Scottish Government Covid-19 Advisory Group minutes: 24 August 2020

Attendees and apologies

Advisory group members

• Andrew Morris
• Marion Bain
• David Crossman
• Tom Evans
• Roger Halliday (joined later)
• Steve Reicher
• Jacqui Reilly
• Chris Robertson
•  Sheila Rowan
• Aziz Sheikh
• Carol Tannahill
• Colin Ramsay (for Jim McMenamin).

Invited attendees

• Cat Carver

Scottish Government

• Daniel Kleinberg

Secretariat

• [Redacted].

Items and actions

• minutes
• summary notes

Minutes

Welcome and apologies

The Chair welcomed Colin Ramsay.

Apologies – [Redacted]

Minutes and actions

All group members were content with the minutes from the previous week.

The group heard that the approach to surveillance in schools was still being discussed and agreed. The Secretariat will take on the action of linking those leading that work to the ethnicity reference group.

HEPA filters and ventilation

The group discussed the key points from a rapid evidence summary on aerosol transmission and mitigating strategies which had been shared with the group.

The paper looked at evidence sources on ventilation related to the questions asked of the group as a result of the Cabinet Secretary for Health and Sport’s interest:

• what is the role of aerosol transmission and what this might mean for schools?
• What advice should be given to settings (and especially schools) be given on ventilation, use of air-conditioning and storage heaters as winter approaches
• What role might HEPA filters play in all of this?

Data on aerosol transmission is growing but limited. Published research broadly agrees that:

• short range aerosol transmission is possible but not probable significant cause of transmission - there is an absence of evidence as to its relative importance compared to other routes of transmission
• good ventilation is important means of addressing aerosol risks
• air conditioning can be beneficial through dispersing air but can cause the spread of droplets if the air is recirculated
• the potential spread of droplets in other ways cannot be dismissed
• distancing, mask use and hand hygiene continue to be important in these environments

There are no perfectly safe indoor environments. Close-proximity of individuals was likely to be the highest risk factor but mitigating measures can be put in place – limiting occupancy, physical distancing, facemasks, clean surfaces & hands and good ventilation - opening windows.

Providing good ventilation does not eliminate the need for the other COVID-19 preventative measures. Where ventilation is not good, short duration is a mitigating factor. There was limited evidence relating to air conditioning systems and transmission, but the evidence available points to a higher risk associated with re-circulated air. Operational guidance should help mitigate risk in relation to reducing recirculation of air.

European Centre for Disease Prevention and Control (ECDC) guidance is helpful and Scottish building notes are available based on these principles, including for schools. It was noted that the group was asked a specific question around storage heaters but no research evidence had been uncovered in relation to this.

While HEPA filters have a theoretical efficacy to filter COVID-19 there are no direct studies of this ability and specifically the filters having an impact on transmission rates. Further research on HEPA is needed before a positive recommendation could be made. Even so, HEPA filters are highly specialised and unlikely to be widely used outside of clinical settings or laboratories. 

Advice on ventilation could not be specific as there is such wide range of build environments - the specifics would be for operational guidance. In addition to the ECDC guidance, BB 101 (Ventilation, thermal comfort and indoor air quality) provides guidance on ventilation, thermal comfort and indoor air quality in schools.

The group agreed to provide a response to the questions based on the evidence available, noting the absence of evidence in relation to some issues and referring to other sources of specific expert advice as required. Discussion with a member of the SAGE Environmental Modelling Group identified that the EM group is working on guidance for education which will go to SAGE soon. The group’s advice should be re-considered in the light of that evidence, once it is available.

The advice would necessarily be general in nature, aimed at risk minimisation (noting that close physical contact was the greatest risk) and pointing to existing advice on physical distancing, the wearing of facemasks and clean hands, clean surfaces as well as the importance of good ventilation wherever possible in all spaces which have multiple occupancy. In spaces that don’t have opening windows, getting outdoor air into the building avoiding re-circulation was desirable. Advice should refer to existing sources of operational guidance, including HSE, and note the need for further research around HEPA filters (and some of the other issues considered) before more definitive recommendations could be made.

Perhaps we can include the actions of:

Action: Secretariat to submit HEPA advice once finalised.

Update from education and children subgroup

Face coverings

The group received an update from the Chair of the Education and Children subgroup on face coverings in schools.

It was highlighted that since the group gave its original advice, while much remains the same there has been further evidence that:

• older young people may play a greater role in transmission than previously thought
• face coverings not only protect those around the wearer, but also protect the wearer to some degree
• there is further evidence on face coverings in relation to viral load

The group highlighted that the World Health Organisation (WHO) had produced updated advice on young people and face coverings over the weekend. At the time of the meeting, the Cabinet Secretary for Education was in discussions with stakeholders about the guidance on face coverings in schools.

The subgroup has given the Scottish Government three additional pieces of advice:

• school children of all ages should wear face coverings on school transport
• senior secondary students attending workplaces or HE/FE settings should wear face coverings in these places
• all secondary school pupils and staff should wear face coverings in communal areas where social distancing can be difficult and mixing between classes/ cohorts is much greater

The subgroup is not advising the use of face coverings by pupils in classrooms or labs but is emphasising the importance of other mitigations, including distancing wherever possible. If there is a local outbreak, students may be advised to wear face coverings throughout the day.

The subgroup has highlighted that there are areas where there is an absence of evidence, including in relation to risks associated with face coverings being put on and removed throughout the school day. The group acknowledged that it may be asked for further advice about fomite transmission, including dealing with discarded face coverings.

The group had a discussion around the wearing of face coverings by secondary school pupils, HE and FE learners.

The group considered the proportionality of advice that suggests that all children wear face masks in school environments, given the evidence of lack of spread in these settings, the impacts of mask-wearing on educational loss, and whether it would make sense or not to institute a blanket mandate. 

It was highlighted that the Education subgroup’s advice was consistent with the WHO advice. In relation to public opinion on the issue, the group was told that there has been a lot of correspondence received by the Scottish Government, reflecting a range of views about the use of face coverings in classrooms. Equalities issues needed to be taken into account as part of assessing the balance of harms. 

The group agreed that face coverings were just one instrument in the risk minimisation strategy.

There was a discussion about the value of any policy being clear and simple to follow. One group member suggested that the basis for applying the precautionary principle in selective circumstances wasn’t clear. The group was unsighted on the costs associated with enforcing mask wearing in schools.

It was discussed that the group’s, and future subgroup’s advice should continue to be based on the scientific and clinical evidence and that the risks of harms and the roles of schools in magnifying transmission remain very low. The evidence on this is kept under review.

The Chair commended the subgroup on the quality of its advice; noting that there were a range of opinions in the group on issues in relation to the wearing of face coverings in schools and that the advice should be kept under review as the effects on community transmission of reopening schools and progressing through the routemap become clearer.

Higher and further education

The group received an update from the Chair of the Education and Children’s Issues subgroup on Higher and Further Education (HE/FE).

It was highlighted that these environments were very different from schools and were more akin to international workplaces and that risk assessments should be carried out by individual institutions. It was highlighted that the subgroup had considered how it could enhance compliance.

The group were told about a paper on HE/FE which has been considered by SAGE and there was an imminent need for advice to be produced.

The Chair highlighted that vice chancellors were keen to receive clear guidance.

The Chair indicated to the group that Independent SAGE had given advice that teaching fully online is the default option for HE/FE.

The group were given an update on a UK-wide SAGE topical subgroup to develop the evidence base on HE/FE. Group members and SG officials are supporting that effort.

The group discussed matters relating to HE including quarantining and testing and the practicalities involved when students are coming from countries or rUK areas that are of higher risk.

In relation to risk of transmission the group agreed that there is more risk if people are attending HE/FE in person. It was suggested that there was little evidence that in-person teaching was better than teaching on-line.

It was highlighted in towns where local communities are made up of high proportion of students, the standing of universities would be greatly affected if students were found to be a main source of transmission. The problem of the potential for blame and stigmatisation in relation to international students was also highlighted.

The group discussed the issue of compliance in relation to young people and considered that it was wrong to make generalisations in relation to the behaviours and attitudes of young people.

It was noted that the creation of new households as students returned to HE could result in a rise in transmission. The group recognised that while there is no current ask of it for scientific advice in relation to policy for HE/FE they were ready to offer advice should it be needed.

The Chair accepted [Redacted] offer to draft a discussion paper drawing on research on how students could be worked with to produce a covid safe culture and effectively mitigate against HE/FE transmission.

It was highlighted that different universities and even individual departments were taking different approaches and also that the international response was different from campus to campus.

It was agreed that this advisory group should focus on the health impacts in relation to the return of students to HE/FE and that it is the remit of other groups to look at the balance of the other harms.

Action: Secretariat to invite Stephen Reicher to produce a paper on behavioural science issues in relation to HE.

SAGE review - four nations science advice

The group was given an update on how the relationship that SAGE has with other advisory groups and government departments was likely to change and what this might mean for devolved administrations. A further update will be given at a future meeting but the discussion touched on outbreaks and scapegoating; vaccinations; reinfection and immunity.

Horizon scanning

Owing to time constraints, the group agreed to discuss at the next meeting; topics it would need to look at in the future.

SAGE and subgroup updates

SAGE – there was discussion at SAGE on outdoor activities and venues which looked at different activities and considering what happened with audiences.

PHTAS – the group’s advice in relation to flu vaccinations and winter preparedness has been sent via the CMO to the Cabinet Secretary for Health and Sport. The group intends to meet again to discuss any feedback received. 

Nosocomial group – the group will be discussing the built environment and ventilation, physical distancing and the challenges around remobilisation. The group will also discuss health care worker testing in light of some of the recent modelling from Public Health England. The group will also look at admission testing. 

Testing – the group has been having discussions around Test & Protect signals at different locations across Scotland. The group will be considering rapid volume testing at its next meeting. 

AOB

It was highlighted that the group may be asked to look at the report of a reinfection from Hong Kong. Item on horizon scanning postponed till the next meeting.

Summary notes

The group discussed aerosol transmission and mitigating strategies and considered the available evidence on ventilation in relation to COVID-19.

1. The group discussed indoor environments. Close-proximity of individuals is likely to be the highest risk factor but other mitigating measures can be put in place as well as ventilation – limiting occupancy, physical distancing, facemasks, clean surfaces & hands. Good ventilation can be as simple as opening windows.
2. The group received an update from the Chair of the Education & Children subgroup on face coverings in schools and on Higher and Further Education (HE/FE). 
   The group had a discussion around the wearing of face coverings by secondary school pupils and agreed that face coverings were just one instrument of a risk minimisation strategy. The chair noted the range of views in relation to the wearing of face coverings in schools and the group agreed that the advice should be kept under review as the effects of reopening schools become clearer.
3. In discussion, it was highlighted that HE/FE educational environments are very different from schools and more akin to adult workplaces and that risk assessments should be carried out by individual institutions. The Group noted that work was ongoing on HE/FE issues.
4. In relation to risk of transmission, the group noted that there is more risk if people are attending HE/FE in person. The group discussed the issue of compliance in relation to young people and considered that it was wrong to make generalisations in relation to the behaviours and attitudes of young people.
5. Where the group provides scientific advice in relation to HE/FE it focuses on the health impacts in relation to students & staff of HE/FE – it is the remit of others to look at the impact of the other harms.