 Good afternoon, Prinanda. I'm Dr Frank Art and I'm the Chief Medical Officer for Wales. What I wanted to do today was to take the opportunity to just bring you up to speed with the current situation around coronavirus here in Wales and talk about some of the things that we can all do to try and protect ourselves and to stay safe in the run-up to Christmas. So, the starting point for this has to be that we are in a very serious situation here in Wales. Coronavirus infection is spreading and spreading fast. It's accelerating across the country. That's happening more quickly than we'd anticipated as we came out of the fire break just a few weeks ago and it's accelerating at a greater speed than we've seen during the autumn months. So, if we look at our latest figures, they show that the all Wales figure is continuing to rise. That's true in almost all of our local authorities. 21 out of 22 local authorities, the rates are rising. Overall, for Wales, it's reaching almost 350 per 100,000. That's very high. And there are 10 areas in Wales, 10 local authority areas where the rate is actually higher than 400 per 100,000. So, this is really quite a worrying situation. It's also affecting all age groups. We've seen this across the UK previously, that often waves of infections start in younger people under 25s and then spreads into the over 60s. And that's certainly what's happened in this wave of the pandemic. And that matters because we know that as older people become infected in greater numbers, they tend to have more serious illness and tend to end up in hospital and need extra support. So, this is really quite a worrying situation. The other dynamic that we have to keep in mind is the impact on our NHS. There are serious pressures on our NHS across the whole of Wales, but particularly in the south and up in the valleys. And this is seen in our hospitals. It's seen in our ambulance services. And it's particularly acute, of course, in our intensive care units where staff really are working flat out to protect people and to keep them safe and to keep them alive. And we actually all owe that debt of gratitude to the NHS and to the staff working in those very difficult circumstances at the end of what has been a very challenging year for them. Just to some numbers, we've got more than 1,800 coronavirus-related patients in hospitals as of yesterday. That includes suspected, confirmed and recovering cases. If we look at just the confirmed cases, there are about 1,100 patients in hospital. And that matters because they tend to be in hospital for quite a while, up to three weeks, so that really leads to problems with hospital occupancy. And in terms of intensive care units, yesterday we had 77 patients in intensive care units across Wales. That's a slight decrease on the day before, but the numbers go up and down a little as we know. So what do all these figures mean? What it boils down to is essentially that we have widespread community transmission of coronavirus in Wales, and that is causing huge pressures on our system. It does mean that we're all at risk of catching coronavirus and spreading it to other people, so we all need to take extra precautions in the run-up to Christmas to keep ourselves and our loved ones safe. And I'm going to come back to that point in a moment. One point of good news, obviously, is that as of yesterday here in Wales, we started vaccinating people against coronavirus. It was really good to see the first clinics up and running, people coming along to receive their vaccination after the months of hard work and dedication that had gone into planning all of that. So that gives us some hope that there's a way out of this coronavirus pandemic. It's a real breakthrough, and in fact, yesterday we vaccinated almost 1,500 people. We expect to do about the same today, hopefully getting to about 6,000 people this week and the same number next week. So we're starting to see the vaccination coming on stream. The important point to make is that that doesn't mean the pandemic is over. It doesn't mean we can all go back to business as usual as yet. It puts us on the road to recovery, but it's a long road ahead of us. We know that the vaccination will protect people from getting serious illness. What we don't know is how long the immunity from the vaccine will last, and we don't know whether the vaccine will actually stop transmission from person to person. That will only become apparent over time. So it means that all of those measures that we've talked about so many times really have to continue to be in place here in Wales and across the UK. Social distancing, respiratory hygiene, hand washing, the hands face and space messages are really still vitally important to us all. Now obviously many people, most of us will be making plans now for Christmas and I think we just have to accept that this Christmas has to be different from previous ones. As everybody will know, we've agreed across the four nations some relaxation of the rules over the five-day Christmas period and that's to allow people to have some Christmas together to celebrate with their families. That was a really important joint decision that was made across the whole of the UK. In the light of where we are in Wales, we all need to think about what we should and could do over Christmas. We all need to think about our plans and to perhaps rethink our plans. I'm certainly doing that. I was intending over Christmas to travel to Northern Ireland to visit relatives. I'm not now going to do that because I think the best thing to keep people safe, keep my family safe is to not to do that. I was planning to visit some of my children who were living in England but I decided not to do that. It's just one Christmas and I'm prepared to make that sacrifice to keep my family safe. What I've decided is that the best way to manage myself and my family this Christmas is to stay home to have a small, quiet Christmas just with my own household. I'm not going to be going to any pubs or restaurants or shops for Christmas. I'm not going to go to any Christmas fairs. All of those places are low risk because they can be managed and with social distancing but they're not zero risk so I want to bring my risk as low as I possibly can so that I don't risk catching coronavirus myself and I certainly don't want to risk passing it on to anybody else either. You'll be aware that we did introduce some new restrictions here in Wales last Friday. That was on the basis of rising, evidence of rising infection rates, new restrictions on hospitality and indoor entertainment. Those were new rules that we put in place as government but the important point I want to say to people is that it's not just government rules that will keep us safe. It's really about how we all act, how the choices that we make are so important at this time over the coming days and weeks and that's going to define what happens really over the Christmas period and how much we can enjoy Christmas with our families. We've said it lots and lots of times but the coronavirus unfortunately is a social virus. It likes us coming together. It thrives on human contact so whenever and wherever we come into close contact with each other the virus can be transmitted from person to person. It doesn't just come from strangers. It comes from people that we know, people that we trust, people that we live with, people that we work with. So we all have to think about how we can reduce our risk of the virus transmitting within our families, within our households and within the broader community. So it doesn't matter whether we're indoors or outdoors if it gets into our homes it spreads very quickly. We know that, it can spread through households very quickly once it finds its way in. We've seen that in hospitals, we've seen that in care homes and we've seen that in households. Although most of us, if we catch coronavirus we'll have a mild infection. As the high numbers in our hospitals show us a lot of people will need expert care they'll need hospital care and sadly people will die. We had 31 deaths of people from coronavirus just yesterday in Wales very sadly. So really the best present that we can give to our families ourselves is a coronavirus free Christmas. We do know that the virus spreads from person to person very easily. So to reduce it we have to all work to reduce the number of people that we're in contact with between now and Christmas. That's a really critical period. My message on this is really very simple. It is don't mix with people outside of your household in the period between now and Christmas. Anything that leads to increased mixing of people is increasing the risk. So don't mix if you can avoid it. If we do that, if we all do that we will be able to keep our families and ourselves safe over Christmas. That's my main message for today. Thank you very much Diolch yn fawr and I'll take questions from journalists, yeah, thanks. I think we have, oh Catherine Haft-Jones from BBC Wales first. Hello Catherine. You've been reducing the risk over Christmas and rethinking Christmas plans. But if families do plan on seeing grandparents over Christmas should those parents take them out of school this Friday so they can isolate ahead of those meetings around the 25th? Yeah, well we're doing a lot of work with schools to think about what the best plans are. We're not advising people to take the kids out of schools at the moment. I know some schools are making their own plans and many schools will be thinking about closing a day or two early possibly. The real important thing is to make sure that children whether they're safely in school or back at home are encouraged not to do too much mixing themselves in the run up to Christmas because as they come into contact with older family members over the Christmas period that's the really risky time when the virus can transmit from younger people potentially to older people. So we're not advising people to take children out of school at the moment but what we are doing is encouraging them to avoid as much mixing as we can in the 10 days running up to Christmas to keep ourselves safe. The other point I would say Catherine is although there's five days of relaxation of rules over Christmas it doesn't have to be five days. It may be that bringing elderly relatives around just for a couple of hours over Christmas. Obviously that's safer than an extended period of time. So there are ways that people can think to manage the risk and reduce the risk even if as many people want to do they feel the need to spend time with loved ones over Christmas. Diolch. Given that one of the key considerations with any restrictions is to avoid the Welsh NHS becoming overwhelmed in your professional opinion and you've spoken of personal choice but are the current hospitality restrictions in Wales enough? We've always tried throughout this pandemic to balance the direct risks of coronavirus harm with the economic and social risks and that led to some very difficult decisions last week that ministers had to take about the decision to put further restrictions on the hospitality industry and on the indoor leisure industry. The question as to whether they're enough is a really important one. We are at risk of getting into the Christmas period with rates much higher than we had anticipated or had hoped. So ministers are considering what further things might be possible in the run-up to Christmas that needs to be considered. We also need to think about the Christmas period managing our risk to make it as low as possible during those five days of Christmas and then beyond Christmas. I just don't know where we will be. We will have to see where the virus transmission is, what the rates are, what the hospital situation looks like but it may well be that we need to think about further restrictions beyond Christmas catering. Thank you. Adrian Masters from ITV Wales. Thank you Dr Arthurton. You've said several times that the transmission rates are higher than you anticipated. The head of public health at Swansea Bay warned of a catastrophic situation if the infection levels keep rising. Has the political leadership of the Welsh Government and the medical leadership including you have you lost control of the situation? Well it's true that the rates are much higher than we hoped for Adrian. When we went into the lockdown it was on the understanding that we would have a two week short, 17 day short, sharp shock and it did lead to reduction in viral transmission but it was also predicated on as we came out of that fire break that we would have to rely on people's behaviour not to mix, not to do those things I've been talking about in order to keep the rates of viral transmission low. That has not happened as we anticipated and that's probably understandable given people's enthusiasm to start to think about Christmas given the tiredness of everybody because of what's happened over the last few months. I don't think things are out of control but rates are rising, they're rising too quickly and so we have to ask ourselves well why are they rising and who can do something about it. They're rising because people are mixing. People can stop the risk of infection by not mixing, that's a simple message. People have a role to play. Everybody in Wales has a role to play in this. Government has a role to play in this by setting the rules but government alone cannot do this. Government cannot save the situation around coronavirus. It has to rely on what we all do. When I talk about central government we talked about the rules around hospitality that were put in place last week. We need to think about what local authorities can do around enforcement, they're doing a fantastic job but making the environment as safe for people is really important. Everybody has to think about what their role is in this and ultimately we need to remind ourselves that our own personal responsibility requires us to continue to make sacrifices to continue not to mix so that we don't spread the virus. In the light of everything you've just said and everything that you've said throughout this press conference so far are you reconsidering the Christmas rules? I realise that would be very difficult for Wales to do on its own but are you talking to other chief medical officers about a possible rethink? We're not reconsidering that. We've made a commitment to the people of Wales and the people of the UK that those rules will change over the Christmas, the five day period. What I am saying is that people should think within that framework about how they can keep themselves safe back to that point Adrian of personal responsibility, personal decisions. So no, we're not going to change those rules that would just confuse everybody for sure. The rules are as we agreed across the four nations but we will really have to look very carefully as we come out of that period over Christmas. What the rates are, what the hospital activity is looking like and how resilient we are as a nation and we will have to decide about whether we need further restrictions beyond the Christmas period. Thank you. Thanks Adrian. We have Rebecca Miles from LBC. Thank you. We've just said we all have a role to play in this. We have technical advisory groups advising people to self-isolate for 10 days so that they can get together with their Christmas bubbles over Christmas. If they did that they need to start this weekend. Are you going to make an official recommendation of that? If so it's not giving people much time to plan. That's an ideal Rebecca. I know people who are doing that who are staying entirely in their own household are quarantining themselves in the 10 days before Christmas so that they know that they can safely spend time with elderly relatives. I know there are people who are doing that. It's a very difficult thing to do. It's not something that everybody can do but as a council of perfection it's something everybody could think about and even if they can't do that fully during that 10 days if people can reduce the number of people they're meeting that means anybody on the side of your immediate household whether it's shopping or whether it's going to Christmas fairs whether it's going to cafes that are still open. All of those things are not, there may be low risk but they're not zero risk so we all need to think about how we can reduce our personal risk. I go shopping once a week now I go to a supermarket at a time of the day when it's, I know it's not going to be busy. There are simple things that we can all do to reduce our human contact to avoid mixing and to make us safer as we go into the Christmas period. Well we have heard this morning about two people having allergic reactions to the new Pfizer jab. Is this normal for a new vaccine and what would you say to people who were already concerned about taking this new jab? Yeah, we heard late yesterday evening that two people who have been vaccinated in England did have quite serious reactions. We've always said there are side effects of course for any vaccine and these are at the more serious end of it. I'm glad to say it as far as I know both those people have been well treated and are now well. Any vaccine, any drug can cause this type of a reaction and so we always make sure that where we are providing vaccines any vaccine, whether it's coronavirus vaccine or any other vaccine that we have facilities to identify and to manage these kinds of side effects. So I've this morning been talking with my colleagues and getting messages into the whole of the NHS so that we make sure that all of those arrangements that need to be in place to support people if they do run into problems with side effects are there. It's about having the medicines available, the adrenaline and the oxygen available that we make sure that people are available, the staff are properly trained in recitation. So that's a part of normal vaccination. The reality is of course that the vaccine is still safer than suffering coronavirus and so I still encourage people to come forwards for vaccination. Thanks very much Rebecca. We have Adam Hale from PA. Afternoon Doctor Allerton. You've said that your message to people over Christmas is don't mix with people outside your household but of course whilst the government have very publicly announced that 5D relaxation over Christmas which has given people the clicking light to do so. Can you understand people's confusion at the contradictory messages they're receiving from you and other places people in authority? No I don't think there's any confusion. People understand and the First Minister made this very clear that just because somebody can do something doesn't mean that they should do something. It was felt important across the four nations to give some licence to people to increase the number of households that could mingle over Christmas and that was on the basis that people need to spend Christmas together and that people would want to do that anyway whatever the rules are. So it was important to put some parameters around it. The message is very clear. If you want to stay safe don't mix with other people. If you want to stay absolutely safe don't mix with anybody. If you want to stay safer keep your time of contact as low as you can. Maintain social distancing in the house. If you do mix with people from outside your household and continue to practice those issues around respiratory hygiene making sure you wash your hands clearly often sorry. I don't think there is a confusion. I think it's important that people take personal responsibility here as well as relying on government rules. Thank you. The blame has been pointed out to the public for mixing with each other as you've just done for the rise and transmissions across the country. I'm not sure I've heard from yourself or the Welsh Government that people in Wales would adhere to rules than elsewhere in the UK. Given that Wales is currently the country before and worst with case rates what did those that set the rules and issue the guidance here who should bear responsibility for where we are currently? This is in no way putting blame on to people. This is just explaining what is happening and explaining the way in which the virus transmits from person to person. The more we mix the more the virus spreads and the rates of illness and death. That's just the reality that we face not just here in Wales but everywhere else. The message I'm trying to give is that government can do so much. It can set the rules, it can try to protect people, it can provide the NHS services that we all rely on. But there is something about personal responsibility as well for how we behave individually and collectively. Thanks Adam. Will Hayward from Wales Online? Thank you. If it wasn't Christmas on December 25 would we be going into a five-break lockdown before that date? Well given where we are with the current rates of transmission in Wales we really do need to look at what additional measures need to come into place. It's a hypothetical question about the Christmas issue. Certainly beyond Christmas we're going to have to really think seriously about where we are. The prospect of a full lockdown over Christmas would be unpalatable I think to everybody. But it would be something that beyond Christmas we may need to come back to in terms of what further restrictions are needed. But that will be determined largely by where we are at Christmas and we can't just know that at the moment. It's fair to say that if given where cases are if we didn't have Christmas coming up we'd probably have gone into some form of lockdown. I just want to ask you about Tidfield. We're now several weeks on from the mass testing in Murher and cases there are the third highest in Wales. Can you explain whether this was effective? Did you reach a high enough percentage of the population? What have we learned for it and could it be used in other areas soon? Well you know on the mass testing we've always regarded it as as a pilot as a trying to learn from it. We saw what happened in Liverpool and there was some limited success in Liverpool and that's why it was introduced in Murher and colleagues there have done a huge amount in terms of developing the programme. It still hasn't been properly evaluated we need to do that. The early indications are that significant numbers of people have come through but are they the right one? Will it lead to reduction in community transmission? I think the jury is out on all of those questions still will and that's why we need to be cautious about just rolling out mass vaccination to other parts of Wales before we really can be clear that there is a positive impact because of course with any testing initiative like that there's negatives as well you know people queuing up outside centres as well puts them at risk and the weather is not good etc. So we need to learn a lot more before we can roll that out on a larger scale. What I can say is that as well as the kind of mass testing of the whole community there are plans afoot to test because we have lateral flow tests available or becoming much more available now so there are a number of settings where we can test in a more targeted way healthcare staff, social care staff, visitors to social care to long term care facilities etc and possibly into schools. So there will be other settings where we can use testing more effectively the question of mass testing I think the jury is still out on. Thanks Will and Andy Davis from Channel 4. Thank you Dr Atherton. Yesterday we spoke to Dr Dave Jones who is leading the ICU at the Prince Charles Hospital in Merthyr Tydfil and he painted a really bleak picture of what's happening there. He didn't have any available critical care beds. Staff were absent either through sickness or stress they basically run out of ideas on how to cope he said and he worried that the five day Christmas break would to quote him poor petrol on an already burning fire. Are you confident with the rates that are currently and with the Christmas relaxation in the rules? Wales will have enough staff intensive care beds for those that need them in the weeks ahead. Yes thanks. The intensive is up there in Merthyr as well as across the rest of Wales are doing a fantastic job and they are under enormous stress. I absolutely understand that. The numbers as I say in intensive care units are high 77 hours of yesterday that had come down slightly. The trajectory is on the upward we do have plans in Wales for expansion of more beds but you're right to flag the issue of workforce because you have to have trained staff to run those critical care beds absolutely. So the situation is really quite fraught and it all brings you back to the question about how do you solve the problem. There are two things I would say to that. One is first of all that although we have 77 patients with coronavirus and critical care beds we have a lot of non-coronavirus patients and so we have in Wales taken the approach of trying to keep our non-essential services in the NHS moving, keep them active and that does lead to pressure. So in fact most people in critical care beds in Wales are not suffering from coronavirus for other reasons. It may be that we will come to the point that we might have to change that policy of being able to provide non-essential services in Wales. That's what we did in the lockdown if you remember, the initial lockdown in February, March. We haven't reached that point we hope not to reach that point we want to keep non-essential services moving if we possibly can, but that may be something that we need to seriously think about. The other point is that obviously we have capacity running into problems in different areas at different times and so we do have a clear process of mutual aid in Wales where one area, one local health board area can provide support to another but it is perilous and the real answer is of course that we have to reduce community transmission of coronavirus we have to somehow get this down. That will happen ultimately through vaccination but in the short term it will only happen if what I'm talking about today happens which is that we don't mix and we keep our household mixing down our interpersonal mixing so that the virus stops spreading as rapidly as it has been doing. Thank you. A document from the technical advisory cell suggests that the number of deaths from Covid happening in Wales at the moment is tracking above the reasonable worst case scenario. I mean that's an extraordinary position to be in isn't it, to be dealing with more deaths than the predicted worst case scenario. You've said that ministers I think you said this earlier are considering what possible further restrictions might be introduced before Christmas if that's correct but are you personally comfortable that the restrictions currently in place before Christmas are enough? Andy, when I look at the trends that we've seen over the last week I am really worried about where we're going and I've always said that we need to get into Christmas with a lower rate of transmission of coronavirus as possible that really isn't that isn't where we are at the moment. So we have to ask ourselves what more can be done in the short time we have available to us before Christmas one thing that can be done is that everybody can take personal responsibility and that's what I've been talking about now Ministers are considering other options they will, they continue to look at that continually cabinet is meeting this week and we'll be looking at other possibilities around schools local authorities have a role to play in the environment that they provide I am worried, I'll be honest that we still have Christmas fairs and Christmas attractions running in some of our major cities I think we should be questioning some of that, we have to somehow reduce human to human contact if we're going to get the numbers down before Christmas Thanks Andy and finally we have Nathan Shusmith from the speaker Thank you Dr Afton The self-hospitalisation and quarantine period in Wales has been reduced from 14 days to 10 days from tomorrow Can you explain a bit more about why that change has been made and the evidence behind it? This has been kept under constant review again on a four nation basis so the four chief medical officers have looked at the evidence base around this and in fact what's transpired as we've learnt more about the virus is that if we use a period of 10 days rather than 14 we capture most of the infections that are going to happen there's a very marginal difference between 10 days and 14 days and also we know how difficult it is to self-isolate to quarantine yourself for 14 days and we know that the rates of people who do manage to successfully do that are not as high as we would like to be so anything that can safely reduce the length of the quarantine period can hopefully improve compliance as well so that was the evidence that was presented to chief medical officers and collectively we decided that that should happen across the UK Thank you and the Pfizer-BioNTech vaccine has particular logistical changes as we know in being rolled out last week you said that you couldn't say when care home residents would receive it due to the storage temperature requirements have you got any updates on that or anything you can say to reassure people in care homes or those who've got loved ones in care homes about when they might get the vaccine Yeah well that's still something that we're working very hard to try to find a way around the issue you're right to flag it Nathan the cold chain problems are really difficult but we're looking at how we can work around that the latest issue of course around some side effects that we're learning about from the vaccine does kind of add another dimension to that that we need to play in as well so it's work in progress not just here in Wales but across the four nations and we share information across those it's absolutely the case that residents of care homes and care homes and NHS staff remain the highest priority for the vaccine and we're just trying to find operational ways of making sure that we get the vaccines that we have available to the people who need them as soon as we possibly can that will continue Okay thank you very much everybody for all of those questions really appreciate that thanks to all the NHS staff who've been working so hard I've said it before I'll say it again great debt of gratitude and I think the best way that we can start to repay that debt is by keeping ourselves and our loved ones safe over Christmas by not mixing by doing all of those things that we surely now know can keep ourselves safe so I wish you all well thank you have a safe week and a safe Christmas thank you