Wales' top doctor on what lessons the country can learn from its Covid response
The lessons Wales needs to learn from Covid-19 have been set out by the country's top doctor.
Dr Frank Atherton has made Wales' response to the first phase of the pandemic the focus of his annual report.
The special 86-page report makes eight recommendations.
1) Invest in health protection services. The report says: "The Welsh Government, Public Health Wales, health boards and local authorities should review and enhance investment in health protection services."
Analysis: This is particularly important in the very early stages of any outbreak. As we saw in Wales at the start of the pandemic in January, there was an attempt to isolate, test, track and trace every case, but as the situation escalated systems could not keep up. Months later, in May, Wales launched its Test, Trace and Protect strategy (TTP).
2) Monitor the resilience of existing Covid-19 systems: The report says: "To ensure maximum effectiveness we need to keep reviewing and adapting the delivery of the programme as the nature of the pandemic changes and in line with new scientific evidence."
Analysis: We have learned through the pandemic that the situation is extremely fluid. New variants of the virus change the transmissibility and infection rates. This, in turn, impacts the workload of the systems in place to track the virus. When TTP was launched in Wales, people would have around four contacts. In later weeks that rose, in some cases, to 20 or 30 and put a huge strain on the operation. That impacts staffing.
3) Prepare for future pandemics: The report says: "Preparing for future pandemics is essential, so that when they occur we are in a position to act quickly and decisively."
Analysis: At the start of the pandemic, experts were telling the public that Wales and the UK was 'well prepared' for Covid-19 but criticism of the UK's response soon grew. PPE shortages and the emergence of a 2016 report into pandemic preparedness also added to the growing sense that, contrary to what the public were being told, the UK was not prepared.
4) Engage fully with the public on all parts of the response: The report says: "Solutions to many of the challenges responding to Covid-19 rely on engaging with the public and the communities where we live and work.
Analysis: Getting public buy-in when governments bring in measures to limit the impact of the pandemic has been a constant feature. From the five-mile rule that was seized upon by some as a 'cruel rule' or the need to try an incentivise people to self isolate instead of feel compelled to go out and work to make money are all part of the need to get public support for measures being brought in.
5) Adopt a One Health approach to sustainable development in Wales: The report says: "The Welsh Government and its partners should prioritise some of the ‘wicked issues’ we face as a society. These include threats from climate change, zoonoses, antimicrobial resistance, as well as food and water safety and security. These should be addressed using a ‘One Health’ approach."
Analysis: Anyone (like me) who has been soaking in the hot tub of healthcare in Wales for a few years will hear bells ringing when they read the term 'One Health' approach. It sounds very similar to the 'Once for Wales' doctrine that has for years been used to describe a way of doing something for the whole of Wales once instead of in a fragmented way. In theory, it's a good idea - and the pandemic has shown what can be achieved - but it'll be a case of keeping up the momentum.
6) Enable the health and social care response including the Covid-19 vaccination programme: The report says: "The Welsh Government, local government,NHS Wales and social care organisations should maintain and add to existinginnovation and creative solutions, with particular attention given to the wellbeing of our health and social care workforce and wider key workers whilst providing sustainable services."
Analysis: Much like point five, this is all about keeping up the momentum. Taking the good things from the pandemic. In order to do this, though, you need staff to feel engaged and involved. The pandemic has brought many working in the NHS close to the edge, they'll need a lot of support to keep going long after Covid isn't filling hospitals with patients.
7) Continue to monitor inequities and where they exist identify solutions to address them: The report says: "The Welsh Government, NHS Wales, social care organisations, local authorities and voluntary organisations, should sharpen their focus on reducing health inequities by ensuring policies are routinely subject to impact assessments and are targeted at those most in need, as well as monitoring and mitigating the effects on our most vulnerable groups."
Analysis: The pandemic has brought into even sharper focus the inequalities in Wales and the UK. Death and serious illness from covid is more likely to have occurred in those from more deprived areas of Wales. Work is ongoing to understand why this is. The same work is also being carried out to try and better understand why COVID-19 disproportionately affects those from BAME backgrounds.
8) On-going research into tackling and monitoring the direct and indirect long-term effects of Covid-19: The report says: "Research is at the heart of making sure we continue to use the best available evidence to address the direct and indirect effects of Covid-19."
Analysis: The pandemic is not over yet and as the virus continues to mutate, populations continue to be affected and new measures to combat the spread continue to be implemented, there is still a great deal of learning to do. We will be living with Covid-19 for the foreseeable and that requires a continued vigilance and understanding of how we can live with it and, crucially, manage it.