Scottish Government COVID-19 Advisory Group minutes: 11 May 2020

Attendees and apologies

Advisory group members

• Andrew Morris
• Gregor Smith
• Angela Leitch
• Aziz Sheikh
• Chris Robertson
• David Crossman
• Jill Pell
• Mark Woolhouse
• Stephen Reicher
• Sheila Rowan
• Tom Evans
• Jim McMenami
•  Jacqui Reilly
• Devi Sridhar

Invited attendees

• Mary Black

 Scottish Government

• Roger Halliday
• Niamh O’Connor
• Richard Foggo

Secretariat

• [Redact]

Items and actions

• minutes

• summary notes

Minutes

Welcome and apologies

Chair welcomed all attendees. Apologies [Redacted].

The principle of reciprocity for SAGE papers was reiterated to the group. All papers that go to SAGE should be made available to the group members.

Thanks to all those who contributed to the deep dive on Friday. These will now take place on a weekly basis on a topic determined by the First Minister.

The National Clinical Director may be invited to some future CMO Advisory Group meetings.

Minutes, action points, Chair update

Past Actions:

• SLACK should be used for internal discussions. We should be precise about when the group is sending official advice to CMO and Ministers
• request for advice: a formal process for advice to Ministers will be put together by the Secretariat. This can draw on existing Scottish Government guidance on seeking science advice

CSA update

The CSA expressed her gratitude to the group for their input to the government. 

Scottish Government update

The CMO asked group members whether the Advisory Group had met their expectations thus far. Group members spoke of the appreciation that their advice was valued by Ministers and of their enjoyment of group meetings.

Discussions on R:

• the range of R across the UK was discussed. The highest is 1.1 and the lowest 0.6. A group of estimates are around 0.8/0.9 which is felt to be the level of accuracy these can be described in. The figure from England appears to be more precise as this is based on a greater number of estimates and cases
• ONS will be rolling out a twice weekly survey of swabs, aimed at estimating R
• statistics for ITU and attendance are not reflected in the transmission rate
• other metrics may be able to show a better perception of how the epidemic is evolving. The political discourse is becoming dominated by R and there is a demand to publish a daily R level. This will need to be carefully considered. There may need to be added public about other metrics which together show the evolution of the epidemic

UK Nations:

• differing approaches between UK nations is not something that has been sought by the First Minister but is based on a need to act differently, based on the advice received
• once data supports changing restrictions, this will likely take place. The approach is perhaps a more cautious one based on the belief these are the best decisions for Scotland

Action: The group has been asked to contribute to a technical briefing for the media on R to be held this week.

Deep dives

Hospital and Care Home Transmission 

Background:

• nosocomial expert group members provided an update from their last meeting. The nosocomial group are looking at hospital associated and hospital onset COVID-19, not care homes. The key focus was healthcare worker testing. The nosocomial group made a recommendation on healthcare worker testing
• frequency of this is critical (England suggesting 14 days) the Scottish group would suggest seven. A clear understanding of what would be done with a positive results was noted as important
• in first instance this could be done focussing in hospital with known nosocomial problems. A whole system approach is important, though there are capacity constraints and this will take time to roll out. Pilot studies seen to be a positive start

Discussion:

• the proposal of weekly testing would be PCR firstly, then antibody at a later date. The approach being advocated is for asymptomatic individuals who test positive would remain in isolation for seven days, or more if they develop symptoms
• interventions to promote infection control outside of COVID-19 wards, with an emphasis on staff behaviour is important. Better infection control indicators are also needed
• a minority of patients acquired the infection from outside, healthcare workers appear to be getting their infections from other healthcare workers
• there is a need for observational research into behaviours, so this can feed into recommendations being made
• a targeted viral genome approach is one that Scotland is well set up for. This level of forensic transmission is feasible, and this can address questions of who is infecting who
• it would be interesting to see how other countries such as Germany and South Korea are looking at nosocomial transmission

Shielding

Discussion:

• current shielding categories are based on flu, but there are categories of people not a high risk within those. Others need to be included and a data driven approach to identify those at high risk and who would need to be included. Age is the most important risk factor (80+)
• risk appetite is a big issue in choosing to continue shielding
• more research could also be done on outdoor transmission and specific risks from outdoor transmission to those shielding

Action one: Discussion on R – Provide a methods briefing to the media and put together a one pager paper of composite measures.

Action two: The group will be kept updated on the nosocomial workflow.

Action three: Shielding paper and discussion prepared for Friday.

Summary notes

1. The advisory group discussed the increased attention being paid to R by politicians and the media. While acknowledging the importance of estimates of R, it was noted that this is a calculation and should be considered along with other metrics when assessing the evolution of the pandemic. 

2. The group received an update of the latest nosocomial group meeting. Following this they discussed nosocomial infections and the role that testing and behavioural interventions targeted at healthcare workers could play in reducing this.

3. The group discussed the important role that shielding plays in the latest guidance from the UK Government. It was agreed that shielding should also be considered in future guidance from the Scottish Government. Increased COVID-19 patient data will begin to allow researchers to begin to re-examine who is most at risk from the virus.