Scottish Government COVID-19 Advisory Group minutes: 14 May 2020

Attendees and apologies

Advisory group members

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

Invited attendees

• Mary Black

Scottish Government

• Roger Halliday
• Niamh O’Connor
• Richard Foggo
• Marion Bain
• [Redacted]
• Orlando Heijmer-Mason
• Daniel Kleinberg

Secretariat

• [Redacted]

Items and actions

• minutes
• summary notes

Minutes

Welcome and apologies

Chair welcomed all, including Marion as a new member, and Orlando and Louise as guests from Scottish Government on shielding policy.

Apologies – [Redacted]

Minutes and actions

No comments on last minute. R briefing to the media went well. Noted volume of requests and secretariat working on an approach to ensure requests are reasonable and tracked appropriately.         

Action: Secretariat to organise SLACK tutorial

CSA update

Note that WHO has put out guidance on schools around the same time as ours and this is in line with what the group had concluded. Noted the fine line between scientific and policy advice – the group does not exist to endorse policy decisions.

SAGE update

Brief update on topics discussed in two recent SAGE meetings:

• conditionality of changing restrictions
• modelling assumes effective track and trace. England may set a new target for testing of cases
• care homes and nosocomial transmission
• monitoring strategy, this is UK wide, Caroline Lamb is leading work
• survival of virus – may be short in sunlight outdoors, decay within minutes
• asymptomatic transmission still concerning
• serology results vary around the country
• Scotland results in due course.
• bubbles – caution required, not yet recommended. 1+1 bubbles may be possible.
• biosecurity centre
• further research on the virus

Discussion:

• presentation of bubbling has been problematic, could be used as a way to help vulnerable, reduce inequity, but has been presented as a sociable end to lockdown

Shielding

Summary of current Scottish Government policy development and where scientific advice would be useful. Aim of policy is to save lives, rather than reduce NHS burden. What can science tell us about the virus that will help to address the tension between preserving life and the need to maintain quality of life.

Discussion:

• at-risk groups – epidemiological analysis is helping to show which groups are truly at increased risk of death
• difficulty that rarer conditions won’t show up in statistics
• individual assessment may be ideal but burdensome for primary care. This would allow people to make informed choices
• age is still the strongest risk factor
• wide variation in approach internationally. Where shielding isn’t enforced, it doesn’t seem to be effective, especially in reducing household transmission. Household members need to protect themselves if it is to be effective
• issue of risk – individuals may accept the need to protect others, but will feel they have the right to decide to take risks in relation to their own health

Action: group to prepare for session on shielding with FM tomorrow. Science of risk groups and international evidence key points for focus. [Redacted] will add slides from a behavioural science perspective.

Action: Secretariat to consider how policy team can be kept more regularly updated with scientific papers.

Children

Noted the reports of children presenting with COVID19 antibodies and Kawasaki-like symptoms. These reports are now coming in globally. Unclear if this definitely does relate to COVID19, if so how many children may be affected and what proportion of exposed children are affected. The group will continue to monitor the evidence as it develops.

Care homes

Update following the most recent meeting of the nosocomial transmission group.

Discussion:

• does Scotland have sufficient data to understand prevalence within care homes? More data would be helpful
• further research needs – looking at how cases are being brought into care homes and how this can be prevented. More data required. Consider whether similar testing to England should be carried out
• SAGE and NERVTAG are currently considering research needs and this should be coordinated
• is there a consortium pulling together data on this?
• could nurses provide leadership on IPC in care homes?
• should wider residential settings be considered?

Action: [Redacted]to put a note to [Redacted] on the points discussed

Summary notes

The Advisory Group held a deep dive discussion on shielding, noting that the primary aim of the policy is to save lives but that shielding is very onerous for those being asked to isolate themselves completely for an extended period of time. The group noted the importance of making use of scientific knowledge to determine which groups are truly at highest risk. 

The group considered different approaches being taken to shielding internationally, noting a wide variation in approach. The group discussed that age is the strongest general risk factor, but that rare conditions by their nature may be difficult to accurately determine a level of risk for as they won’t show up in statistics. 

Reports from the UK and internationally of children presenting with Covid19 antibodies and symptoms similar to Kawasaki disease were noted as concerning. The group agreed that further information is needed and to monitor the evidence base as it develops as highlighted by SAGE.

The group discussed the issue of transmission of Covid19 within care homes, noting the need to coordinate research across the UK as highlighted by SAGE.