Image source, Reuters

Our live coverage has come to an end, but here are some of the main developments from the fourth day of the Covid inquiry in Wales.

• Dr Chris Williams, consultant epidemiologist at Public Health Wales (PHW), said attempts to contain a virus like Covid were worth trying, even if it became “essentially impossible after a while”. He also said that an earlier UK-wide lockdown would have reduced deaths in the first wave of the pandemic
• Dr Roland Salmon, previously PHW’s director of communicable diseases, criticised aspects of the Welsh government’s lockdown strategy, including the decision to restrict access to supermarket aisles and prevent pubs from selling alcohol.
• Salmon said that “if people are going into the supermarket, why do you want to shut one aisle and not the other?” adding that such decisions suggested a “lack of lived experience”
• He also said he believed that restrictions disproportionately impacted children, students and young adults. “Those losses of opportunities and that economic loss will translate into ill-health and loss of life expectancy,” he said. “It may not be as immediate but it will certainly be there”
• The inquiry also heard today from Prof Ann John, a member of the Welsh government’s technical advisory group, who said there was no evidence of “pandemic fatigue”. “If you put forward clear and consistent messaging, and supported people to adopt certain behaviour, there was no evidence it existed,” she said.

Now today's session has ended, here's a look at who will be appearing before the Covid inquiry next week.

Witnesses will include Sir Frank Atherton, chief medical officer for Wales, who will appear before the inquiry on Monday morning, while Dr Andrew Goodall, former chief executive of the NHS Wales and now permanent secretary of the Welsh government, will be a witness on Tuesday.

Simon Hart MP, who was Welsh secretary until July 2022, will appear on Friday afternoon, and we’ll also hear from various officials, including from Public Health Wales, throughout the week.

The full list of who will appear next week is available here, external.

The names of those appearing for the third and final week of the inquiry – which is likely to include senior government officials, including First Minister Mark Drakeford and former Health Minister Vaughan Gething – are expected to be released sometime next week.

A number of questions raised this weekpublished at 16:53 Greenwich Mean Time 1 March

16:53 GMT 1 March

Jenny Rees
BBC Wales health correspondent

Timings, messages, modelling … they all came up in today’s evidence.

Should we have locked down sooner? Should we have locked down at all?

But should we also have been better at explaining the logic behind the rules, when Wales went its own way to England?

And is there likely to be less compliance with rules when you can buy from some supermarket aisles, yet find other aisles are closed off?

There was also a return to a topic raised at various points this week – the diversity of voices around the table, advising decision makers.

The conclusion – that no, it did not accurately reflect the varied experiences of people around Wales, who ultimately found themselves at greater risk of the virus.

The two-week firebreak lockdown introduced in Wales in late October 2020 should have been longer, according to Prof Michael Gravenor of Swansea University.

The expert in pandemic modelling and epidemiologist told the inquiry: “I think a longer firebreak would have put us in a much better position in December and potentially could have avoided some of the worst of that second wave,” he said.

He also said he believed care homes would have fared better from an earlier lockdown.

“The late lockdown meant we had a very high prevalence of infection throughout April and early May in the UK,” he said.

Following Prof Ann John's comments on the differences between Wales and England's face masks rules on public transport, here's a little more from Dr Chris Williams, epidemiologist for Public Health Wales, who spoke to the inquiry a little earlier.

He said he believed making wearing face masks mandatory sooner in Wales “would have been a reasonable approach", even when there wasn't much evidence available to support their use.

Face masks became mandatory on public transport in Wales on 27 June, more than a month later than in England, and in shops on 14 September - in England face masks had been mandated in shops on 24 June.

Dr Williams said he recalled “verbally arguing for face masks” during the Wales Technical Advisory Group’s meetings.“I thought it might be worth a try of masks even in the absence of evidence,” he said.

John said isolation was very challenging for people on zero hour contracts – who struggled to feed their families – and people in frontline occupations, who needed support to stay home.

But she said there was also no evidence of “pandemic fatigue”.

“If you put forward clear and consistent messaging, and supported people to adopt certain behaviours, there was no evidence it existed,” she said.

As restrictions eased, it was important to understand how that might be done safely, she added.

The assumptions on how the public might comply with restrictions were "very conservative" and based on lower levels of adherence than were found, Prof Ann John said.

“We didn’t make the most of the public wanting to both protect themselves and those around them.

“We failed to recognise sometimes how much the public and communities pulled together.”

Image source, UK Covid-19 Inquiry

Clearly communicating the different Covid rules across UK nations “sometimes was missing” during the pandemic, a member of Welsh government's Technical Advisory Group has told the inquiry.

“There is no doubt in my mind that the idea that if we’re following the science why are we coming to different conclusions was difficult for people," Prof Ann John said.

She said it would have impacted trust in the government, as well as how people behaved.

The public health and psychiatry expert recalled how at one point train passengers had to wear a face mask in Wales but could remove it when they crossed the border into England.

“Clear consistent messaging is important," she added.

As well as being sceptical about Wales' need for a firebreak lockdown, Dr Roland Salmon said he felt the restrictions on society during Covid disproportionately impacted children, students and young adults.

Schools in Wales were shut for more than three months during the first lockdown in 2020 and later some classes were done online.

“Those losses of opportunities and that economic loss will translate into ill-health and loss of life expectancy," he told the inquiry.

"It may not be as immediate but it will certainly be there."

The inquiry heard that during the pandemic Salmon wrote a blog claiming Wales’ Wellbeing and Future Generations Act “singularly failed to translate into any sort of systemic evaluation of the downsides of global lockdown approaches”.

Image source, Getty Images

Good adherence to restrictions was needed to help reduce Covid's spread in Wales back in October 2020, not a 17-day firebreak lockdown, according to Dr Roland Salmon.

He said because up to 30% of cases in young adults were asymptomatic it meant that the virus would increase once any firebreak ended.

He said because of this, a respite from infection would only last a small number of weeks – too short to deal with track and trace issues or before a Covid vaccine was ready.

Salmon felt this warning was borne out and said: "I understand the enthusiasm from some clinicians for the firebeak - almost any respite is welcome.

"But I think this was very expensively bought and hard to justify on social grounds.”

Should we have all been made to stay at home?published at 13:50 Greenwich Mean Time 1 March

13:50 GMT 1 March

Owain Clarke
BBC Wales health correspondent

The decision to introduce hard lockdowns was almost certainly the most significant of any made during the pandemic.

Before Covid, Wales' first minister or any UK politician would've never thought about forcing people to stay at home - stopping them even meeting their own families and depriving us of our freedom.

The Covid inquiry has heard from two eminent epidemiologists who take opposing views on whether such a lockdown was necessary.

Dr Chris WIliams helped lead the Public Health Wales (PHW) response and he says he believes the scale of the spread, risk to life, threat that the NHS might collapse under the strain made lockdown not only inevitable but he believes it should have been introduced sooner.

Dr Roland Salmon, who had been director of communicable disease at PHW, felt the right approach would've been to focus protections on the vulnerable rather than locking down everyone.

His view is the harm of lockdown, some of which continues to be felt on children's education and the economy, ended up being more than the benefits.

Dr Roland Salmon criticised the Welsh government's decision to restrict access to certain supermarket aisles and prevent pubs from selling alcohol as part of its strategy to stop the spread of Covid.

“I can think of no basis on why you might think they would work”, he said.

“Whether you leave the aisles open or you leave them shut really doesn’t matter. Actually, if people are going into the supermarket, why do you want to shut one aisle and not the other one?”

Dr Salmon also referenced a comment made by a witness yesterday who discussed “a lack of lived experience” by key decision makers.

“I think it seemed to suggest a lack of lived experience of even going to the supermarket,” he said of the pandemic response.

He also criticised the decision to ban the sale of alcohol in pubs, suggesting it was “perhaps an overly enduring legacy” of similar moves along religious grounds.

“Pubs and restaurants settings are an issue when people congregate in them. Those people who are vulnerable are best avoiding them and advised to do so. But opening up and not having a beer, that seems perhaps an overly enduring legacy of the chapel heritage, I don’t know.”

The inquiry is now hearing evidence from Dr Roland Salmon, who is the senior crematorium medical referee for the Cardiff council crematorium, and was previously Public Health Wales’ director of communicable diseases.

Salmon was one of the few public health experts in Wales during the pandemic to question the policy of introducing “hard” lockdowns, fearing the long-term harms to society would outweigh the benefits in reducing the speed of the virus spreading.

He has continued to question whether the approach was effective, saying they “cost a lot” financially, as well as in terms of mental illness, domestic abuse, addiction and delays to health treatment.

“I feel there have to be other approaches to this,” he said in October 2021, when a potential return of Covid lockdown restrictions were being discussed.

Salmon said it would be more efficient to prioritising vaccinating those over 60, or clinically at-risk groups who had not yet had their second Covid jab, rather than urging younger people to get vaccinated.

Williams was also asked about his team’s research regarding the source of care home infections.

It had confirmed that transmission had been largely driven by the exposure to the community from care home staff – rather than from patients being discharged from hospitals into care homes.

He said it was possible that discharged care home patients could have contributed to the spread of Covid in those homes, but that health experts felt “there was a bigger risk and an ongoing risk from the community to staff to care homes”.

Williams said he believed there should have been a UK-wide lockdown on 12 March or “ideally earlier than that” because of evidence it would work from China and northern Italy.

Instead, the UK government announced it wanted people with Covid symptoms to stay at home from 13 March.

Williams said: “It would have reduced the impact on the first wave, in terms of hospitalisations and deaths, however there might have been a rebound effect on the second wave.“

He said he understood it would be difficult to lockdown in Wales and not in England given the movement of people across borders.

By 15 March, the Welsh government's technical advisory cell - which included Williams - had written a report warning that the NHS in Wales risked being overwhelmed if stringent interventions weren’t brought in.

Image source, UK Covid-19 Inquiry

We're currently hearing from Dr Chris Williams, consultant epidemiologist at Public Health Wales, who says attempts to contain a virus like Covid was worth trying, even if "essentially impossible after a while".

At the start of the pandemic a track and trace approach was adopted in Wales as it was across the UK.

Asked whether containment was the right approach for Wales in February 2020, Dr Williams said: “I think it was worth trying the best you can. It will slow infection but as more and more people travel you get cases you’re not aware of - that’s when it becomes untenable.”

He was asked whether an email on 20 February 2020 between Wales’ chief scientific advisor and its chief medical officer, highlighting that 40% of positive cases were missed, should have led to Wales taking a different approach on containment to other parts of the UK.

“I think you have to try [to contain the spread] even if it’s difficult and essentially impossible after a while,” Dr Williams said.

Image source, Reuters

More from yesterday's written evidence that we didn't get to hear live, with the Welsh government's head of science saying minsters in Wales had “a lack of confidence” about what action to take at the start of the pandemic and benefitted from Boris Johnson's "decisive leadership".

Dr Robert Hoyle wrote: "In my opinion, there was not a desire amongst Welsh ministers to avoid a lockdown. What there was at the time was a lack of confidence by ministers in what action should be taken given the uniqueness of the circumstances.

"Despite what the prime minister [Johnson] did subsequently during the Covid-19 crisis, I have to admit that, in my view, he did act decisively on behalf of the whole of the UK, even [if] it was a bit late, and that Welsh ministers needed that decisive UK-wide decision-making and leadership."

After yesterday's hearing we received some written evidence from the inquiry that wasn't heard live, including how one of Wales' top scientists was surprised by Mark Drakeford's claim that there was "no value" in testing all care home residents for Covid.

The first minister's comments came in a TV news report about testing on 29 April 2020 - at which stage all care home residents in England were being offered tests, but in Wales they were only available for those with symptoms.

Drakeford said: “The clinical evidence tells us that there is no value in doing so [testing everyone] and because of that we don’t do it.”

The following morning, the Welsh government's head of science Dr Robert Hoyle emailed other senior officials to say that Wales’ chief scientific adviser Peter Halligan was “keen to understand the rationale, evidence and advice behind the first minister's comments last night on the telly that there is no value to testing for Covid-19 in care homes”.

“Please can you enlighten us. Thanks.”

Testing for care home residents and staff in Wales, regardless of whether they had symptoms or there was an outbreak in their care home, was not announced until several weeks later on 16 May 2020.

Image source, PA Media

Image source, Getty Images

Here are some of the key moments from Thursday's session:

• Prof Dan Wincott, an expert in Welsh government decision-making, told the inquiry that structures to help the Welsh and UK governments to work together are “much less well-developed than would be optimal in a system like the UK”
• The inquiry also heard the Welsh government and First Minister Mark Drakeford only learned Wales would take charge of its own Covid response three days before the UK-wide lockdown was introduced by Boris Johnson
• Prof Sir Ian Diamond, chief executive of the UK Statistics Authority, took the inquiry through the “very strong peak of deaths” in April 2020, largely driven by Covid
• Dr Robert Hoyle, head of science at the Welsh government, also said that debate within the technical advisory group – the Welsh government’s scientific advisory body – was not met with enough “really hard challenge” from members
• Hoyle also criticised his boss – Prof Peter Halligan, the chief scientific adviser to Wales – for his response to Covid, saying more should have been done earlier. Dr Hoyle accused Prof Halligan of treating the pandemic as a “case of that’s someone else’s problem” when he raised it with him

Welcome back to our live coverage of the fourth day of the Covid inquiry in Wales.

Today’s hearing will include evidence from experts in disease control and public health, who will discuss the Welsh government's response to the pandemic.

They include Dr Chris Williams, an epidemiologist for Public Health Wales, as well as Dr Roland Salmon, from the Cardiff Council Crematorium, and previously with Public Health Wales.

Later this afternoon we'll hear from two professors at Swansea University – Prof Ann John, who focuses on public health and psychiatry, and Prof Michael Gravenor, who specialises in biostatistics and epidemiology.

Stay with us as we bring you the latest lines and analysis, and you can also watch the proceedings live by clicking the Play button at the top of this page.