 Prin an da! Good afternoon everybody. I'm Dr Frank Affiton. I'm the Chief Medical Officer for Wales. And I'm Andrew Goodall, Chief Executive of NHS Wales. Today, Frank will give you an overview of the latest situation in Wales, and I will update you about the impact on the NHS in Wales. Frank. Yes, thanks very much Andrew. It will come as no surprise to everybody to know that the situation in Wales is very serious at the moment. Felly, fy ngniwch gyrsbydd amser o'r poros yn lleol honi rhai. Fy gennym amser o'r cymhwylo pobl sy'n dweud nid yw'r 4700 o hyffredig. Felly, mae'n bwysig bod yn gweithio bydd yn poros unrhyw fffanol o'r cyfrifiadau. Fy gennym amser o'r bwysig o'r bwysig bydd yn ei bwysig o'r bwysig yng Nghyrch, Yn gyntaf、 Fflyn��도f, a i'n Denbyg. There are two real reasons for this. One is for too much population mixing, but the other one is of course that there is a new variant strain. I'll talk a little bit more about that in a moment. Just a couple of indicators of the severity, about one in four of all the coronavirus test that we're doing in Wales at the moment are coming back as positives. So this shows that there's a lot of, it's very widespread in terms of transmission in our communities. Felly, wrth gwrs, ac mae'n cael ei gydl allan. Rydym weithio gennym yn y rhesaniad ar y ffordd y Gymraeg yma o'r ddeud yn maen nhw'n gŵr ar y teimlo'r gwrs. Rwy'n credu'n gweithio ar gyfer! Mae yna pwn yn tyfrifau syfodol yn ryw unrhyw rhai ar gyfer gydych yn siŵr. Rydym weithio'r sydd iawn i'r syfodol i gael Rhonddaeth a'r cyfnod yn y rhopes. Yn y fan y ffordd y cwestiynau, ydym ni'n fawr y newidol,ion o weld ddegwyd ar y bydd y Llywodraeth a'r Siwydd o Llywodraeth, ac yn glwyrdd ystynnu'r draff yng ngwyn fyddion sswyr mewn. Dych chi'n dwylo'r straf ni yw nad oed yn sicr ystynnu'r draff yw ystynnu heb fyng readd ei ffamil, os rydych chi'n ddysgu. Mae'r gwahanol, wrth i'n cael ei ddechrau, yn bryd o'r rhaglennu'r drinwys yn beth yw yw gweithrechan. cynfodd yn gyflawni'r cyflawni. Rwy'n gyflawni'n gwybod yn y Llyfrgell Llyfrgellol yn y Llyfrgell Llyfrgell yn y Llyfrgell Llyfrgell. Rwy'n gilydd i weithio ddim yn ei ddweud y rhaglen. Ond yw'n ddiddordeb yn maen nhw, yn y ffordd, yn Llyfrgell a'r South East, ar y llwythau yma yma ym 3 wg. Rwy'n gydag 25% o'r virusiau a'r dewis o'r newydd, oedd yma yw ym 9... o'r 9... o'r 19.95%. Cotton Mews very quickly and we believe that there's a similar trajectory of the new variant here in Wales as well. In fact there's a slide and we could have a quick look at that maybe. There should be two maps that you can see and the slide on the left, the first slide, just shows where we were with the new variant as of December the 7th and the red dots are cases of new variant that were identified. ac y dyma'r gweithio'r maes yma yma yn y rhaid, yn ystod y same ymlaen, ond mae'n... mae'n... mae'n... mae'n... mae'n... mae'n mynd i'r tynnu'r ffordd yma o'r newydd. Mae'n... mae'n mynd i'n... mae'n mynd i'n mynd i'r ffordd yma yn y Nallaneth, ac yn y South Wales. So mae'n rhaid i'r ffordd yma, ond mae'n mynd i'n ffordd y newydd i'r ffordd i'r Newi ddoedd. Mae'n mynd i'n mynd i'n mynd i'n mynd i'r ffordd yw i'r newid iawn i ddweud yng Nghymru. Y...! Mae'n mynd i'n mynd i'n mynd i weld yng Nghymru, a gennym i'r ffordd ymlaen though i ddarparu hwnnw i'r ffordd yma. Ond vi'n mynd i ddweud yllin o wneud Yng nghymru yng nghymru yng nghymru, mae'n bethau ddoedd yng Nghymru i ddweud unrhyw i gael'r hosbitalisio ac oesodd bysgyn sydd wedi'u gwirionedd. Dyma'r pethau isioedd, mae, as ychydig y mae'r gymuned gyda'r ysgolwyr ac i'w cael eu chyflodau mewn gweld o'r hynny o'r Llyfrgell yma, o'r Llyfrgell ac Ilyfrgell yma yma yma yma yma… … ymlaen â'r ysgolwyr yma, o'r ystod yma yma yma yma yma yma yma yma yma yma yma yma yma yma yma yma yma yma... … mae'r ystod yn Ymllun o'r ystod yma yma yma yma yma. Ystafell y dyfodol, rydym eu cyfnod o dechrau gyda y brifysgaffid ym Mhwyl yn Siaradau Biyreidol, yn y Cyfrun Llywodraeth. Fy rydyn ni'n ddweud y dyn nhw'n ddau oherwydd sy'n cyfrunol ym Mhwyl yn y Cyfrun Llywodraeth, ac o'r ddweud ymmerdu cyfreithiol. Bydd y ffaith y mae'r cyfrun llyfr ymddangos yma ymddangos ymddangos yma. Llywodraeth 5 ysgwerth o gyhoedd ymgyrchu ridei'r cyffredinol, eu cyfeirio gynhyrch yn dechrau'r ymgyrch yn cyrwnaeth Cymru, yn ymddir i'r cyfath, yn y cyfathau 21-ddirydd, yn ymddir i'r gryffwlad. That was what provoked us to make that decision around the threat level. I think I'll probably better now if I hand over to Andrew, and he just explains the pressures and the impact this is having on the NHS here in Wales. Thanks Andrew. Thank you Frank, Dioch. Ysgolwyddoedd wedi bod y pandemac yn ychydig cyffredinol o'r cymdeithasol yn y cyfnodol yn gweithio'r hosbydl yma, roedd ymryd i'r hunain yn cymryd ac, os yw, yr hyn yn ymryd i'r hosbydl yn gwneud. Y bod yn yma'r hosbydl yn gweld ymryd ymweld, mae'n gweithio'r hynny yn gweithio ymweld yn gweithio'r hosbydl ymweld. Yr hynny'n gweithio fyddechrau'r hosbydl yn gweithio'r hosbydl yn gweithio'r wawr, a quarter for more than three weeks. This means beds are occupied for longer while more people are being admitted for treatment every day. We have four levels of escalation in the NHS which reflects the pressures in the system. Today, there are 16 hospitals reporting levels three or four, the two highest levels of pressure. Six hospitals are at level four. The NHS is working very hard to balance winter and emergency pressures with the demands of looking after increasing numbers of people who are seriously ill with coronavirus. The NHS is very challenged at the moment and faces a difficult period ahead. This is always the most challenging time of the year, but the pandemic pressures means this is even more intense as a period for the health and the care system. The number of people admitted to hospital with coronavirus symptoms has continued to rise over the last two weeks. There are now almost 2,800 COVID-related patients in Welsh hospitals. This is 4% higher than the same point last week and it represents the highest number on record. If this trend continues, very soon the number of coronavirus-related patients in hospital will be twice the peak we saw during the first wave in April. More than a third of hospital beds are occupied by COVID-related patients. This varies across Wales and is close to 50% in two health boards. This has a significant ability, impact on their ability to deliver local services. There are 140 people currently in critical care with coronavirus. This is the highest we have seen during the second wave. Intensive care units are under enormous pressure at the moment. Our critical care capacity is operating at almost 140% of its normal occupancy. We can expand beds further, but this means that other clinical services are disrupted as we move into other clinical areas. We are not able to deliver a complete range of NHS services with such high rates of coronavirus in our communities or hospitals. Our priority is to save lives and minimize harm and to ensure that staff are supported to provide safe care. We can only respond to pandemic, emergency and urgent care needs by stopping other activities. These difficult choices are being made as services and staff are stretched beyond the levels that we would normally see even at this very challenging time of year. As you've heard from Frank, the four chief medical officers have raised real concerns about the risk of the NHS becoming overwhelmed in several areas of the UK. The NHS Wales is under immense pressure, but we have made significant changes so people can continue to receive life-saving treatment. It's essential that people get emergency care if they need it, and please don't delay getting help. If you need non-urgent medical attention, please consider some of the alternative services and contact as necessary your GP or perhaps call NHS 11 or other services like pharmacies. The last few weeks in particular have been extremely difficult for the NHS and for staff at all levels. I wanted to acknowledge the commitment of the health and care workforce throughout the last year. You are maintaining a response on behalf of the Welsh population despite the enormous impact of coronavirus on our system. Please hope we don't take advantage of their professional approach. We need to act together to control and reduce levels of coronavirus in our communities. You can help us to help you by following the rules, keeping your distance from each other, practicing good hand hygiene, working from home wherever you can, and wearing a face mask in indoor public places. If we don't do this, we may see numbers of people being admitted which will overwhelm the NHS' ability to respond over the coming weeks. You can also help us with your choices about accessing services. Please help us to help you. Help och ni, ich hel pi chi. Thank you. Frank, back to you before we take some questions. I just want you to emphasise one final point. That's the point about vaccination. This week has been good news in that we are speeding up our vaccination programme across all nations of the UK. That's with the arrival, of course, of the Oxford AstraZeneca vaccine. That's really good news because it potentially offers us a way out of the pandemic, but it's going to take quite a while to protect everybody who needs it with the vaccines that we have available and future ones that might come on stream. Of course, the pipeline is really important on that. So, as we face a different future with the prospect of vaccinations around the corner, it's really important that we still continue to meet the challenge of the virus which is moving very quickly across the UK, partly because of the new variant that I've described. So it's more important than ever that we follow the rules and the guidance that we have in place here in Wales to keep ourselves safe. First of all, it is a legal requirement for everybody to stay home unless they have a reasonable excuse. If they have to travel to work, if they can't work at home, if they want to do essential shopping or they need to exercise. Secondly, it's really important that we don't mix. It's mixing that helps the virus to spread. So don't mix outside your households. The exemptions, of course, are with the support bubbles for single people, single parents that we all know about. Thirdly, it is social distancing that will keep us safe. Those messages about hands face space are really important and we all need to follow that. And finally, of course, if we do develop symptoms, all of us need to self-isolate and get a test. And if we test positive or if we're a contact, we need to self-isolate. It's more important than ever that we follow these rules. We are really at a critical moment now here in Wales and across the UK. Thank you very much, Diolch yn fawr. Now, we'll take questions from journalists and, of course, all our answers, as usual, will be broadcast on social media channels. Thanks. Thank you very much. So we will start this afternoon with James Crichton-Smith from ITV Wales. Good afternoon, James. Good afternoon. Thank you. Dodger Arthurton, are you certain the existing vaccines work for the new variants? And if the vaccine programme takes longer to roll out fully in the virus mutates further, what are the risks of the vaccine not being affected? So, James, thanks for that. Yeah, yeah. I mean, the, when the new variant was first identified, there was a worry, as there was, if you remember, with the mink variation some time ago out of Denmark, that it may not be as responsive to vaccine as the original virus that came out of Wuhan. The evidence so far is that that's not a risk that both the antibody response to the vaccines does cover both the original virus and the variant virus. And, of course, there's also a T-cell immunity. So, both types of immunity we believe do work with the new variant as well as the original virus. What was the second part of your question, James? It was, if this virus mutates further and the roll-out isn't speedy, what's the risk that almost the virus outstrips or outpaces the roll-out of the vaccine? Thanks, James. It is an excellent question. You know, because viruses mutate, they evolve all the time. We know they do that. And, you know, this is about the long game, really. We need to think, you know, as we get more experience with the vaccine, we will have to just watch how vaccine effectiveness changes over time if it does change. There's always a risk that, you know, new variants will emerge and they'll be less susceptible or less amenable to vaccine control. And it may be that in the fullness of time we have to move, for example, like a flu vaccine where we have different strains of virus being protected by different vaccines over time. But that really is for the future. The pressing need now is to deal with the virus that we know we have and to get the vaccine rolled out as quickly as we can. Thank you. My second question probably is to you again, Dr Atten, which is, but what's the scientific reasoning and evidence behind the decision to keep nurseries open that schools have to close? So, specifically, why are nurseries seemingly safer and therefore opening schools, including primary schools, not as safe and therefore closed? Yeah. Well, both schools and nurseries, you know, have made great strides in providing that coronavirus safe environment that is absolutely necessary. The issue, really, for nurseries is there's, of course, many essential workers who rely on nurseries and if we were to close all the nurseries, then we would really have a crisis in the workforce, not just in healthcare, but in social care and beyond. So, there's a fundamental issue there and that's why across the four nations, by and large, nurseries are remaining open. Yeah. Thanks, James. Okay. James, thank you very much. Moving for the next question to Catherine Haft-Jones in BBC Wales. Good afternoon, pronunciation to our Catherine. Mae fyddai. In England, they set a target to give all the top four priority groups the first dose of the vaccination by mid February. Yesterday, Dr. Jill Richardson, who leads Wales's vaccination programme course, said that if the supplies forthcoming, Wales would hope to match that timescale. A question to both of you from a strategy and delivery perspective, is that achievable in Wales as a target? Vaccinating over 700,000 people in Wales by mid February? I'll start, Catherine. And then, Franklin, I know you'll have a professional view on that as well. First of all, to say that the delivery of the Oxford AstraZeneca vaccine this week, you know, really does change our ability to now push on with volume within the system. It was only last Wednesday that we had the regulatory approval and the first set of vaccinations with the Oxford AstraZeneca vaccine were being issued on Monday across Wales, but of course across the UK at the same time. And we will be dependent on ensuring that there are supplies in line with those broader UK commitments that we're able to discharge in Wales. But yes, our numbers will be increasing. We will see increases in activity noticeably as we go through January and we will continue to increase those. I think we have to recognise that the NHS has never done something at this scale before. We're very experienced in delivering vaccines, you know, for a range of different reasons for flu, for childhood vaccinations, but never to a whole population to these types of timescales. But there is a very significant commitment and ambition from the NHS to be able to step up to this to protect the Welsh population and of course to ensure that we can move through those cohorts as well. We are looking for some confidence and certainty about the delivery schedules and the supplies and of course we'll liaise across the UK on that at the moment. But we will catch and see increasing volumes of activity taking place, certainly as those supplies materially and visibly increased during the month of January at this stage. So we will obviously want to make sure that we're able to track those measures and find mechanisms for making sure that we can describe those, you know, more publicly. And of course we will be able to make sure that there is a schedule of understanding about the developments here. But perhaps before I hand over to Frank just to say, in order to really underpin the priority, the Minister and I were meeting with the National Program Board, with all of the health organisations across Wales who were all describing their plans for the expected increases in activity that we will want to see over the next six weeks or so. Frank. Well, just to add, I mean, as Andrew says, all of our health boards, you know, developing their plans, rolling out the plans to rapidly increase the vaccination coverage. That's being done through mass vaccination centres through general practice. Surgery is of course and also there's discussions with community pharmacies here in Wales so that we can use that route. So we're looking at every available route but we're going to go as fast as we can, Catherine. You know, that's the reality, but there are some constraints we have to bear in mind. We have to go fast but we have to go safe. We have to do it as safely as we possibly can. We have to avoid wastage. You know, this is a precious commodity. We can't afford to waste it. And you know, we always will have for the foreseeable future limited supply so we will go as fast as the pipeline and the supplies allow us. Diolch. A new strain of the virus seems to be becoming quite dominant now in some parts. I suppose this is a question to both of you again. How much do we know about this new strain? Is there any data you can share with us from Wales as to whether it does lead to more hospitalisations than the previous strain? And does the new strain make it more likely that coronavirus cases could overwhelm the NHS in Wales in the next couple of weeks? Yeah, thanks, Catherine. Is that right if I start, Andrew? I mean, what I would say to that is that, you know, as I said earlier, there's no evidence that it's a more serious strain. People don't get, you know, a more serious type of illness, but the fact that it spreads more rapidly means that there are more people getting infected. And if you get more people infected, Catherine, you get more people in hospital and more people requiring intensive care. So that's really the dynamic that's playing out in here. In terms of the the kind of Welsh statistics, obviously we're we're keeping an eye on that and it varies very much across Wales, you know. So in the north at the moment, which, you know, is quite a hot spot for the new variant. We think about 70% of the cases that are proving positive are probably related to the new variant. In other parts of Wales, it's probably a bit less, but it does vary, but there is a significant amount of it. And as we've seen in London and the southeast, once it's in the population, it rapidly spreads to become the dominant strain. Thanks, Catherine. Catherine, on the variant and just building on what Frank has said about the prevalence up in north Wales. Whilst I can't directly talk about hospital patients with the variant as such, you know, what is clear to us in north Wales that with the growing community prevalence, it has led to an increase that is very visible in north Wales over the last four weeks in particular. So as an example, we now have seen the number of COVID-related patients in beds in north Wales, in hospital beds in north Wales go up to 258. That's gone up about a third since the beginning of December. I think most noticeably in terms of pressures up in north Wales, again, not all of this will be because of the variant, but just shows how quickly things can change. The number of patients in critical care for COVID-related reasons in north Wales has actually tripled, has gone up from 6 to 20 just over the course of the last four or five weeks or so. So things can happen very quickly. In respect of the general pressures on the NHS, and as I was saying, we are obviously managing the normal operational pressures of winter. We would not normally be responding to those pressures with 2,800 beds occupied by patients with COVID. And as I said earlier, these patients are staying longer than our typical emergency patients who will come into the system. So we are genuinely concerned about the resilience of the NHS system, but we do have plans and preparations to respond. But it comes with impact on other services and other access points for our patients in Wales. So every health board in Wales is having to make judgments on a choices framework that we have endorsed nationally to balance the emergency care alongside what they can do for planned care. But inevitably, the kind of choices they're making to prioritise COVID patients will be having an impact on other areas, for example, on waiting lists or access to diagnostic care as well. So we also have a responsibility to continue to provide those services and to make sure that patients with urgent needs get into the system. But this is going to be a very challenging and difficult period of time ahead of us. And hopefully, we will see some translation of some of the reduced community rates that Frank described translating into lower hospitalisation rates. Catherine, Diolch yn fawr iawn. Thank you very much. I'm going to move next to Mark Smith from Wales Online. Good afternoon, Mark. Good afternoon to you both. This is more of a question directed at you, Dr Goodall. Latest figures show that the Welsh NHS came very closely using its maximum hospital critical care capacity over Christmas with some health boards facing no other option than to transfer very unwell patients to intensive care units many miles away from their homes where beds were vacant. Do you think this problem has been compounded by the fact Wales historically has had far fewer critical care beds per head of population than many other European countries? And do you feel that patients to beds and perhaps staff to patient ratio needs to urgently improve in Wales? I mean, talking very generally about critical care, you know, really important to recognise the specialist nature of the workforce that we require in those areas. And if we're developing our core bed capacity, then obviously we need to make sure that we develop and train our staff and are able to expand and you'll be aware Mark of funding that has been provided even over the last couple of years to make sure that we could expand those overall bed numbers. I think what we've tried to do in the pandemic response and this will be consistent with what colleagues across the UK have done is whatever the core capacity is available, what opportunities do we have to actually expand beyond that safely, recognising that that will have an impact on other areas and it provides a choice between what you can expand in terms of available beds in critical UK units themselves. So, for example, a recent advantage in the move to the Grange Hospital that actually expanded the physical space available for those beds. But actually what we're able to do by using some of the skills, expertise and indeed clinical areas that are in other areas of hospitals on the acute hospital sites across Wales. You know, our numbers at the moment, I talked about the increase in the COVID-related patients and those numbers currently stand at 140. Our actual overall numbers of patients in our critical care beds in Wales is 216. And that requires us to have extended the definition of critical care to all of those clinical areas that I've spoken about. That's why we are operating at about 140% of our occupancy. I should say that I'm really grateful, you know, alongside all of our NHS staff but for the particular work that our critical care staff have done in Wales because it's been a very intense and long period of time for them because whilst we've seen the numbers go up and down for coronavirus over the course of the last nine, ten months, their workload has been maintained at a very high level of course because when we've been able to bring in other patients, it means that we're dealing with other operations, patients with urgent needs who require critical care support as well. So we will want to continue with the investment and the additional capacity that we'd be looking to put into critical care. I think the pandemic response has allowed us to show that we can expand those beds at this stage but critical care will be affected as with any other area of Wales by workforce shortages and there will always be things that we need to manage. The current approach across Wales would have one of our units in Wales at the highest critical care declared level. All of the other sites are very busy in dealing with expanded numbers of beds but at least are slightly lower down on the tiered system that is in place at this stage but if I was sharing what are my concerns for the forthcoming weeks it will be the fact that whilst hospital patients may be stabilising or some emerging signs of stabilisation the numbers continue to increase on critical care because it does represent that there are very seriously ill patients needing care within our system in Wales. Thank you very much Doctor Goodall and a question for Doctor Atten if I may. The British Medical Association in Wales has raised concerns about the fact many frontline staff are facing a delay in getting their second dose of the Pfizer vaccine due to a changing guidance by the UK's four chief medical officers who want to administer as many first doses as possible to the population. The BMA believes these employees need to be given protection at the very earliest opportunity particularly in light of the fact many thousands of workers are absent due to contracting COVID-19 or facing self-isolation. So do you share the concerns of the British Medical Association at this moment in time? Yes, thanks Mark. I've had extensive discussions with the BMA this week and I don't share that concern. The decision to amend the scheduling of the vaccines across the UK was quite a tough one but when we were presented with the information that the first dose of both the vaccines gives between 80 and 90% vaccine effectiveness it became rapidly apparent that given the epidemiology that we've been describing the pattern of viral transmission in the UK it was really important to get the first dose into as many people as possible. So that's what led to the decision by the chief medical officers which is really based on the advice from our independent advisor group the joint committee on vaccination and immunisation, JCVI and of course on the advice of the regulator the MHRA. So I think it was the right decision given in the UK where we are in terms of our epidemiology and the absolute need to get protection to as many people as we can including of course frontline healthcare workers because had we remained with a position of providing the two doses on a three or four week schedule it would have taken much much longer for people to get that level of protection. So we've got high levels of protection for health and social care staff going forwards. Thanks Mark. Okay Mark thank you very much. Going to move next to Dan Bevan from LBC. Good afternoon Dan. Thank you Dr Goodall and yourself Dr Atkinson very good afternoon. This is a question for you both if you don't mind. We've been in effectively lockdown for two and a half weeks in Wales now and we haven't seen the rates lower than what we've previously seen say in the firebreak lockdown. Are you concerned by that on this current trajectory how much longer can the health service sustain itself and just finally do you think that there are tougher measures that could be brought in and what would they look like because at the moment there are very few things that people in Wales can do that they couldn't do during the first lockdown? Shall I go first not Andrew? Yeah thanks thanks for that Dan. Look you know the it was only on the 20th of December of course that we moved to the lockdown the level for arrangements here in Wales so we wouldn't expect to have seen the signal of that to date. The data has been a little bit messy over Christmas you know a significant number of people came forward for testing immediately before Christmas there were fewer people actually over the Christmas period so the data is a little bit unstable and I think it will only be towards the end of this week and early next week that we really start to really understand the trend of what's happening and I would fully expect that we would start to see that signal of the the lockdown effect it'll be a bit messy of course because we had a a period a short period of relaxation across the four nations where people you know were were mixing over the the two day period so so inevitably there's been additional mixing that will have led to some viral resurgence and so on you know we'll have a little bit of that that effect and and the start of an effect around the lockdown what I would say you know is we need to really learn from the past we did have an an impact from the fire break because you remember Dan and that was that was not long enough lived you know that the fire break was a two week period the the impact lasted probably about two three four weeks so what we have learned is that you know longer periods of of restriction of movements do lead to a longer term a reduction in viral transmission and so that's one of the lessons we have to take into now that would be the kind of main measure change I would think you know most of the things that we have in place in Wales from the 24 December are consistent with what's happening in Scotland and in in England and and over in Northern Ireland there's actually very little difference now some marginal ones perhaps so and I think that consistency actually helps us in terms of our messaging because we try always to try and keep messages as simple for the public as possible and that's why I say you know stay home is the most important things to keep your distance is really really important Dan the full national lockdown and the legal arrangements about that came into effect on the 20th as as Frank has said and you know we have seen some reduction in the community prevalence rates from the peak Frank I think of around 630 that we saw in Wales on the population ratio and those reductions you know have have happened without probably seeing the full impact of what a national lockdown would mean so we do need to very closely monitor the data as Frank said for the rather unusual period that we've been through at this stage obviously from my perspective alongside looking at the community prevalence I need to be able to monitor and understand how that is translating into the NHS impact in itself so tracking on a daily basis sometimes hourly but certainly on the weekly trends the way in which we're seeing the growth in the health service in Wales you know over the last week or so we've seen some slowing down maybe in some of the growth of patients who are who are ending up in our hospital areas with COVID although it remains very busy and very challenging but as Frank said probably gonna need to at least use the next 7 to 10 days if not up to two weeks to really see whether there is any evidence of that you know stabilizing the hospital outlook which would be welcome for the way in which we need to manage our pressures for the four to six weeks ahead of us Dan Thank you very much both and Dr Ratharton this question is mostly based for you but Dr Goodall please fill free to answer if if you've got any input we're seeing reports that travelers coming into the UK may soon have to prove that they've tested negative the virus before they come here but the borders have been largely open throughout the pandemic albeit with quarantine rules for certain high-risk countries is the mandatory testing or vax excuse me at the mandatory testing that you and other CMOs have recommended to the UK nations previously and if not why is that the case? Yeah the whole process of border border controls is under review Dan I would say and there was a call between ministers earlier this week where Michael Gove you know talked about a UK wide review and I think everybody is committed to to look at that again what I what I could say is that you know given the current level of viral transmission here in Wales you know the the amount of imported viruses probably quite small compared to what is being transmitted here in Wales as the numbers come down in future then the possibility of importing viruses becomes more important so it's a good time to to to look at that again really thanks Dan Dan thank you very much I'm gonna move for the next question to the channel for good afternoon Andy good afternoon thank you first question to Dr Atherton please you spoken specifically about the role of the new variant in north Wales how concerned are you that rates in parts of north Wales continue to rise despite Wales being in a lockdown and despite schools being closed which does appear to be a different pattern to elsewhere in Wales is it possible that the current restrictions just aren't enough to keep numbers under control and have you had any discussions about whether you need to take further steps yeah so the picture in north Wales is you know complicated Andy as ever one of the things which you know we we have seen of course is that when the the viral virus kind of research in late in early late November early early December you know it was predominantly in south Wales and south east Wales in particular and then it kind of moved you know into into north Wales and so so there may be a time-lag effect that we're seeing that's an additional thing I think there is an impact of the new variant I believe it's more prevalent in north Wales we're still looking at you know on picking all the data around that north Wales are likely to be the new variant and it's lower we think in other parts of Wales so those two factors you know combine I think to give the differential picture that we're seeing in north Wales as to the question of you know whatever measures it's back to the point about you know the lockdown measures have only been in place since the 20th of December we know from previous experience from the firebreak indeed and before that the march lockdown across the UK that those measures are effective you know if people do not come into close contact they cannot spread the virus spread that way thank you when you and other CMO said on Monday that there was a material risk of the NHS being overwhelmed over the next 21 days in several areas of the UK whilst Wales one of the areas being referred to Dr Atherton and Dr Goodall what could that mean for patients if the NHS in Wales is overwhelmed what could that look like would it mean rationing of treatment in intensive care settings for instance to my part of the question Andy the answer is yes the south east of London east of England London sorry south east of England London and the east of England you know were our particular hotspots but south Wales as well was an area of considerable concern and still is I mean Andy we've always tried to ensure that we have a way of operationally responding to the pressures whatever is coming through the front door in order to be able to protect the Welsh population but obviously the more we have Covid dominating our hospital and system environment right through from the ambulance call through to those patients in hospital beds the more it inevitably has a knock on effect and of course there are many other settings and services that are operating which are outside of that hospital environment that we have to rely on so my concern at this stage is as I said in my introduction over a third of our beds of our occupied beds are there with Covid patients we have some individual health board areas that are approaching 50% of their beds being taken up by this we had anticipated this in December and that's why we had endorsed a choices framework in Wales that means that organisations were able to make choices about the range of activities that they could provide to secure safe staffing to be able to distribute staff and resources from other areas to re-prioritise those staff that may be needed to allow some of the expansion into critical care and I think those plans whilst they have a knock on effect have actually worked with some of the resilience of our system at this stage but inevitably it comes at a cost and we've been constantly tracking through the pandemic our response and experience the impact on other services the level of referrals coming into the system the number of patients coming through A&E the number of cancer referrals that we have so I think we just need to continue to monitor those issues coming forward I mean the minister has been really clear with myself and with the system in Wales that if there is a need for us to step into national directions that are similar to what we needed to do back in March and April that we would do so but that has not been the advice to date that has come from the NHS at this stage and we will monitor it really carefully and closely over the course of the next few weeks or so but it is a very difficult and challenging environment for our NHS and our social care staff at the moment given the pressures that we are responding to because of winter but also because of course of the COVID experience okay thank you very much Andy I'll move on now to the next question which is Brannwyn Jones from S4C Brannwyn Brannwyn In hand that this question could possibly be for both of you a handful of people we have spoken to have told us that their loved ones who are over 80 years old have yet to be contacted about a vaccine or receive any information on when they will be vaccinated can you explain why that is and how long must these people wait? Frank I'll start if you want to come in please let me know of course as I was saying earlier the logistics of what we are doing at the moment is on a scale that we have never undertaken before in the NHS in Wales or across the UK events move on very quickly it was only last Wednesday that we had the regulatory approval to be able to use the Oxford AstraZeneca vaccine as I was saying earlier and we were able within five days to have the start of patients and staff being vaccinated using that vaccine you are aware that through December we have been able to use the Pfizer vaccine and have had certain volumes of those coming in but you will also be aware about some of the constraints on the ability to use that in a lot of our normal settings just simply because of some of the specialist refrigeration that is required around that so we have deliberately tried to focus on mass vaccination centres for that stage with some support and an ability to at least go out into some of our care homes in Wales but the availability of the Oxford vaccine in this week just changes the dynamics of the way in which the system operates it normalises that we can use our normal practitioners in their normal contacts to do this whether that is in a pharmacy in a GP surgery and that is where we will be able to make the most progress in hitting those early cohorts that have been declared by JCVI including the over 80s at this stage from a planning perspective we have been operating a week in advance of the availability of supplies and what we are hoping to do now with greater certainty is if we can start being aware of the supplies for the next two, three, four weeks we will be able to revert more to an appointment based system with some of those categories but I am aware although clearly there will be individuals not accessing at the moment there is a much higher volume of over 80s that are now coming through our system and I think that will change very visibly over the course of the next two weeks Branwyn Thank you, Neil and my second question to Dr Atherton with the Oxford AstraZeneca vaccine being carried out for the first time in Wales this week does the Welsh Government plan to publish the number of people vaccinated each day? There is an active discussion about how we the periodicity that we use to give that information whether it is on a daily or weekly basis there is a meeting this afternoon to kind of look at that and we will need to also look at what Scotland what England and what Northern Ireland are doing so we will just defer a decision on that but we will let you know that as soon as possible Okay Thank you Branwyn We are going to move next to Steve Bagnell Will you post? Good afternoon Steve Good afternoon Dr Goodall and Dr Atherton Probably for the two of you this one You have talked about the rise in North Wales and particularly in Wrexham and Flintshire about the virus We do have the new more infectious variants but are there any other reasons you may be aware of why it is spreading quicker compared to say North West Wales? Is it simply the new more infectious strain arrived in North East Wales first and has become more prevalent such as a denser population or larger industrial areas where people have to go to work to commit to more mixing and drive the virus? Partly speculative Steve but I would think it is around population density to be honest and we saw earlier in the pandemic a significant uptick in infections before we had the variant in Wrexham if you will recall and that did lead to quite a lot of concern around there There are issues around borders and border with England what we saw in the first wave was infection moving from east to west and there may be a bit of that so it does tend to move east to west from south to north and that's the pattern we're seeing probably in this second wave the same as we saw in the first wave but that's somewhat speculative but that's what I think is happening I would just say Steve continue to ask the public to work with us alongside us to help us protect the NHS with their choices and making sure that by complying with the guidance they are limiting their interactions that they are following all the things that we've both tried to describe this afternoon it's that that actually improves our effectiveness in our response the NHS will respond on the one hand but as happened during the first wave we really need the public to be with us in the ability to stop the transmission of this virus and obviously there's been some concerns raised about North Wales lagging behind with distributing the vaccine what reassurances can you give that Wales regions will be getting their fair share of the vaccine and people will be getting vaccinated as soon as possible alongside the Welsh population share which has been part of the conversations and agreements that we've had in place with UK government clearly we expect all of the vaccinations to be distributed and to be implemented on a population share across Wales so North Wales will have its respective population share as will all of the other health board areas of Wales at this stage I've had contact myself with the ministers I was describing earlier with all of the health organisations in Wales this week and it was really clear to me that I was able to see evidence of the expansion plans for Betsi Gdwaladr how they were looking to expand as I said earlier Steve the availability of the Oxford vaccine to be able to be used in more normal settings like pharmacies and GP practices the way we can deliver this and make sure it is much more accessible particularly for the vulnerable groups and I'm sure that will be the case in North Wales I understand that there is a very high level of commitment from GPs in North Wales to want to be part of the vaccine distribution and the rollout to make sure that the North Wales population are protected Steve, thank you very much and just as our final questions for this afternoon just now I'm moving to Yolo Jones from Golwg 360 Yolo? I'll be asking my questions in both Welsh and English my first question is similar to one of Mark's questions by a direct mind towards you Dr Gudo yn siarad y golwg wrthnos hwn a ddoctafil White Cadeiredd bydd gormydd y gonteli cymryg o ddi'r pryddeol ni'n hylch y rhaig yn blechi y brifryd ddeuw i ddybylch rhwng y drwsys a ddeud bod y gap yn ddiogel i'r cyhoedd ond mae'n tymlo iddyn nhw'n stafffraen bland heb yndwysus yn gyd a stafffraen bland rwy'n edrych i'r rydio nad yw i'n dos yn mynd i dda'r pari i mewn edrych o'r ddigonol a chythdae'n bryw i ddweud o'r argyg cymry ydych yn rhan i'r pryddeol yn yma Speaking to Golwg this week Dr Phil White, chair of the BMA's Welsh GPs Committee has raised concerns about the vaccine rollout his main concerns the length of the gap between the vaccine doses 12 weeks of course except that such a gap may be safe for the general public who feels that frontline medical staff should receive their doses sooner frontline staff and regular contact with the virus and he argues that the single dose might not provide the level of immunity that they require as chief executive of NHS Wales do you share these concerns? I mean Yolo, I suggest really that I ask Frank to answer in the first instance given the professional basis of the question and you know Frank, you've obviously been involved with other CMOs in the network and the agreements over this last week. So Yolo, I disagree with Bill on this one and the BMA I think are mistaken in thinking that it is inappropriate to vaccinate as many people in Wales as we possibly can if we were to not have moved to the extended vaccine schedule it would have delayed the first dose of vaccine being administered to healthcare staff, to social care staff and of course to the general public and in that time people would become infected people would be hospitalised and people ultimately sadly would die so it was based on a decision based on a really clear prediction that there would be more harm by sticking to the schedule than by extending the schedule of course the second dose is really important and it has to be administered from the data that has been made available that it can be done safely and effectively over an extended period I mean just to speak generally Yolo in my NHS Wales chief executive role we do have a concern at the moment about seeing high levels of sickness and absence across Wales currently our levels are as high as 10% at this stage about 4.5% of that will be because people are off the reasons of Covid but also because of reasons of self-isolation tracing or family environments etc that are happening at this stage and it's really important therefore that we are supporting staff and their wellbeing in these very difficult environments but we do need to make sure that there is a real commitment to deal with the focus on health care and social care staff across Wales in the JCVI criteria and again as part of the discussions that were taking place with health boards this week about how they were approaching that we could actually see that there was already visible progress that we were going to be expecting through this week next week about completing some of the individual staff cohorts that we've been expecting as well so I hope the speed of the roll-out in the manner that Frank has described will actually help give some confidence about where we go next with the vaccination roll-out for our staff in Wales There you go and just as to my second question ma'r cydwad yw'r cymreu cyngalu o'n flinorethu y thrawon oedd i fewn i'r aigle'n frech chi ac mae datblyf i galwad wedi cael i atu cyfnethu gan gyhoedded wedi'r cystu Williams am ysgolion a symudad padwad ma'r sylfaen beth bydd eich email o'r ddyl yma a ddyl ythraf o'n gallu flinorethu o fewn i'r aigle'n frech chi The Welsh Conservatives are calling for teachers to be prioritised within the vaccine programme They argue that their call has been strengthened by Christine Williams since recent announcements in schools and sticking to online teaching with the time being What do you think of this argument? Should teachers be prioritised within the vaccine programme could they be on par with frontline workers even? Should I answer that, Andrew? So we've looked at this in Wales and we've looked at it in conjunction with other CMOs across the four nations and we all recognise that a commitment to keep schools open is really important for children for young people and for their futures However, teachers as a group have done a great job of trying to create COVID secure environments and that needs to continue Teachers themselves are not at any greatly higher risk than the general population or than some other professions in terms of hospitalisation and poor adverse effects from coronavirus So in my opinion it would be a mistake to raise them up the priority groupings and the reason for that, Yola is that if you raise somebody up the rankings you have to drop somebody down Who would you drop down? Would you drop down the over 80s? Would you drop down the clinically extremely vulnerable? Would you drop down health and social care workers who have much higher risks? And I think any rational person who has asked that question would answer no, you shouldn't do that So there is a commitment here in Wales to stick with the JCVI the Joint Committee on Vaccination and Immunisation their prioritisation schedule we will as chief medical officers be asking them to keep that under review So if new evidence comes to light we can look to them to update the prioritisation list But at the moment there is a deep commitment here in Wales to stick with those priority groups Yola Diolch, thank you That's the final set of questions for this afternoon Thank you for those questions and thank you for joining us this afternoon Diolch yn fawr iawn