‘Direct impact of Covid passes probably quite small’ – CMO
Future lockdowns, the danger of flu and Covid and when there will be a fourth wave – Wales’ Chief Medical Officer Dr Frank Atherton speaks to Welsh affairs editor tor Will Hayward
THE Welsh Government’s chief medical adviser to the Welsh Government has spoken about what he thinks Covid has in store for Wales in the coming months.
In a wide-ranging interview Chief Medical Officer (CMO) for Wales Dr Frank Atherton explained what he thinks of Covid passes, how likely we are to have a fourth wave and the dangers posed by flu this year.
■ Western Mail: The Welsh Government has said that flu could be back with a vengeance. How do you expect Wales to be affected by flu this winter?
■ CMO Dr Frank Atherton: So we are in a position at the moment in Wales where we’re starting to see cases of flu in the community. And of course, we already know that we have very high levels of Covid transmission in the community as well. And the other thing that we know, increasingly, is that people who get infected with both flu and Covid really do have a problem. The harm that they come to is increase the death rate is increased by about 10%. So it’s really important that we get good uptake of our flu vaccine this year. We are starting to see cases already that we normally see in flu season.
We will see the first few cases in October or early November, and then it will take off in December/January.
So it looks more likely this year that we’re on a normal sort of trajectory for flu compared to last year when we didn’t see very much in the way of flu at all because lockdown basically kept us free of flu.
So I am expecting a resurgence of flu this year and our vaccine coverage is not yet what I would expect it to be. In fact, we’re lagging a bit behind where we were last year. So I’m m really keen that everybody gets the message that getting a flu vaccine is one e of the best ways to keep yourself safe afe this winter.
■ Do you think people are e more lax about getting their flu jab ab this year?
■ It’s possible that there maybe aybe an impact. But I’m also putting a challenge to health boards to make ke sure that the rollout goes smoothly othly – there’s obviously a workforce e issue because the same people often en who are delivering the Covid jabs are also doing some of the flu jabs as well. There are difficulties in the system, but it’s really important that the he system responds and that people take up the offer wherever they get the advice.
■ e about ovid
Can you just explain more the risks of getting flu and Covid at the same time?
■ Simultaneous infection is s the particular worry, obviously. In any given flu season, we do see people, sadly, who pass away from flu. This pre-existed Covid and that’s really why we have a flu vaccine and why we target the most vulnerable, the elderly, people with co-morbidities such as respiratory infections, respiratory problems, heart diseases, etc. And particularly diabetics and pregnant women, it’s really important that all of those groups come forward and get their get their flu job to reduce
■ Did you say it was a 10%? risk of death if you get both?
■ Yeah, but the science is currently evolving around that. But there’s certainly an increased risk of death if you are coinfected with Covid and flu, compared with Covid only.
■ Regarding vaccinations, are the vaccinations people are getting at the moment the same as before? Is the Pfizer vaccine you’re getting in your arm now the same as you’re getting in January or has been tweaked because of variants? When do you think a fourth rollout might be?
■ The current Pfizer vaccine being used predominantly for the boosters here in a Wales is exactly the same vaccine that was used for doses one and two, back at the start of the year.
And that that vaccine will be used for everybod everybody, whether they had the AZ vaccine or the Pfizer vaccine. It’s being rolle rolled out the moment of course, beca because, as we know, there is some waning wani of immunity. That’s why although althou community rates of transmission are extremely high in Wales, and some people are coming to harm, we we’re still getting some protection from the vaccine, but that vaccine effectiveness effe is waning.
What we know is that, particularly the waning effect is more significant with the AZ vaccine. But the good news is that anybody who gets Pfizer vaccine after afte an AZ vaccine, it really gives a very good boost to the immunity. So that is actually the best combination.
I myself had h two doses of AZ vaccine. It’s almost alm six months ago. So I know that if I get my Pfizer vaccine, towards mid middle to late November, I will then have very good level of immunity. imm
As A to your question about the future, I think it’s a bit too early to say what will ha happen, we’re increasingly confident co that we’re going to have to live with this
virus v one way or another.
But how quickly immunity will wane, or if it will wait at all after, after a booster dose, we just don’t know.
That’s something that the science really has to keep an eye on and we have to make decisions as we go.
In terms of the vaccines needing to be modified for any future variants that is always a risk.
We’ve repeatedly said that new variants which can escape the vaccine are a very significant risk.
There aren’t any in the world that we know about at the moment, so that’s good news. But if they did come up, then the science would need to evolve and the vaccines would need to be adapted, rather than like we change the flu vaccine every year. So there is a scenario where we could end up with a Covid vaccine booster every year, but it’s too early to really know that for sure.
■ Half of the people in ICU have got Covid. Do you think that in two weeks’ time you could be advising that maybe we do need to tighten up some restrictions and bring in Covid passes elsewhere?
■ We’re watching both the community rates and the hospitalisation consequences very, very carefully. The community rates are very high here in Wales, but they’re actually dropping
at the moment – we are on the ebb tide with that.
So that’s good news and hopefully they will continue to fall, but they are very, very high. What we are seeing is a steady trickle of people coming into hospital. It is nothing like the numbers that we had in the second wave, leading up to Christmas last year and that really reflects the weakening of that link between community transmission and hospitalisation due to our vaccination program.
But the numbers are still trickling in because we’re seeing between 30 and 50 patients a day coming into hospital, we have just over 850 patients with either suspected, confirmed or recovering from coronavirus in hospital at the moment – just under 10% of our bed capacity.
So it is a material factor in terms of the business of the NHS – the NHS is just very busy with everything else, the seasonal pressures, the demand on acute services, and the attempts to recover from the lack of planned care that people have had over the last year and a half.
The NHS is incredibly busy. ICU capacity is a worry here. We have currently 75 patients in ICU beds across Wales, our normal capacity is 152.
We’ve expanded that to just over 180. Just under half of our beds currently are occupied by patients with Covid and that really does reflect the pressures that we’re seeing now.
What will happen in the future if the community rates continue to fall, then we can expect with a lag about two to three weeks, the hospitalisation rates to fall also fall.
There’s always a lag effect around hospitalisations.
But irrespective of that, it’s really important that we drive down that community rates because if we drive them down, we will also drive down future hospitalisations. And we talked about now, you know, about early December in the run-up to Christmas.
It’s quite important that we give ourselves as a community that headspace and the way that we will drive down community rates, well vaccines will help.
They’re not the only answer. But those things that we’ve learned, over the last year and a half, that keep us safe will be the things that stop the virus from transmitting.
So maintaining social distance, not mixing with as many people, using face coverings in crowded indoor spaces, all of those things are still so important.
And I’m really keen that the public understands that if we’re able to continue to adopt those measures that will drive down community rates, it will reduce hospitalisations, and it will keep us safe in the run up to Christmas.
■ If cases are going down, it probably won’t be necessary to recommend further restrictions at this stage. Is that fair to say?
■ I would hope so. We’re watching the community rates very carefully. We’re watching hospitalisations very carefully. The next three weeks, there’ll be towards the end of November and ministers will look at those figures very carefully and decide whether or not further restrictions are needed.
■ What are your thoughts on Covid passes? Politically, there are lots of issues about it, but from a purely virus control point of view, do you think there’s merit in them helping to control the virus? Is there actually a scientific underpinning for that?
■ The evidence is still building around Covid passes. Lots of other countries around the world have adopted them. Wales decided to adopt them as well. The actual direct impact is probably quite small. But there are bigger impacts in terms of the messages that gives and the reminder to people that we’re not out of the woods yet; that we really are still at a difficult stage in the pandemic, and that we need to do everything so.
So it’s probably a small positive benefit to Covid passes.
What we have to do when we have such high rates of community transmission is to take anything which gives us more benefit. So face coverings give us a small benefit, social distancing gives a larger benefit. Covid passes probably give a small benefit and we’ve got to add those things up.
All taken together, they can help to drive down the rates.
■ We get a lot of messages about how Wales has overall stricter rules than England, but has had consistently higher rates since the end of the summer. Why has Wales got higher rates of Covid, despite having stricter rules? And does this mean that mask wearing hasn’t actually hasn’t got that many merits?
■ It’s a really complicated picture. First of all, there is a lag effect. Here in Wales the rates went up after they went up in Scotland and England, so there was a bit of a lag effect.
We’ve had an impact from the laboratory issue in Birmingham, where the laboratories were reporting false negative results, and I think there has been some unexpected transmission in Wales as a consequence of that.
Interestingly, people in the southwest of England, Bristol and the south west, are seeing a similar picture around that.
I think there is something about the fact that Wales was relatively spared in previous waves, compared with say, London or the south east and so there is a bigger pool of susceptible people. Not as many of the Welsh population have natural immunity so there’s something around that.
Also, people have heard of this new sub-variant of the Delta variant, which is called AY4.2. And it seems that that has a slightly greater transmissibility effect than the Delta virus that we’ve seen for most of this year.
So there’s a whole range of things playing out. Your question about face coverings about all of these things, again, I have to come back to they have a small marginal benefit.
That’s what we’ve said throughout the pandemic. It’s what I’ve been saying throughout the pandemic. But given where we are with the rates as they are I don’t think we should be dismantling any of the precautions that we sensibly have in place here in Wales.
I think when rates go down, that’s the time to start to consider removing any further restrictions that we have.
■ Can you explain about this new variant? There are just over 2,000 cases in Wales – whereabouts are they? Is it evenly spread or are their pockets in different parts of Wales? And how long has it been circulating?
■ We don’t test every PCR test in Wales, we couldn’t do that, about 10%. But the ones we tested, about 10% of them are showing this particular sub-variant, and it’s pretty evenly spread across Wales, that figure varies across regions of England is probably higher, or in some areas of Scotland as well.
So we do have, you know, a fair amount of that variant around. And that’s reflecting its greater transmissibility.
The good news about it is that there’s no evidence as yet that it has any ability to evade the vaccine. And there’s no evidence as yet that it’s more pathogenic, by which I mean there’s no evidence that it causes more harm or that you’re more likely to go to hospital.
■ Where do we go from here? Modeling suggests that cases will continue to fall providing behavior stays the same. Are we looking at this decline in cases up until Christmas?
■ It’s really hard, I don’t have a crystal ball. We have watched the modeling very carefully and to date, we’ve actually followed the modeling very, very closely in Wales, except from three weeks ago where we had an uptick in he the numbers. This really worried me, because we moved completely away from the modeling. But we seem now to be tracking back towards the modeling.
I would be hopeful that if we are cautious as a society and if we don’t throw caution to the wind, that the rates will continue to form.
If we do have too much mixing then I am fearful still that the tide could turn again – and turn in the wrong direction.
The modeling actually suggested that we might have another upswing in the spring. If that happens, the good weather is coming and hopefully won’t be so extreme, but that’s really too far in the future to make accurate predictions about.
■ Would you ever recommend bringing in restrictions to control flu? The NHS before Covid was close to being overwhelmed every year. We still had cancelled operations. We still have patients in corridors. Would you ever sanction that or recommend that for a huge flu spike?
■ That depends what measures you’re talking about. I think we should make the flu vaccine as widely available as possible. And one of the things I’m discussing with colleagues is whether we can make the criteria for flu vaccination wider than they even are at the moment.
I have worked in places in Canada, for example, where everybody is eligible for a flu vaccine there. Here we have targeted it at the most vulnerable.
So I think there’s a question that we can pose about that for future years.
I’m not a great fan of mandating or making vaccinations compulsory. I think that the challenge in Wales is to make it as easy as possible for people to get flu vaccine or coronavirus vaccine and to make it absolutely as easy as possible to give people the right information so they can make an informed choice and make the choice which protects them, protects their families and their loved ones.
■ So you don’t anticipate a flurelated lockdown or anything like that?
Well, we’ve never done that. We’ve had good years and bad years with flu. I don’t think, I don’t foresee that we would be locking down society to deal with a flu outbreak or a flu, a seasonal flu issue.
Probably as we come to live with coronavirus, we may well be in the same space in future years.
It may be a virus which causes us seasonal trouble and where, rather like with flu, some people will succumb but hopefully not in the sort of the large numbers that we saw in the first and second wave which required a much more fundamental societal response.