Scottish Government COVID-19 Advisory Group minutes: 27 May 2021

Attendees and apologies

Advisory group members

• Andrew Morris

• Dave Caesar

• David Crossman
• Tom Evans
• Nick Hopkins
• Audrey MacDougall
• Jim McMenamin
• Jill Pell 
• Stephen Reicher 
• Jacqui Reilly 
• Chris Robertson
• Sheila Rowan
• Aziz Sheikh 
• Gregor Smith
• Devi Sridhar 
• Nicola Steedman
• Carol Tannahill
• Mark Woolhouse

Invited attendees

• Cat Carver
• Gabe Docherty

SG

• Gill Hawkins
• Daniel Kleinberg
• Marion McCormack
• Arlene Reynolds 
• Liz Sadler

Secretariat

Redacted

Items and actions

Welcome

The Chair welcomed group members, SG observers, and other guests, noting this is the 50th meeting of the group. He thanked group members for their participation. The Chair noted the thanks of the group to the Chief Scientific Adviser for her enthusiasm and contribution to this group, as she prepares to step down from her role as CSA.

The Vice Chair will take over as Chair during the meeting (from the SAGE update), when the Chair needs to leave the meeting.

Minutes

The minutes of the previous meeting have been circulated for comment. Comments should be sent to the secretariat by 9 am on Tuesday 1 June.

The Chair thanked Nick Hopkins for representing the Advisory Group as part of the Academy of Medical Science’s Review discussed at the last meeting.

Subgroup updates

The Chair noted the group’s thanks to members who had agreed to be part of new sub group on universities & colleges, which will meet alternate Tuesdays with the Children & Education sub-group, also chaired by Carol Tannahill. The importance of dedicated advice for Universities & colleges was noted.

Children & education

The chair noted that the sub-group was turning its attention to planning for return after the summer. Modelling suggested there would be difficulties to be overcome. Currently there were some school closures and increasing numbers isolating, though this was mostly precautionary and at a lower level than November. The sub-group would be discussing the relationship between levels and mitigation in schools; testing, particularly asymptomatic testing and vaccination. Children remain unvaccinated in the UK but the position is changing elsewhere. The approach in Scotland would be guided by JCVI. The primary aim is the sustained return of children to school.

It was noted that there was low uptake of asymptomatic testing by teachers and pupils. This was being experienced elsewhere and the Juniper collaboration on asymptomatic tests in England had produced useful research to evidence, which appears to confirm that uptake is patchy and may be due to local influences. Uptake by healthcare staff also was not high – vaccination probably a factor, with most healthcare staff having already received two doses of vaccine. Undetected asymptomatic cases risk transmission to families

The issue of how we maintain behaviours which keep us safe is a familiar one, which has arisen in multiple settings. Redacted. The factors are first understanding the issues and secondly establishing social norms, such as it being anti-social not to be tested or to go to work while coughing. Messaging could undermine as well as support these norms – it needs to be supportive and backed up by other measures e.g. financial support for isolation.

It was noted that as asymptomatic testing was likely to be a key issue for next 12-18 months, there was a need to consider how it would be delivered in the short, medium and long term. It would be increasingly important as the proportion of disease prevalence was likely to be higher amongst children as vaccination proceeds. This was likely to be something to be discussed by SAGE.

SAGE update

The chair had to leave the meeting at this point, with the vice-chair taking over and providing an update on SAGE.

New variant was the most important aspect. R number driven by rise in Apr02 (Delta). Conclusion is that there are 2 epidemics – B.1.1.7 (Alpha) dying out and Delta growing. Wide confidence intervals meant a wide range of possible developments – still the possibility that Delta has a 50% growth advantage. Still to see if May 17 releases will impact & further release in June a concern. Redacted. Data on vaccine efficacy was positive, but no data yet on transmission and hospitalisation post-vaccine. Indications were that prior infection with Beta and Gamma variants did not provide immunity to Delta. Latest indication on natural immunity from NERVTAG paper was that it was sustaining at 8-10 months, which was encouraging. Work on CO2 monitoring to assess ventilation to be taken forward by DfE & HSE. A teach-in on ventilation was being arranged and SG officials would be encouraged to attend.

State of the pandemic

CMO noted that the Delta variant was a concern due to experience with Alpha. While we appeared to be in a better position, Delta could still present significant risk. The projections currently have wide confidence intervals and we are in a period of speculation rather than certainly. Real life experience in parts of England is a couple of weeks ahead of Scotland– we can learn from impacts there but differences in environments mean that uncertainty may remain a real problem. Data over the next week will be critical for decisions in Scotland. There are some positive indications from the EAVE II Study and Glasgow, but it is still early days and more information is needed.

The group received a presentation on findings from EAVE II data, which demonstrated that S-gene positive cases now exceeded S-gene negative/dropout cases marking the Alpha variant – with 90% of the positive cases being the Delta variant. 70% of those testing positive are unvaccinated & have no symptoms. Hospitalisations for S-gene positive cases have increased and they are now the majority. The latest data suggests that Delta has more impact than Alpha, though no statistically significant difference so far on vaccine effect. Most hospital admissions are now in the 40-60 years age group.

It was noted that projections show data tracking above predictions, which was concerning, with R exceeding 1 for Delta variant, even with all mitigations in place. The second analysis of the AstraZeneca vaccine effectiveness is now more positive as it has been monitored for longer.

Experience from hospitals in Glasgow was that not all cases admitted were serious but, even if sent home the next day, will still show in the data returns. It may be helpful to look at average length of admission, which may be a better indicator – it was noted that ICU numbers were flat at present. The vaccine data are encouraging – people are much less likely to get ill, even if they are carriers. The impact of the virus is much less now compared with last April or December/January 2020 from a health service perspective. While the future is unclear, doubling time will be important – while it had been 7 days it is now 22 days, which gives more time to consider options and get people vaccinated.

International update

Key international issue is vaccinating age 12-16 for school return. This was starting to happen in the US, though no vaccines had approval in the UK as yet. Potential learning from elsewhere on recognising the tipping point e.g. Israel was ahead of us on vaccinations.

Advice on certification

The group considered the request they had received for advice on certification, focusing on the strength of the scientific case for using certification.