Scottish Government COVID-19 Advisory Group minutes: 11 January 2022

Attendees and apologies

Advisory group members

• Andrew Morris
• Linda Bauld
• Graham Ellis
• Tom Evans
• Julie Fitzpatrick
• Nick Hopkins
• Audrey MacDougall
• Jim McMenamin
• Jill Pell
• Nick Phin
• Stephen Reicher
• Jacqui Reilly
• Chris Robertson
• Aziz Sheikh
• Devi Sridhar
• Mark Woolhouse.

Invited attendees

• Graham Foster

Scottish Government

• Daniel Kleinberg
• Arlene Reynolds

Secretariat: [REDACTED]

Items and actions

Welcome

The Chair welcomed group members and guests to the 59th meeting of the advisory group. On behalf of the group, the Chair congratulated the Chief Medical Officer for his recent knighthood. The group noted apologies from David Crossman.

The minutes of the previous meeting will be cleared by group members in correspondence.

The Secretariat will contact the group following today’s meeting to give group members the opportunity to update their entries in the group’s register of interest.

Scottish Government update

The group was given an update on ongoing work by the Scottish Government. Cabinet met today, with the First Minister announcing updates in parliament early this afternoon. The government is now looking ahead to the coming year and the adaptations that will be needed in our response to COVID-19. The group heard that a new version of the strategic framework is being prepared as part of this. Among the questions for scientific advisers will be questions around the possible future evolution of the COVID-19 virus. Planning is underway to secure scientific input from the group and others on this subject.

State of the pandemic

The group was given an overview of the discussions that took place at the SAGE 102. Key themes from that meeting were the biology of Omicron and its apparent ability to outcompete Delta; the heterogeneity of the pandemic across the UK with parts of the UK seeming to begin to plateau; the apparent attenuation of disease severity with Omicron; and impacts on children.

Data shows changes in individual behaviour in the period leading up to Christmas. It remains to be seen how long these changes in behaviour will last and the rate at which behaviour will return to levels seen prior to the emergence of the Omicron variant. Among the measures in place, there has been high uptake of lateral flow testing.

The group noted questions about how long it will take for different tranches of the population to become exposed to Omicron due to the heterogeneity in the geographic and demographic spread of Omicron. Early estimates had predicted that Omicron would fully replace Delta; there still remains a low level of Delta cases. There is uncertainty about the timing of the peak of Omicron, with multiple factors potentially affecting this. We are now seeing a higher growth of Omicron cases in the elderly which remains a concern. There is evidence from England that the length of stay in hospital from Omicron cases is shorter. The group discussed the reported reduced severity of disease for omicron in patients admitted to hospitals, with a reduction in those requiring oxygen and ITU care when admitted. It was noted that the burden in hospitals is expected to get worse before it gets better. Modelling shows there is still potential for strain on hospital capacity. Hospitalisations are currently rising with an increasing proportion in older people. There is ongoing research into the generation time of the Omicron variant, and the rate at which positive cases are admitted to hospital after becoming infected. Group members considered where Scotland may be in relation to an Omicron peak. The group noted that changes in data resulting from changes in testing policy and the challenges this presents to the way data is analysed and communicated. The group and the Scottish Government will continue to draw on a wide range of data in assessing the state of the pandemic, including the ONS Infection Survey and wastewater surveys.

The group were shown data from the EAVE-II study. Within this study, analysis of data on vaccine effectiveness remains unaffected by changes in testing as this always relied on symptomatic PCR tests, though other analyses will be impacted by this change in testing policy. For all groups there are slightly higher hazard ratios for omicron, meaning the protection against infection from vaccines is not as effective as against Delta. There is a very large reduction in risk for those vaccinated compared to being unvaccinated. Comparing data for mortality, these appear to be following the same pattern as hospitalisations, though this is still preliminary data.

For Omicron, protection from previous infection is lower than the protection this provided against Delta. Protection against symptomatic infection is high two to three weeks after the booster dose, though this decreases slightly in following weeks. The EAVE-II data shows waning of vaccine protection against symptomatic infection for both variants. The group noted that data for those who were the first to receive their booster will include individuals who are at the greatest clinical risk. Group members noted that Israel have proceeded with the rollout of the fourth dose.

The group discussed the approach to modelling the easing or release of current protective measures. Current modelling assumes changes in behaviour over time and also includes assumptions on waning. The group heard that, at present, modelling of easing of protective measures does not include assumptions of changes in the use of lateral flow tests but focusses on changing patterns of interactions.

Group members considered the challenges in determining whether a patient is admitted for or with covid, in particular given the high levels of community prevalence. Both categories of patients contribute to increasing pressure on hospitals. The use of new therapeutics against COVID-19 should continue to improve the prognosis for patients in hospital with COVID-19.

The impact of behaviour change on the current wave is something that is important to communicate with the public, to underline the impact of this behaviour change. The language used in referring to measures is important. The group noted the different potential framing of measures as restrictions, or protective measures, and underlined the fact that many measures currently in place such as testing do not necessarily restrict but enable individuals to manage their own risk. Discussions of the social contract will continue to be important.

Subgroup updates

Education and children’s issues

The subgroup has met on a number of occasions in recent weeks to review evidence to inform the return of schools. Among issues considered is staff absence, with levels currently better than those anticipated prior to the holidays. Some concerns remain and these will continue to be monitored. Changes to self-isolation rules have some impact here.

With regard to pupil absence this is currently at relatively low levels though this could increase. No decisions have been made for exams and currently these are still going ahead, though a plan B has been devised by the SQA. There is a lot of work taking place on ventilation and the subgroup continues to review evidence on ventilation and aerobiology relating to this. The group touched on the latest data around paediatric admissions – in Scotland hospital admissions have increased in late December for under fives, particularly for children aged one and under. At present there is no reason for concern regarding paediatric admissions as the severity of disease for children remains low (high confidence).

Work is underway in the subgroup preparing an evidence paper on non-covid harms to children, such as the impacts on development in younger age groups. The uptake of vaccines in those children who are eligible continues to be important.

Nosocomial Review Group

A situational assessment was undertaken on Omicron which led to advice on the frequency of testing of healthcare workers with lateral flow tests. In addition, the advice noted the importance of optimising adherence to all IPC measures in the hierarchy of controls. Early insights from behavioural research underway and lessons learned from recent clusters point to the importance of minimising transmission of COVID-19 between healthcare workers in non-clinical spaces. Given the system pressures and admissions projected and current staff absence due to high community prevalence, the subgroup advised on the importance of ensuring all staff are fit-tested for respiratory protective equipment. The sub group reviewed the latest infection prevention and control guidance from the WHO. The UK IPC cell and the UKHSA have agreed there is to be no change in the UK guidance at this time.

It was noted that two thirds of the current clusters (which include community importations) are in long term care facilities, mental health and rehabilitation facilities in this wave. Increased contacts both in and out of these settings inclusive of patients on pass, higher visitor numbers and healthcare workers socialising in and outside work are common themes emerging from the local investigations. Additional analysis of this will be presented at the next Nosocomial Review Group meeting. CNRG noted the importance of optimising the uptake of vaccination and booster uptake in healthcare workers, particularly for staff in long term care settings and ensuring that inpatients in long term settings had received booster vaccinations.

AOB

Group members noted an upcoming paper on COVID-19 vaccination rates of pregnant women in Scotland. This further underscores the importance of encouraging vaccine uptake in pregnant women.

Group members asked about the current situation with Delta and seasonal influenza. The uptake of vaccines this year has been exceptionally high.