Scottish Government COVID-19 Advisory Group minutes: 19 October 2020

Attendees and apologies

Advisory Group Members

• David Crossman
•  Jill Pell
• Roger Halliday
• Aziz Sheikh
• Tom Evans
• Nick Hopkins
• Devi Sridhar
• Stephen Reicher
• Chris Robertson
• Marion Bain
• Jim McMenamin
• Angela Leitch.

Invited attendees

• Cat Carver

Scottish Government

• [Redacted]
• Niamh O’Connor
• Audrey MacDougall

Secretariat

• [Redacted]

Items and actions

• minutes
• summary notes

Minutes

Welcome and apologies

The vice-chair welcomed group members, invited guests and those attending.

The vice-chair also welcomed Nick Hopkins who joined the group as a member today.

Apologies – [Redacted]

The group were given a brief update on ongoing policy developments within the Scottish Government. An updated pandemic strategy is due to be published which will outline thresholds for intervention and the Scottish Government’s articulation of these. On Wednesday a review of the testing strategy will also be taking place.

Minutes and actions

Group members were content the minutes of previous meetings.

The vice-chair discussed the National Core Studies letter from Sir Patrick Vallance. The letter outlines five areas and six supporting areas of data and connectivity that studies will be commissioned in. The studies are expected to be launched in the coming weeks. Group members noted these, with some group members raising that topics such as genomics and behavioural science and compliance do not appear to be covered – though these could be covered elsewhere.

The group was informed that the first results of the covid infection studies were published last week. Work is also underway to make Scottish data available in collaboration with other UK nations.

Mass testing (continued)

The group resumed their discussion on mass testing. The discussion raised the point that there is a view in some quarters that mass testing will be available earlier than mass vaccination will be. The current challenge is to determine whether using new technologies that are less accurate but may provide additional/quicker results are useful as part of a testing strategy.

Until now, testing has been used as a gateway for isolation and contact tracing. Current testing systems are identifying that approximately 70 percent of positive cases are asymptomatic.

A clear aim will be needed with mass testing. Some aims of mass testing of asymptomatic contacts include:

• increased identification of positive cases
• quicker identification of cases
• classification/confirmation of negative status

The public health gains of these would be to reduce R and reduce the risk of outbreaks.

Options for expanding capacity include pooling. Pooling offers slightly reduced sensitivity because the samples are diluted by pooling. Other devices such as antigen lateral flow testing can provide rapid results though their sensitivity is reduced. There have been suggestions of piloting high-intensity testing in an area with high prevalence in order to identify new routes of transmission. Consideration must be given about the risk of lower sensitivity tests in these settings which could be mitigated by repeat/serial testing.

It was noted that regular testing of healthcare workers and all hospital admissions is being recommended by the nosocomial subgroup. More frequent testing of care home staff is also important.

The group reaffirmed that testing and contact tracing alone do not solve the problem of transmission. Ensuring that those who test positive self-isolate is very important and making sure there is support in place is crucial for this.

The group commented that reports of data on positive cases being shared with police are concerning as this could discourage individuals from getting tested.

The Test & Protect system will need to be agile if it is going to work with new technologies such as hypercube model and other forms of innovative testing. The purpose of new technologies and of the overall testing system must be clear for the overall system to be successful.

The group briefly discussed students and the uses of testing around the return of students home for Christmas and their return to campuses following the Christmas holidays. The group will discuss the winter holidays in detail at an upcoming meeting.

Action: Secretariat to schedule a discussion on winter holidays for a future meeting.  

Thresholds

The group was given an update on plans for triggers for action and the guide thresholds that may be set for these. Draft plans at the time of the group’s meeting were that restrictions would come into place at Local Authority level, with some scope for this to be at sub-Local Authority level. This accommodates some areas where the Local Authority covers a large area that is not densely populated, such as parts of Highland Council. A breadth of indicators will be used, to prompt an analysis of a situation that would then lead to set of measures being rolled out.

It is expected that triggers for analysis will be based on change over time, rather than moving across a threshold. Indicators being considered include test positivity and the number of cases where figures are increasing or decreasing consistently in an area over six out of seven days. This would then lead to further analysis and to a decision of whether the level will change.

The three indicators to guide the level would be the following: number of cases per 100,000, test positivity rate, and a forecast of hospital and ICU capacity of a health board area four weeks from that point.

It is hoped that defined levels will allow succinct local messaging and make communication more straightforward. There is hope this will improve compliance by minimising confusion around local differences. Local outbreak management will continue to take place in situations such as outbreaks in factories.

The advantages of laying out a guide are that the public and businesses are able to see where the current situation is and what might be likely to happen if there are changes to indicators. The group expressed their view that measures in a given tier should be the same across all areas in that tier. They noted that having different rules apply to different areas under the same tier suggests that decisions are not made on the basis of scientific evidence.

Group members were supportive of using a rate of change rather than absolute value to assess the level in different areas. They noted the importance of clear communication to help with the understanding of different lockdown phases. As part of this, the group suggested that the data and forecasts used in decision making should be made public. The group reiterated that measures to increase compliance with COVID-19 mitigation measures, such as an enhanced regulatory regimes, could be implemented within the new framework.

Group members also offered support with data sources available via the EAVE II platform.

Group members recognised the impact of delays to testing turnaround from Lighthouse Labs on understanding the impact of the introduction of restrictions across the Central Belt. The delays also have an important impact on modelling and continued delayed will bring challenges when implementing tiered, as decisions for these will depend on the availability of regular testing data.

Subgroup updates

Education and Children

The group met to review the evidence submitted around schools. Group members found that the evidence supported the policies currently in place. Some additional safeguards are being recommended based on new evidence and these are currently being summarised. This advice will go to the C-19 Education Recovery Group (CERG) this week.

Testing

The testing subgroup continued to discuss university testing in their latest meeting.

SAGE update

There was awareness that across the UK incidence and prevalence have continued to increase. Current data shows deaths are now in-line with reasonable worst case scenario planning levels and are expected to exceed these in coming weeks.

There was also a discussion of whether segmenting the population by age was likely to be feasible or effective. There was more evidence considered on the role of children in transmission in education setting. Evidence of the role of children in household transmission is mixed.

AOB

The secretariat noted a submission that will be sent to the First Minister following increased interest in published materials from the group. There is a likelihood that this will lead to more detailed minutes of the group being published on the group’s website.

Summary notes

The advisory group continued the discussion on mass testing from its previous meeting. The group heard about work underway to determine the role for technologies that are be able to process a greater number of tests but offer less sensitivity than current polymerase chain reaction (PCR) test. Some potential uses of these new technologies could include identifying new routes of transmission in areas with high prevalence. 

The group noted that testing and contact tracing are reliant on individuals self-isolating in order to prevent additional onward transmission. The group reiterated the importance of ensuring support is in place for individuals to self-isolate. 

Officials provided an overview to the advisory group on the latest plans for the introduction of a tiered system by the Scottish Government. The group was supportive of the introduction of tiers, noting that these should provide greater clarity to businesses and members of the public. 

The group discussed the proposed indicators that could feed into decision making, and the way analysis of these will be carried out.