Scottish Government COVID-19 Advisory Group minutes: 17 December 2021

Attendees and apologies

Advisory group members

• Andrew Morris
• David Crossman
• 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
• Nicola Steedman
• Mark Woolhouse.

Invited attendees

• Graham Foster

Scottish Government

• Daniel Kleinberg
• Jason Leitch

Secretariat: [REDACTED]

Items and actions

Welcome

The Chair welcomed group members and guests to the 58th meeting of the advisory group.

Scottish Government update

The group was given an update on the ongoing work by the Scottish Government, noting the briefing the First Minister had made earlier that day. This briefing stressed that it is unlikely that even the increased pace of COVID-19 booster vaccinations will be sufficient to outrun the current Omicron wave. The First Minister also urged the public to limit interactions as much as possible.

It was noted that input from the C-19 Advisory Group to the Scottish Government continues to be highly valuable to officials and ministers.

The group discussed the current public health priorities of the Scottish Government in its response to COVID-19. The current Coronavirus Strategic Framework intent is “to suppress the virus to a level consistent with alleviating its harms while we recover and rebuild for a better future. ” While this remains the intent, ongoing consideration is being given to the impact of Omicron on this.

Discussing the current Omicron wave, the group asked what level of daily admissions would be tolerated and at what level would the system collapse. Group members noted that should admissions significantly exceed the level experienced last January this would become a very difficult situation to manage and we would be in uncharted waters.

The group noted the existing pressure facing the NHS, even before the Omicron wave increases.

Scottish Government modellers commented that previously modelled central and worst case scenarios are no longer within scope.

SAGE and SPI-M update

The group was given an overview of the discussions that took place at the SAGE 99 meeting, along with the latest models from SPI-M. These predict extremely high number of cases and hospital admissions. The full minutes of the SAGE 99 meeting has been published by the U.K. Government.

The group considered this data and the possible implications in Scotland. While a significant amount of uncertainty remains, the lag between cases and hospitalisations and the doubling time for Omicron make it likely that the very high number of daily infections will translate into significant pressure on hospitals. The most recent modelling shows that measures currently in place will not be sufficient to stem the current Omicron wave. The group was also shown a modelling briefing from the University of Edinburgh. A key message in this is that the level of measures required increases and in fact, accelerates every day due to the exponential growth in cases. The window to implement measures is closing more rapidly every day.

Interventions such as boosters will help but will not stem the current wave. Additional protections will be needed. The earlier interventions are implemented, the greater the impact these are likely to have. The group noted that the point at which measures are introduced must take into account the lag in the time it will take these to impact cases, given the doubling time of Omicron.

Further data on vaccine efficacy against transmission, infection, and severe disease is crucial to understanding the extent to which boosters could mitigate the impact of the Omicron wave. Current data suggests the reinfection rate from Omicron is about 8-9% (Delta 1%) and the secondary attack rate of Omicron is about twice that of Delta. This remains early data.

The importance of having a clear aim for new measures was repeated by the group. This could be slowing the wave of infections to allow more people to receive a booster vaccine.

The group briefly discussed sub-lineages of Omicron.

The group is interested in JCVI deliberations on children aged five to eleven and the risks of future education loss and harms to children. The education subgroup noted the significant harms that can impact children as a result of measures that affect schools as well as concerns about the impact that a high level of self-isolation could have on the reopening of schools in January 2022. 

Domestic update

The group was shown modelling on Omicron and Delta from the Scottish Government. This considers capacity in terms of hospitalisations and ICU capacity and are re-run on a regular basis and compared with modelling from other UK groups.

ONS data shows there has been a marked behaviour change already with high mask use and low levels of spending in hospitality reflecting changing behaviours. There are also very large numbers of sickness absences from illness and isolation. Behaviours have changed, even if mandatory restrictions have not been implemented. The next set of modelling will consider this more closely.

The group was shown polling data on public attitudes in Scotland and the UK with regards to COVID-19 measures. The data showed support for additional protective measures being introduced. It also highlighted some misunderstandings of current measures including vaccine boosters and testing. The group reiterated that it is important that all those who are eligible take up a COVID-19 vaccine, including boosters. It also noted the importance of regular testing with lateral flow tests before mixing for those who do not have any symptoms. This includes those who have received two doses of the COVID-19 vaccines and those who have received a booster dose.

The group noted the data on public attitudes highlights the desire of the public to behave cautiously in light of the new Omicron wave, changing plans where necessary and choosing what to prioritise. They noted the challenges that some mixed messaging could present, using the example of asking individuals to avoid mixing as much as possible whilst large-scale events such as football matches are still able to take place. Greater clarity will continue to help the public to make the best decisions in the coming weeks. The group acknowledged the significant impact that changes in behaviour is already having on businesses.

In Scotland, the majority of Omicron infections are currently in the 20-39 year olds. Research is ongoing into the proportion of hospitalisations likely to result from these cases. Early data could suggest severity may not be worse than Delta, though the number of cases is likely to be significantly higher.

The group acknowledged that the decision around what mitigations or further measures to introduce is one for officials and Ministers. The group noted that in choosing not to take certain measures it is important to also have alternative mitigations in place.

The group briefly discussed the notion of NHS ‘collapse’. Framing challenges in terms of NHS collapse does not account for the fact that decisions will be made that allow the NHS to continue to operate but that these decisions will have an impact on mortality and the care patients receive. Collapse is not binary and preventable or treatable deaths are the key metrics here.

The group discussed the importance of returning to discussions on the origin of Omicron and how this variant emerged. This will be important to feed into planning for future variants of COVID-19 that will emerge. The group will return to these discussions in 2022.

Chair’s summary

1. Noted SAGE and SPI-M updates.
2. From an epidemiological perspective, huge uncertainties remain but interventions are needed now. If we wait too long these will have no effect, the longer we wait the greater the need for mitigation in the future.
3. Notion of increase of cases many times over already baked into system, non-linearity of growth.
4. Boosters help but these are not the entire solution.
5. Interested in JCVI deliberations on children aged five to eleven as we think about future education loss and harms to children.
6. Public appears to have a strong desire to preserve Christmas. The desire to protect family and community and key social events at Christmas are strong motivating forces.
7. Potential damage of contradictory messages and need for clarity about support that can be offered and why not if it can’t be offered.
8. Still too early on pathogenicity data of Omicron vs Delta.
9. Harms – nosocomial, essential services and catastrophic effect on schools and small businesses are a key consideration. Currently self-isolation rules would make schools unlikely to reopen in January.
10. Messaging is important- Stay at home unless a negative lateral flow.
11. Prepare for next variant as another one is highly likely to emerge. Testing subgroup heard about likely recombinant features of Omicron.
12. Real challenges facing policymakers right now.

The Chair thanked the group for its contributions over the past year.