Herefordshire has gone from the most relaxed coronavirus restrictions in Tier 1, to being unable to go to a restaurant for a meal in Tier 3 – in just six days.
The fast-paced nature of the Tier changes led to pubs and restaurants unable to honour bookings for New Year's Eve and New Year's Day.
In one of the biggest differences between Tier 2 and Tier 3, a change from 00.01am on Thursday and announced by Health Secretary Matt Hancock on Wednesday afternoon, hospitality venues can only open for delivery, takeaway or drive-thru.
There are now also stricter laws surrounding household mixing, with socialising between households only allowed in some outdoors settings.
RELATED NEWS: What Tier 3 restrictions in Herefordshire mean
But how did Herefordshire move from being in Tier 1 on December 25, where a group of six was allowed to have a drink in a pub, to Tier 3 just six days later on December 31?
How does the Government review Tiers?
As set out in the Government's Covid-19 Winter Plan, there are five indicators which guide our decisions for any given area, alongside consideration of 'human geographies' like travel patterns.
These are:
- case detection rates in all age groups
- case detection rates in the over 60s
- the rate at which cases are rising or falling
- positivity rate (the number of positive cases detected as a percentage of tests taken)
- pressure on the NHS
Why did the Government move Herefordshire to Tier 1?
Justifying the decision to move the county from Tier 2 to Tier 1 from December 19, the Department of Health and Social Care (DHSC) said the overall picture had improved since the end of England's second lockdown on December 2.
Despite this, the department admitted although the number of patients in hospital with coronavirus was below the national average when the decision was made last week, it was rising.
It said epidemiology indicators, such the number of new cases, had fallen.
"Since the end of national restrictions, the picture in Herefordshire has improved," documents detailing the decision said.
"Overall case rates have decreased by more than 20 per cent and the case rate in over 60s is stable at 41 [cases] per 100,000 [people].
"Epidemiology indicators have decreased sufficiently for the area to be de-escalated to Tier 1.
"It will be important to keep the epidemiology under review to ensure transmission of the virus does not require re-introduction of tier 2 measures.
"The number of daily Covid hospital admissions in the area continues to rise, and while the daily Covid bed occupancy is below the national acute hospital average it also continues to rise."
Figures from the NHS at the time showed there were 28 coronavirus patients at the Wye Valley Trust as of 8am on December 15, two more than the same time the week before.
But during the week to December 15, the number of Covid-19 patients peaked at 31 on December 14, with six on mechanical ventilators.
The infection rate, for the seven days to December 16, is expressed as the number of new cases per 100,000 people.
In Herefordshire, the infection rate in the week to December 16 stood at 76.8, as 148 new cases were found in the week to December 16.
This is compared to a rate of 44.6 with 86 cases the week before.
Why did the Government move Herefordshire to Tier 2?
After just one week living under the relaxed Tier 1 measures, from December 26 Herefordshire was moved back to Tier 2.
This banned people meeting indoors, but the rule of six still applied in any outdoor settings, and pubs, bars and restaurants could only serve alcohol with a substantial meal.
On December 23, Health Secretary Matt Hancock outlined areas of England moving up to higher tiers in a press conference from Downing Street.
He said: "Bristol, Gloucestershire, Somerset including the North Somerset council area, Swindon, the Isle of Wight, the New Forest and Northamptonshire as well as Cheshire and Warrington will all be escalated to Tier 3.
"And I'm afraid that Cornwall and Herefordshire have seen sharply rising rates and need to be escalated to Tier 2."
In documents seen by the Hereford Times, the DHSC said: "In the past week the picture in Herefordshire has deteriorated, with case rates in all ages increasing by nearly 80% since last week.
"In the most recent few days the number of cases is continuing to increase rapidly. The number of daily COVID hospital admissions in the local NHS (Herefordshire & Worcestershire STP) continues to rise.
"The daily Covid bed occupancy is just below the national acute hospital average and stable and critical care occupancy has stabilised.
"The rate of increase of the epidemiology indicators and hospital admissions is concerning and warrants escalation to Tier 2."
The tier change came as the number of coronavirus patients in hospital in Herefordshire doubled over the week.
The NHS England data revealed the Wye Valley NHS Trust was caring for 46 coronavirus patients in hospital on December 22.
That was 20 more than the same day last week, and double the number of beds taken by Covid-19 patients on December 17.
At the Wye Valley NHS Trust there were two people on mechanical ventilators, used for the most seriously ill patients, on December 22.
That was four fewer than the same time a week before.
When the review was done by the Government, he infection rate had doubled in the week to December 17 in Herefordshire.
The infection rate stood at 92.8 cases per 100,000 people, as 179 new cases were found in the week to December 17.
This is compared to a rate of 46.2 with 89 cases the week before.
When the Government moved Herefordshire to Tier 1, it said the infection rate in the over 60s was stable at 41.
But when the county was moved back to Tier 1, data to December 17 showed the rate had risen slightly to 52.5.
Why did the Government move Herefordshire to Tier 3?
After moving to Tier 2 rules from Boxing Day (December 26), different rules came into force on December 31 as the county was put into Tier 3 for the first time.
This move meant live events could not go ahead with crowds, most hospitality and leisure venues had to close and mixing between households was only allowed in certain public outdoors spaces.
In Herefordshire, the five indicators used to look at which Tier an area should be in meant the Government saw the coronavirus situation in Herefordshire as "extremely concerning".
"In the last seven days the situation in Herefordshire has deteriorated with all epidemiological indicators increasing," Government documents seen by the Hereford Times said.
"The case rate in all ages has increased by 150 per cent in the last seven days and is now at 198 per 100,000.
"Case rate in people aged over 60 is also concerning at 162 per 100,000 and with an increase of 267 per cent over the last seven days.
"In the local NHS (Herefordshire and Worcestershire STP), bed occupancy is increasing. Critical Care occupancy has stabilised.
"The rate of increase of the epidemiology indicators is extremely concerning and warrants allocation to Tier 3."
The number of coronavirus patients in hospital at the Wye Valley NHS Trust had reached record levels, and the infection rate was also at one of its highest points.
A record number of Covid-19 patients were at the Wye Valley NHS Trust on Wednesday (December 30), the most-recent day UK Government and NHS figures cover.
Some 58 patients who had tested positive for Covid-19 were in hospital on Wednesday, up from 52 on the same day the week before (December 23).
It means the trust is caring for more coronavirus patients than ever before, with previous highs 50 on April 5 and 52 on December 23.
The number of people on mechanical ventilators, used for the most seriously ill coronavirus patients, had also risen.
On Wednesday, six patients were on the ventilators, up from two on the same day the previous week.
In the week to December 25, the infection rate stood at 181.5 new cases per 100,000 people as 250 new cases were found.
This compares to an infection rate of 107.9 in the week to December 18 and 59.2 for the seven days to December 11.
The seven-day infection rate for the over-60s stood at 155.9 on December 25. That was up from 73.8 on December 18, and up from 37.7 on December 11.
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