Nearly a year on from the first time Wales and the rest of the UK went into lockdown on March 23 last year, one thing does not make sense.
Why did so many more people die in the second wave of coronavirus in Wales than lost their lives in the first?
We knew what we faced. As unpopular as they are, we also knew that decisive lockdown measures were the only way to stop it. And yet it happened right in front of our eyes. Cases rocketed, policies to stop that rise failed, and hospitalisations and deaths followed. By January, the NHS was in desperate crisis and 100 people were dying every two days in Wales.
The Public Health Wales data tell the story. In the six months from March 1 to August 31 there were 18,158 positive cases and 1,594 Covid deaths within 28 days of a positive test. In the second wave, between September 1 and February 28 there were 185,959 cases and 3,783 deaths.
Increased testing in the second wave might muddy the picture when it comes to tests but only one thing explains the deaths: the virus being allowed to circulate in our communities. Nor is this a case of coronavirus deaths in the first wave being missed from the statistics. The ONS figures which record all deaths with Covid-19 on the death certificate tell the same story: 2,301 deaths with the virus between March and August, 4,345 deaths with coronavirus between September and February.
To look back at the coronavirus data from the autumn and early winter now is to see this tragedy play out in slow motion. The first wave was cut short by a brutal, decisive lockdown that came too late to save many. The second wave by contrast was a long convoluted series of measures that never did anything more than temporarily slow the march of a virus until a belated Level 4 lockdown announcement in late December that came to late to prevent a catastrophic January.
Only improved medical understanding of how to treat the virus saved thousands more from serious disease or death.
From the moment thousands of Welsh holidaymakers landed back in Wales at the end of August the Welsh Government arguably made a series of decisions which led to increased loss of life in Wales. Unlike the first wave where there were caveats such as uncertain science over the new disease, a shortage of tests, a lack of PPE and a deeply engrained precedence of following Westminster’s lead – the decisions in the second wave were made in Cardiff Bay. They were the Welsh Government’s and it is disingenuous to suggest otherwise.
Public opinion certainly didn’t help ministers. Despite cases rocketing and the UK’s top scientists warning of the dangers, many in the public remained sceptical of lockdown, angry about restrictions on hospitality and gyms and even as the deaths started to grow, rumours of hoaxes proliferated. Yet the public wasn’t in charge. The Welsh Government cabinet was.
Here are just some of the arguably catastrophic decisions that were made as the summer turned into autumn and led into the bleakest of winters.
An overestimation of and over reliance on Track, Trace, Protect
When questioned over the summer about a second wave of the virus in the winter the response from Vaughan Gething and Mark Drakeford was consistent. They hoped to avoid a full lockdown by using a series of local lockdowns and relying on their Track, Trace, Protect system (TTP).
Vaughan Gething would take every available opportunity to extol the virtues of the TTP system.
Politically this was a real winner because across the border the UK Government’s Track and Trace scheme involving private company Serco was coming under heavy criticism for being too slow and too expensive.
To be fair, over the summer the Welsh TTP system seemed to be performing great. Outbreaks at factories in Merthyr and Anglesey were nipped in the bud quickly with no need for a wider local lockdown. The tracing teams were based in the communities and had local knowledge, all steps to be commended. It was assumed that this system would be able to keep doing this as the nights started to draw in, but this overlooked some serious deficiencies in the system.
First you have the numbers that TTP was having to deal with. In the summer they were dealing with 20 cases and associated contacts a day, they were facing 8,000 a day by the winter.
This quickly overwhelmed the system. On the face of it, the figures still looked good, most people were tracked by contact tracers, but it was taking them still too long to do it.
The World Health Organisation defines a successful contact-tracing system as one where a country can trace and quarantine 80% of close contacts within three days. In Wales it was common for it to take eight days for a close contact. This meant by the time contact tracers caught up with you after you had come into contact with a positive case, you had been mixing freely in the community for over a week and had only got two days of isolation left.
This is not to say contact tracing can’t work, it absolutely can, other countries have proved it. But there is a lesson in the success stories of South Korea, Vietnam, Japan and Taiwan that Wales had not learnt as we went into the summer. You need more tracers, better use of tech and a far more comprehensive definition of what constitutes a contact (Taiwan has an average of 17 close contacts per case whereas the UK average is two).
Most importantly, tracing only works when figures are very low. Once you see cases increasing widely, only a very strict tightening of restrictions seems to stop the virus. As the theory goes, the faster and stricter you go, the less time you then spend in lockdown.
The local lockdowns
On Tuesday, September 8, the county of Caerphilly was ordered into Wales’ first local lockdown.
This meant that people could not enter or leave the council area without a reasonable excuse, everyone over 11 was required to wear face coverings in shops, and people could only be able to meet outdoors.
This is because the area had reached 55.4 cases per 100,000 (Wales as a whole is still over 40). It was hoped that these measures would contain the outbreak and bring it under control. Even at this point there were reasons to be sceptical. The city of Leicester in England had been placed into an arguably tougher local lockdown at the end of June and it had taken well over a month for any real dent in the numbers.
Though the local restrictions in Caerphilly initially saw some reduction in the virus locally, Covid cases began exploding all over Wales. It was not long before the majority of Wales’ local authorities were in some kind of lockdown with Llanelli becoming the town level lockdown on September 25.
The Welsh Government now seems to acknowledge that the local lockdowns did not work. Just last week Wales’ CMO Frank Atherton spoke about their effectiveness saying: “The experience last year with the local lockdowns wasn’t very encouraging.”
But that misses the point that the local lockdowns weren’t really lockdowns. Pubs remained open, although they had to shut at 10. Gyms remained open. Non-essential retail remained open. Schools were open.
Hindsight helps make that point. But the thing that raises serious questions the Welsh Government’s persistence with local lockdowns at the time is the contents of the minutes of a SAGE paper on September 25.
The firebreak lockdown – Too late and too short
At 6pm on Friday, October 23, Wales went into the firebreak lockdown.
This was hailed as a way to get the spiralling virus rates under control, give hospitals some breathing room and according to economy minister Ken Skates give business “a clear run at that vitally important” period in the run up to Christmas. The First Minister repeatedly said that the stricter the rules, the fewer days we would have to spend in lockdown.
In many ways this was a brave decision. No other part of the UK had taken such measures and the Welsh Government was really going it alone. But is retrospect (and yes things are very easy in retrospect), this plan was poorly executed, came to late and was too short.
First let’s look at the timing. Wales went into the firebreak on October 23. This was over a month after the UK’s top scientific advisory body the Scientific Advisory Group for Emergencies (SAGE) published advice where they called for a circuit breaker lockdown.
This advice stated that “cases are increasing across the country in all age groups”.
It added: “Not acting now to reduce cases will result in a very large epidemic with catastrophic consequences in terms of direct Covid related deaths and the ability of the health service to meet needs.
“As in the first wave, the burden of a large second wave would fall disproportionately on the frailest in our society, but also those on lower incomes and BAME communities.”
The advice suggested a package of measures including:
A circuit-breaker to return incidence to low levels.
Banning all contact within the home with members of other households
Closure of all bars, restaurants, cafes, indoor gyms, and personal services (e.g. hairdressers)
All university and college teaching to be online unless absolutely essential.
It concluded: “The more rapidly these interventions are put in place the greater the reduction in Covid related deaths and the quicker they can be eased. However, some restrictions will be necessary for a considerable time.
“Infections are now increasing in each of the four nations of the UK. Transmission is changing from localised hotspots to a more generalised epidemic.”
This is not an obscure academic paper. This is advice from SAGE. The group whose advice and research has guided the response of the UK nations from the beginning. Wales has a representative on SAGE. The advice is considered by Wales technical advisory cell. And this advice was clearly saying lockdown as soon as possible. Lockdown hard. And if you don’t, many of the most vulnerable in Wales will die.
It was also clear that the package of measures in Wales’ local lockdowns weren’t tough enough. were not enough. Yet despite this, four days after this advice was published Llanlli went into a local lockdown. Nine days after this Denbighshire, Flintshire, Conwy and Wrexham went into a local lockdown. Just under three weeks after this advice, Bangor went into a local lockdown after cases rose to 400 per 100,000.
It wasn’t until over a month after this advice was given that Wales eventually went into a circuit breaker. This timeline of events makes the boasts made by the Welsh Government that they were rigidly following the science and acting early ring rather hollow.
There is also the complete debacle over nonessential item sales in supermarkets. Though very small in comparison to delays bringing in restrictions it still proved an unwanted distraction. Not letting a parent buy new school trousers for their child is quite confusing. Why allow people to buy as much booze as they want but not a book in aisle three?
But this in itself is a distraction from the real issues – the fire break was too short and Wales was too slow to accept that the restrictions brought in after the firebreak had failed.
The fire break did slow the virus. For two weeks,Wales’ infection rate fell. There was a consequent fall in hospitalisations and deaths. And yet by November 29, a month after the firebreak began, Wales was back above the level of cases it had been when it went into the firebreak.
If Wales was not safe at 231 cases per 100,000 on October 23 when the firebreak began, why was it safe at 236 cases and rising per 100,000 on November 29?
The part of this chart shaded red shows the impact of the fire break:
There is general consensus that the fire break should been longer. The First Minister has admitted it himself since.
Martin Michaelis, professor of molecular medicine and expert virologist at the University of Kent told WalesOnline that so-called circuit breakers are only effective at very low rates of the virus.
“Firebreak lockdowns only really work when Covid-19 numbers are much lower,” he said. “In Australia and New Zealand, there are examples of three or five day firebreak lockdowns that kept the situation under control and allowed sustainable suppression of Covid-19 spread. If the numbers are higher, short lockdowns will only delay the need for further measures.”
He added that though it stopped a short term overwhelming of the health service, it didn’t go far enough to save all the lives that potentially could have been saved.
He said: “If you focus on not overwhelming the healthcare system and muddling through, you can conclude that this somehow worked. If the aim is to keep Covid-19 sustainably under control without sweeping measures and to save as many lives as possible, this was not really achieved. I think, the main problem is that the numbers were generally allowed to rise too far before measures were taken.”
The totally disastrous run up to Christmas
Perhaps the biggest mistake made regarding the firebreak was how we emerged from it.
On reflection, the restrictions were unbelievably lenient. These included but were not limited to:
Two households will be able to form a ‘bubble’.
People will be able to meet in groups of up to 4 people in bars, pubs, cafes and restaurants.
There will be no legal restrictions on travel within Wales for residents.
Up to 15 people can take part in an organised indoors activity and up to 30 in an organised activity outdoors.
All childcare facilities, schools, further education colleges, work-based learning and adult learning providers could return
All retail businesses could reopen
Sport and leisure facilities, including gyms and swimming pools, could reopen, but the operators must take all reasonable measures to manage risk and maintain physical distancing;
Cinemas, bowling alleys, skating rinks, museums, galleries, bingo halls, casinos and amusement arcades.
Visits to care homes were permitted.
To put this into context let’s compare coming out of the firebreak to coming out of the current lockdown.
When Wales left the firebreak the case rate per 100,000 was 207. Right now in Wales it is about 45.
When Wales left the firebreak the percentage of tests being taken coming back positive was 14%. Right now in Wales it is about 3.6%.
Just this week the Royal Glamorgan hospital said there were no active adult Covid cases there.
And yet even now not all Welsh children are back in school full time. We can not go more than five miles from our house and we are over a month away from going to gym, an pub outdoors or forming a household bubble (unless we live alone). This is not to say that this caution is not merited, especially given the new variants. It is merely to contextualise how incredibly lax the restrictions in Wales were after we left the firebreak – especially considering how high cases still were.
So why was Mark Drakeford so set on not making the firebreak longer? Well the answer seems to be that he felt that having promised the Welsh people a 17 day firebreak he wanted to keep to it. He seemed to genuinely believe that the new restrictions would keep us on track until the new year.
Speaking on November 8 he said: “We took a difficult decision, given we were doing it on our own. We struck a bargain with people then if we made it as strict as we needed to, it would last for the 17 days.
“A lot of people at the time asked, was it necessary? Now I see people saying we haven’t done it for long enough. You have to set out your stall and hold your nerve. Our ambition was to find a pathway through the rest of this calendar year.”
Perhaps inevitably cases began to grow again exponentially. And this is where the Welsh Government made its next series of mistakes.
On Thursday, December 3, the Welsh Ambulance Service declared a critical incident in what Mark Drakeford said was the first real visible sign of the impact of coronavirus on day-to-day care
By December 10 cases had risen to 480 per 100,000 – double what it was before we went into the firebreak. Perhaps even more concerning it was almost 800% higher than 54.6 – the figure it was on September 21 when SAGE said that urgent action was required to prevent “a very large epidemic with catastrophic consequences”.
To combat this rise the Welsh Government did not lockdown. Instead they simply said that from December 4 all cafes, pubs, bars and restaurants will have to close their doors at 6pm and and Cinemas, bowling alleys and other indoor entertainment venues would have to close completely.
At this point schools were still open though some councils like Blaenau Gwent unilaterally closed them because of spiralling rates. It was not until December 14 that all secondary schools and colleges in Wales shut for face-to-face teaching.
By this point a totally beleaguered TTP system was reporting that Covid rates now exceed 370 cases per 100,000 people while the R rate in Wales had increased to 1.27 meaning the number of infections is doubling every 11.7 days.
Things were starting to move very quickly. It was becoming more and more obvious that, if it wasn’t for Christmas coming up, Wales would already be in lockdown. In that middle period of December the Welsh Government took a big gamble. It had still not been long enough to ascertain if the restrictions on hospitality and the closures of schools had the desired effect because it can take weeks for the impact to be seen in the figures. But cases were now growing so fast that if these restrictions didn’t work, even if Wales then went into an immediate lockdown there was still another three weeks of spiralling cases before there would be any real reduction.
There were other factors at play beyond wanting to see if hospitality and school measures would work. There was economic pressure. Retailers had had a disastrous year and were desperate for the Christmas trade to stay afloat. In addition there was fear that a widespread lockdown over Christmas would simply result in large scale non-compliance. As we saw with Dominic Cummings, once rules start being flouted it is hard to put that genie back in the bottle.
Eventually the Welsh Government caved to the inevitable. On Saturday, December 19, the cabinet met and a full lockdown was announced from midnight. The planned five day relaxation of social bubble rules over Christmas was cancelled to be replaced with just two-household bubbles on Christmas Day itself.
With the benefit of hindsight, it is clear that by trying to save Christmas, by trying to use individual measures to try and contain an exponentially growing pandemic, the Welsh Government paved the way for the chaos we saw in hospitals and the awful loss of life in January.
The predictions of that SAGE paper came true – it was catastrophic.
It is worth taking time to reflect on the new variant. The highly transmissible Kent variant had been identified a few days before Wales announced the lockdown on December 19. While the variant was a factor in triggering the lockdown it can not be blamed for the months of spiralling cases in Wales.
As Wales approached Christmas the Kent variant was present across much of the country but was by no means the dominant strain. The Kent variant did not derail a pandemic management strategy that was under control. It was merely a single factor towards the end of a four-month period where a string of mistakes led to thousands of unnecessary deaths in Wales.
To be fair to the Welsh Government, they faced an incredible challenge. They were under immense pressure from many sides in balancing the economic costs of new measures. There was certainly very little pressure from political opponents, particularly the Welsh Conservatives to increase restrictions. In enacting the firebreak they were the first UK nation to act on the SAGE advice.
But this isn’t about other countries. Though limited by a financial dependence on Westminister, the imposition and lifting of Covid restrictions is overwhelmingly the responsibility of the Welsh Government. Mark Drakeford may have been livid about the fact furlough was not extended past October until the UK Government decided on its November lockdown in England. But after that point, there was no lack of financial support for businesses to stay his hand.
It was the Welsh Government and its advisers’ actions that led to the devastating winter spike we saw. Understandable decisions perhaps, human decisions made by people who knew that the public had had enough of lockdown. But still decisions that cost lives. Decisions that many may now feel were mistakes.
When we approached the Welsh Government about this piece a spokesman said: “Our clear priority throughout the Covid pandemic has been to prevent the spread of the virus and keep the people of Wales safe.
“Every decision we have taken has been based on expert scientific and public health advice.”