonal viruses (particularly influenza, RSV, and meningococcal infection) which have been held at bay by COVID-19 control measures and which are likely to adversely affect our population if control measures are removed.
Dr Frank Atherton
Chief Medical Officer