Scottish Government COVID-19 Advisory Group minutes: 21 May 2020

Attendees and apologies

Advisory group members

• Andrew Morris

• David Crossman

• Mark Woolhouse

• Chris Robertson

• Angela Leitch

• Aziz Sheikh

• Devi Sridhar

• Jill Pell

• Stephen Reicher

• Tom Evans

• Jim McMenamin

• Nicola Steedman

Invited attendees

• Mary Black

Scottish Government

• Roger Halliday
• Niamh O’Connor
• Richard Foggo

Secretariat

• [Redacted]

Items and actions

• minutes
• summary notes

Minutes

Welcome and apologies

Vice Chair welcomed all attendees.

Apologies – [Redacted]

Minutes and actions

[Redacted] noted his thanks to group members and Secretariat for their contributions to advice to Ministers this week. 

There will be no meeting on Monday 25 May due to the public holiday. The next meeting will be on Thursday 28 May.

SAGE update

SAGE confirmed that meeting papers and minutes are intended to be published. This will allow transparency.

Reasonable worst case scenario paper discussed noting the need for early warning systems and rapid action from these. No details regarding this early warning system were given.

Presentation on test, trace, isolate in England. A beta system of this will be in place by 01 June 2020 that will allow contact tracing for most of those with positive tests. The system will not be fully operational by 01 June 2020.

Biosecurity centre (JBC) – discussion about target number of cases and advice from these.

Schools – SAGE also commissioned for advice on schools. A paper on this showed R and work/leisure contact with schools plotted onto the graph and the impact on R overall. Asymptomatic testing in schools was also discussed as well as serological testing of teachers. Opening schools in June with the summer holidays six weeks down the road would provide a buffer period if R were to increase, where these would be closed again. This would be tempered by other behaviour changes as society comes out of lockdown.

The full effects of the first waves of changes in England can’t yet be seen. The effect of reopening schools and retail is difficult to assess in advance. SAGE agreed there should be no further release of lockdown until TTIS is fully implemented. The goals for proportions of contacts traced in TTIS was discussed - 80% cited as optimal, 50% also make impact on transmission. This would have an important impact on lockdown duration. 

International experience provides some insight into level of behaviour compliance. It would however be likely to be politically unpalatable to have different interventions in different regions to assess their impact.

Action: [Redacted] to lead a deep dive into data issues around TTIS in Scotland at the next meeting.

Action: [Redacted] to lead discussion at next meeting on JBC discussing the data and experiments that may be needed

[Redacted] joined the meeting

Updates from other groups

SPI-M: The assumption that children are as infectious as adults is being used in analysis, though this could in fact be a worst case assumption. There were discussions on different testing initiatives.

SPI-B: No meeting this week. [Redacted]. Two papers are being written on this, to assess the way policy writing uses co-creation.

DELVE – These look at key questions and what research needs to be in the pipeline. Discussions have focussed on areas including immunology and economic impact.

World Health Assembly – A resolution was agreed that spoke about a vaccine being a global public good. There are a lot of concerns about the United States removing funding or pulling out of the World Health Organisation (WHO) all-together.

Hospital interventions – focus on smaller/community hospital where transmission seems to be happening at a faster rate. Strict IPC and social distancing needed among healthcare staff. Data quality is not good in this area.

NERVTAG – Transmission in schools discussed. Data is observed in different ways. Worldwide there has only been one outbreak associated with schools. Infectivity and its relation to PCR viral titre was discussed. Concerning data from a Dutch study showed that infectivity persisted beyond seven days; the 95% CI showed infectivity decreased after 15 days. No discussion happened on whether the benefits of distancing in schools outweigh the developmental costs of this.

Action: Regular international updates to the group would be helpful. [Redacted] to lead these intermittently (perhaps every second meeting) and external experts may also be invited.

Route map

Officials noted their appreciation for the group’s input on the Scottish Government roadmap. Members noted that participation in the group has been rewarding.

New information may change the existing roadmap as it emerges. It was suggested the decision to leave out timings from the phasing document was wise, though these are likely to now be questions asked to the government. On the current trajectory reaching phase four in six months would be positive, though the hope with TTIS is that this could be reduced to three months. This would require a high level of coverage and efficacy. It was acknowledged that a lot is being asked of TTIS though this type of initiative at this scale is so far unprecedented.

A large amount of preparation is needed to prepare for each phase.

The role of the group may also need to be to raise questions and raise gaps where research is needed, in order to be fully prepared when changes are to be made. This will also help give us reliable lead indicators, rather than just lag indicators. There is now a shift towards evaluation of change, rather than modelling.

Given the end of Ramadan this weekend there may be a need to reinforce the messaging against mass gatherings.

AOB

It would be helpful to articulate the questions that the group is grappling with and discuss which datasets are available to provide insight.

Most countries have advisory groups so there would be value to engaging with members of these in other countries.

Important that we document the evidence behind decisions being taken. There will be a need to account for this.

Looking ahead we might be asked:

• evidence to indicate transmission is rising again, and what levels of change over different time period for different indicators could be triggers for decisions 
• in terms of policy and information on super spreaders would be useful 

Action: Group to bring questions to the next meeting.

Summary notes

Advisory Group members provided updates from additional national and international groups they are members on – highlighting the need for continued exchange between groups. The group noted the opportunity to learn from countries and other parts of the UK that are transitioning from lockdown at different pace and the importance of engaging with experts from these countries at future meetings. 

The group discussed the publication of the Scottish Government COVID-19 route map and the important role that the Test and Protect strategy will play. They recognised that the success of this will be crucial to progress through the phases, along with continue adherence to physical distancing, infection control, and hand hygiene guidelines.

The group reinforced the importance for the scientific community and government to keep articulating questions that will need to be answered as we are to progress through phases of the road map. In particular, there is now a need to identify lead indicators as well as carrying out evaluation of changes where these have been made. This will ensure that decisions continue to be informed by the best evidence available.