Scottish Government COVID-19 Advisory Group minutes: 13 April 2020

Attendees and apologies

Advisory group members

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

Invited attendees

• Mary Black

Scottish Government

• Roger Halliday

• Niamh O’Connor

• Richard Foggo

• Daniel Kleinberg

• [Redacted]

• [Redacted]

• Audrey MacDougall (deputising for Roger Halliday)

Secretariat

• [Redacted]

Items and actions

• minutes
• summary notes

Minutes

Welcome and apologies

Chair welcomed all group members and Andreas Poensgen.

Apologies – [Redacted].

Minutes, action points, Chair update

Chair agreed to move straight into the German Q&A. No comments on minutes and noted that the group is happy for these to be concise.

The German Approach

Andreas Poensgen introduced himself and his work as part of the German advisory group responding to the COVID-19 outbreak.

Questions were posed by [Redacted] on contact tracing, testing capacity and exit strategies.

Andreas Poensgen outlined that testing and contact tracing are done on a local level. Currently the proposal is to have local taskforces testing in care homes and determine those in the wider population that should get tested. These taskforces would also be tracing and following up with those who have been in contact with someone exposed. It has been estimated that 1.5 to 2 people will be needed per case to carry out contact tracing. A Robert Koch programme for ‘containment scouts’ had generated 10,000 applications.

Andreas Poensgen further explained that Germany plans to create a database of those who tested negative after the disease, providing a QR code to allow them to travel and return to work. No formal exit strategy currently exists but proposals are to reopen only businesses where social distancing can be enforced and explore different digital and shift entry options for schools and university to maintain distancing. 

[Redacted] asked whether there is a feeling of where politicians sit with regards to how low to aim to keep R values. Andreas commented that politicians are content with an R value below 1 and they are particularly interested in the number of new cases per day – with a view at avoiding a lack of capacity in hospitals. He added that public opinion pressure to reopen businesses is also important as there have been changes in mood observed.

[Redacted] asked about shifts in public opinion and compliance. Andreas Poensgen replied that compliance issues are mainly to do with younger people who do not comply with guidance, particularly in large cities and those with large international communities.

[Redacted] asked Andreas Poensgen about a serological survey from Bonn University that suggested that Germany could have five times more cases than those reported and whether he thought this was valid. Andreas Poensgen noted this doesn’t provide a generalizable picture of the number of people affected due to sampling issues.

Andreas Poensgen asked whether testing capacity was an issue in Scotland. [Redacted] noted that this is growing and will be delivering about 10,000 per day by the end of the month. [Redacted] also confirmed that labs in Scotland are also trying to make reagents from basic ingredients.  [Redacted] noted that international collaboration on effective methodologies is important.

The chair expressed his gratitude on behalf of the group for his contribution, and thanked [Redacted] for providing the introduction. Andreas Poensgen offered to pass on information about testing kits by email.

CSA update

[Redacted] noted she and [Redacted] had spoken with the chair of SSAC and [Redacted] has also been in touch with them.

Testing deep dive

Richard Foggo informed the group that it was invited to offer its view by the following afternoon around next steps surrounding lockdown, ahead of COBRA-M this week. The chair accepted the commission on behalf of the group and asked that [Redacted] act as the point person for this specific commission. [Redacted] confirmed his agreement.

Chair noted that any advice will include some recommendations on testing. Daniel Kleinberg and Richard Foggo gave an overview of key points from testing paper noting the aim is to reach 10,000 tests/day by the end of this month. [Redacted] strongly endorsed [Redacted] point that testing is not purely about numbers but also speed.

[Redacted] spoke about prioritising, asking what are the expected numbers in each of these categories and how much capacity would then remain to test the rest of the population. [Redacted] commented that in more remote locations, testing and contact tracing could be considered to allow these communities to return to semi-normality.

[Redacted] and Richard Foggo noted the importance of articulating why to test in order to provide ministers with informed recommendations. The chair summarised that using science and data will be crucial to justifying recommendations. [Redacted] and other group members raised the importance of considering the feasibility of options. It was agreed that while testing is important this cannot be presented as a magic bullet solution.

[Redacted] noted there has been substantial growth in NHS capacity and growth SNBTS repurposing has also helped increase this. University of Glasgow mass testing is hoped to run at 7,000 by the end of the month.

[Redacted] commented that choices will have to be made with different degrees of uncertainty. We will need to ask ourselves who is disadvantaged by different strategies aiming at lower R value. [Redacted] suggested that a recommendation could be to commission work to measure the impact on different population groups.

Richard Foggo and [Redacted] stressed that the group should consider all possible exit strategies and scenarios.

The group agreed that testing alone is not sufficient but an essential part of our solution. [Redacted] noted that while there is a balance between the needs of the vulnerable and the fit and healthy this can present a morally dangerous position. We do need to do our best to protect the elderly and the vulnerable.

[Redacted] noted the importance of developing evidence and recommendations in a timely manner to ensure these can feed into policy development.  

[Redacted] noted that the rhetoric is no longer to talk about us being a week behind London as both curves are now flattening out. [Redacted] commented that studies on the language of different strategies is being considered by a group in Cambridge.

[Redacted] asked group to confirm whether there is a need to tighten lockdown measures. The group discussed that compliance has been high so there is not currently a need for this. [Redacted] noted that R is currently less than 1 though there is no cushion to allow for easing off at this stage.  

[Redacted] stated that we have not yet reached a final position, given options outlined in her paper. The chair suggested that different scenarios need to be weighed up as demand vs. supply.

[Redacted] asked whether [Redacted]’s team could model exit strategies. [Redacted] – yes.

Concluding remarks

The Chair summarised that it was agreed lockdown should be extended. Discussions will need to look to coming weeks and the testing and exit strategies to implement in due course.

Action: Group members to email [Redacted] with ideas to feed into the commissioned paper. [Redacted] asked group members to email him with ideas to go into the paper.

Action: Niamh to share a sample template with [Redacted].

Action: [Redacted] and [Redacted] to discuss modelling of different lockdown exit strategies.

Summary notes

1. The Advisory Group had a question and answer session with a member of the think tank group advising the German government. Topics covered include plans for contact tracing, public opinion and compliance in Germany, testing capacity, and lockdown exit strategies under consideration.
2. The Scottish Government asked the group to provide advice on the current lockdown arrangements and next steps. This commission was accepted. The group agreed that the current evidence does not suggest the need for a more stringent lockdown, but neither did the evidence suggest that the current lockdown could yet be relaxed. 
3. The Advisory Group held a detailed discussion of testing. The following points were agreed by the group:
   a. testing is not, in itself, a strategy to end lockdown but will be essential to any strategy and is important to get right.
   b.speed of results is important, as well as the overall number of tests.
4. In relation to testing, the group noted the increase in capacity that has been set in motion and discussed the need for clear prioritisation of who will be tested in order to protect the most vulnerable. It was noted that an increase in testing should also inform modelling of different exit strategies.