An “urgent” Wales-wide lockdown must begin before Christmas in a bid to save lives, a body representing frontline NHS staff has warned.
The Welsh Intensive Care Society said critical care would be unable to cope in the coming weeks without “intervention at the highest level”.
It comes after the number of positive Covid-19 tests passed 100,000 in Wales
Health Minister Vaughan Gething said people would “make up their own rules” if the Christmas meet-ups were banned.
In a letter, addressed to the health minister, Dr Richard Pugh warns critical care services will not be able to cope over the winter period unless urgent action is taken.
With 184 critical care beds already being used – half by coronavirus patients – the baseline of Wales’ intensive care was, he said, effectively full.
“Welsh critical care services will be unable to manage rising demands relating to Covid-19, to maintain emergency non-Covid activity, and to continue providing peri-operative care for high risk urgent surgical cases in coming weeks without intervention at the highest level,” he said.
Up to three households can stay together and form a “Christmas bubble” from 23 to 27 December, after an agreement was made by all by all four UK nations.
But two health boards in Wales have already cancelled some non-urgent care – Swansea Bay and Aneurin Bevan University Health Boards.
Mr Pugh said there was now a case for this to happen on a “national basis” to allow the NHS to be able to treat new patients as coronavirus cases increased.
“There is an urgent need to implement such changes before the Christmas period, and to minimise the risk of major incident declarations,” he said.
Mr Pugh said that while imposing more stringent rules ahead of the festive period was difficult the impact of lockdowns took weeks to impact departments.
“Viewed from a front-line perspective, I am afraid that we do not have the luxury of deferring such steps until after the Christmas period,” he said.
It was announced on Monday that Swansea Bay University Health Board was postponing some surgery and outpatient appointments.
Aneurin Bevan health board has also suspended non-urgent care, with one consultant saying her hospital was “stuffed full with patients”.
Mr Gething said the situation across Wales was “very serious”.
He said hospital managers were having to make difficult choices to concentrate on treating patients with coronavirus, to “help with the difficult days and weeks ahead”.
“We are now looking very carefully at how we can support all those people who are in hospital but who are ready and able to go home,” he added.
Mr Gething said officials were now working with hospitals and stakeholders to look at how to send patients who were no longer infectious – especially the elderly – home.
But he said: “We’ve got to give people assurance that they won’t then be infectious and potentially cause greater harm to the family home they return to, or to a care home.”
The seven day case rate for Swansea Bay health board area, which treats patients in Neath Port Talbot and Swansea, now stands at 770.3 per 100,000 people.
It has the second highest rate for any of the board areas in Wales, behind Cwm Taf Morgannwg University Health Board which has a weekly case rate of 870.3.
There were also more than 250 Covid patients in Swansea Bay hospitals, with another 115 recovering patients. This is about a third of all patients.
Wales’ First Minister Mark Drakeford warned the Welsh NHS was in danger of becoming the “national coronavirus service” when the number of positive Covid-19 tests passed 100,000 in Wales on Saturday.
Speaking during the Welsh Government’s coronavirus briefing on Monday, Mr Gething said the Welsh NHS had experienced one of its busiest weekends of 2020 as it dealt with rising cases and winter pressures.
“Coronavirus is putting additional and sustained strain on our health service – it is unlike other winter illnesses that we normally see,” he said.
He urged people to abide by rules and regulations, adding: “We need everyone’s help to get through what remains of this year.”
On Monday Dr Ami Jones, an intensive care consultant at the new Grange hospital, Cwmbran – which is Wales’ newest district-general hospital – warned the hospital was “full” and people were queuing in ambulances as there was “no space”.
Dr Sarah Aitken, the health board’s interim executive medical director, said there were now 404 patients with confirmed coronavirus in its hospitals.
This compares with 283 in April, at the peak of the first wave of the pandemic, but she said the service was “not close to breaking point”.
She added that the situation was intense as they were trying to keep other essential departments, such as cancer treatment, going.
“Our staff are tired, and they are distressed by the seriousness of Covid and what they’re seeing,” she said, adding more younger people who were seriously unwell were being admitted.
Dr Jones, ICU consultant at the new Grange Hospital, said it was “stuffed full with patients with very significant needs”.
She said keeping patients without coronavirus from getting the virus was hard and Second Welsh health board stops non-urgent care non-urgent treatment had to be halted.
She told BBC Radio Wales Breakfast: “As the numbers of patients with Covid in the hospital get more and more, that becomes more difficult. It’s not just pure beds, it’s trying to keep those patients safe.
“We have reached a tipping point, we have more patients that have Covid than don’t have Covid now.
“My ICU is probably two-thirds, three-quarters Covid patients who are not getting the care.”
On Sunday the health board apologised after a 73-year-old man waited more than 19 hours in an ambulance outside the hospital.
Ted Edwards’ family said he had been waiting outside following suspected sepsis or a stroke.
Dr Jones said people were queuing outside the hospital as there simply was no room inside, adding: “We are stuffed.”
“It’s very difficult, but the staff are working really, really hard, we are really sorry to the patients who are not getting the care,” she said.
Dr Jones said many staff in the hospital were now off sick, either due to stress, having to isolate after catching Covid themselves or having been in contact with someone who tested positive.
“We’ve had nine months of slogging it out,” she said.
“I’m not absolutely bursting to the gills in ITU, but I don’t have enough staff to look after my patients, I think that’s similar everywhere in Wales.
“We’ve got enough beds, and we’ve got enough ventilators, but that doesn’t make an ITU bed, we need nurses.”
She added: “It’s very tough, we don’t want to get to the point where we can’t deliver the care we want to deliver.”