Scottish Government Covid 19 Advisory Group minutes: 10 August 2020

Attendees and apologies

Advisory Group Members

• David Crossman
• Stephen Reicher
• Aziz Sheikh
• Jacqui Reilly
• Devi Sridhar
• Jill Pell
• Mark Woolhouse
• Roger Halliday
• Carol Tannahill
• Harry Burns
• Tom Evans
•  Jim McMenamin
• Chris Robertson

Invited attendees

•  Mary Black
• Louise Cardno
• David Taggart
• Cat Carver

Scottish Government

• Daniel Kleinberg
• Jonathan Cameron
• [Redacted]

Secretariat

• [Redacted]

Items and actions

• minutes
• summary notes

Minutes

Welcome and apologies

The Chair welcomed David Taggart and Jonathan Cameron, Louise Cardno and [Redacted].

Apologies – [Redacted].

Minutes and actions

All group members were content with the minutes from the previous week.

The group was updated on discussions around testing in universities, with discussions on feasibility engaging principals in relation to asymptomatic testing. Advice to Ministers is expected to go up this week.

Action: Carol Tannahill to update the group once there is an update on possibly linkages between the education subgroup and the expert reference group on COVID-19 and ethnicity.

Proximity tracing app for Scotland

Jonathan Cameron from the Scottish Government and his colleagues shared slides with group members summarising the work on the Proximity App to date. This app will follow the model used in Ireland and Northern Ireland, where Bluetooth technology monitors contacts an individual has been in close proximity to for 15 minutes or more. This is useful to highlight contacts which might not otherwise have been known through the current contact tracing system.

The critical element is to protect privacy. The data is stored on phones, not an NHS or central government server. The app will not track user locations, it will only Bluetooth proximity with this information stored on individuals’ phones. The app also will not include a symptom checker or test booking facility. It will purely be a proximity tracing tool. The app will also include webforms where additional information about the contact can be collected, e.g. whether they work in a care home, use public transport, or have been to a pub or restaurant.

The app will not be mandatory for the population to use though a high uptake will be strongly encouraged and will improve the effectiveness of this tool. Group members stressed that the benefits of uptake are not linear and the greater the uptake the increase in potential contacts that can be traced. It will be important to stress the collective benefits from using the app. Group members reiterated the need to support members who may be asked to isolate for 14 days, given concerns that this may not be possible for those who risk suffering financial hardship as a result of this. 

The group was highly supportive of the app, and its function as an additional tool to aid contact tracing. The group discussed the presentation of the app, noting that this should use the latest Scottish Government guidance to ensure information is accurate and up to date.

It was noted that the app does not accommodate for someone who was wearing PPE at the time of the contact, such as waiting staff but also those working in hospitals. Group members also recognised the potential challenge of different apps being in use across the UK, particularly for those in border regions.

The app also represents a good opportunity to target age groups such as secondary, higher and further education students. The app will be linked in minority languages and it will not be piloted, as a full released is deemed to provide the greatest likelihood of high uptake.

Near me testing and new technology

The group received a presentation by David Taggart from NSS. The presentation touched upon the different testing systems that exist, and the pros and cons of these. There is currently a large number of sampling kits in storage. A potential barrier is the number of people able to carry out the testing.

The turnaround time of different testing systems was a major focus, with rapid turnaround times estimated at around 90 minutes. Group members discussed the uses of these, particularly those considered as point-of-care (POC) tests focussing on the potential these may have in acute settings where they could allow the testing of admissions from emergency departments. This would avoid patients being treated as ‘assumed positive’ whilst test results are awaited, as well as managing capacity issues.

There has recently been significant interest POC testing in media. [Redacted] spoke about the three categories of Cartridge based PCR that exist: GenXpert, Liat (lab in a tube), GeneXpert portable system for use in the Scottish Air Ambulance.

Fully integrated and automated systems have been introduced to each health board.

Work is also ongoing to develop and test the feasibility of saliva testing. This is considered to be a less invasive form of testing. 

20 to 40,000 tubes of viral PCR sample solution have been put into production. This allows samples to go straight onto PCR machines when samples arrive into labs. This is not suitable for home collection.

The group commented on the balance between the volume of test that can be performed and the accuracy of these. If all acute hospital admissions are to be tested then these need to be accurate. A low sensitivity would not provide sufficient benefit from testing in this context. In acute settings speed is important. 90 minutes would be considered on the higher side.

Data for some newer technologies is not available – manufacturer data may not always be accurate in practice.

Group members also noted that individuals should be encouraged to get tested as early, to ensure the contact tracing and other measures are as effective as possible.

The Chair of the nosocomial subgroup noted that their group considered testing of emergency admissions and pathways for people as a result of that. UK guidance requires testing of emergency admissions, otherwise patients must be assumed to be infected. Improper use of PPE, such as using the same gloves for different patients, increases the risk of infections and of other multiple drug resistant organisations. The priority of POC testing should be for emergency admissions.

Subgroup updates

Education subgroup – greater clarity needed on criteria and escalation points where additional mitigation measures would need to be put in place in schools. Guidance on ELC and childcare settings and schools trips with overnight stays was put up by the subgroup. The subgroup also considered school activities such as physical education, drama, and music. The unregulated children’s sector will also be considered by the subgroup.

PHTAS – The group is expecting a flu season and considering the issue of co-circulation of flu and COVID-19. POC testing for GPs, where a patient may have COVID-19 would make rapid testing extremely helpful though it is acknowledge this will not be available in the near future. A care pathway will need to be recommended in these circumstances. The group is finalising recommendations to the CMO and Cab Sec.

Nosocomial group – there is a new focus on the healthcare built environment. This is particularly the focus of dentistry and endoscopy. The group also received a presentation on hospitalisation risk to frontline workers. Infection prevention and control and identifying gaps in care homes was also considered.

Testing priorities – discussion ongoing around anticipated symptomatic demand for testing. There are potentially areas of divergence between the Scottish Government and UK Government in terms of testing priorities going forward.

Borders – quarantine and isolation addresses part of this risk. Mass testing on arrival unlikely to happen.

Aerosol transmission

The group noted the paper endorsed by SAGE on aerosol transmission. This reaches similar conclusions to a World Health Organisation (WHO) evidence review that was published at the end of July. Notably, the paper does not endorse the use of visors as a substitute to face coverings.

Airborne transmission – there is probably some small particular aerosol transmission in coughing, singing and shouting. As a normal route of transmission this will remain comparatively small, though a higher risk indoors where there is poor ventilation. Recommendations for ventilation have been set out to address this.

AoB

The group may be asked to provide advice on regulations for hospitality and bars. Group members reiterated the high risk nature of bars and the potential for low compliance due to alcohol.

Summary notes

The Advisory Group welcomed officials from the Scottish Government who gave a presentation on the Proximity Tracing App for Scotland. This app will focus on using Bluetooth technology to anonymously alert users if they have been in close contact with another user who has tested positive for COVID-19. 

The Proximity Tracing App will be a tool that will complement the existing person to person contact tracing, which will remain the main component of NHS Scotland’s Test and Protect system. Group members had the opportunity to ask questions on the content and messaging of the app.

Officials noted that use of the app will be voluntary. Group members highlighted the benefits of a large uptake of this app. 

The Advisory Group then received a presentation on new testing technologies. Group members recognised the potential of new technologies which may allow the turnaround time for tests to be reduced. The group also discussed the potential implications this could have in patient-facing settings. 

The group noted a paper on aerosol transmission of COVID-19 from SAGE and support the conclusions reached in this paper.