Scottish Government COVID-19 Advisory Group minutes: 28 January 2021

Attendees and apologies

Attendees:

Advisory Group Members:

• Andrew Morris
• David Crossman
• Tom Evans
• Roger Halliday
• Nick Hopkins
• Angela Leitch
• Jim McMenamin
• Jill Pell
• Stephen Reicher
• Jacqui Reilly
• Chris Robertson
• Sheila Rowan
• Gregor Smith
• Aziz Sheikh
• Devi Sridhar
• Carol Tannahill

Invited attendees:

• Cat Carver
• Gabe Docherty

Scottish Government:

• Daniel Kleinberg
• Angus Macleod
• Alisdair McIntosh
• Arlene Reynolds

Secretariat: REDACTED

Items and actions

Welcome 

The chair welcomed group members, guests and SG observers. 

Chair’s update

The chair covered action points from last meeting. The group was given a brief overview of a paper on new variant surveillance which outline the potential of expanding whole genome sequencing. The Chair reiterated the importance of near real-time data flows to address urgent scientific questions for policy to address vaccine rollout. 

Work on scenario planning for the next 6-12 months has continued within government. The Chief Scientist (Health) noted the difference sources of advice and scientific advice that feed into government and noting the role of scientific advice in the broader policy process in government. 

Action:

• Angela Leitch to speak with Andrew Morris offline with regards to real-time vaccine data linkages
• David Crossman to share scientific advice slides

Government’s update

Work in government is underway on the expansion of testing and accelerating the vaccine rollout. The strategic framework is also undergoing a review. International travel work is an important consideration now, with the group feeding into this. Modelling and draft scenarios have been valuable to start to shape short and long term thinking across government. 

Key issues right now are travel, and the potential for strengthening the Scottish Government’s approach. Other major issues are what next steps could be for nursery, primary and secondary schools, and when face-to-face learning could return as quickly as possible. The CMO noted his thanks to the chair and members of the education subgroup. 

Supporting isolation, vaccination and operational deployment have also been at the forefront this past week with work ongoing by policy leads in this area. 

Situation report – state of the pandemic

The group was shown data on S-gene dropout from the EAVE-II dataset. True S-gene dropout case numbers are currently decreasing but not as rapidly as the wild-type. It is expected that the wild-type variant will eventually disappear in Scotland. This is significant as measures that were more effective with the old variant may not have the same level of effectiveness against the new variant. 

Hospitalisation rate is about 50% higher with the S-gene dropout with 30-40% increased mortality from reports in England and Wales. These trends have not yet been observed in Scotland though likely due to our position in the pandemic being approximately 1 month behind the other parts of the UK. 

SPI-M estimates for R in Scotland are between 0.7-1.0. There are some difficulties with pillar-II data due to the switch to later flow tests. The scope for easing lockdown will be particularly dependent on whether prevalence is dropping. CoMix data shows mean contacts between age groups appear consistent between the first and current lockdown. At the lowest point of the first wave R reached 0.6. This suggests it will be difficult to open up society until the impact of vaccination is felt. It is unlikely that the rate of infections will be reduced faster than the current rate. 

The group briefly discussed whether there was any evidence that case numbers in younger children are higher than during the first wave. In Scotland we haven’t seen that the S-gene dropout was associated with children. The pattern of decrease is the same across age-groups, though slightly flatter for primary school children. Age group data from England is similar and shows plateauing in the 2-10 age range. This could be from nurseries being kept open or higher attendance at primary schools now compared to the first wave. 

Preparation for scenario planning

Detailed scenarios are being developed, looking across the 4 harms. These can be used as the basis for what our actions would be in each of these scenarios. The group’s input is important to consider how to improve our system and ensure it is reactive and resilient to potential future shocks. 

The group discussed education, with the chair of the Education and Children’s Issues subgroup providing an update on that group’s meeting earlier in the week. They noted there are real concerns about wider health impacts on children (beyond the classroom) notably vulnerable children and it is important to ensure there is a broad range of resources available to support children’s health when they return to school. Children transitioning from secondary school to work and higher or further education are likely to face specific challenges which could have a lasting impact on their lives. 

An important factor in any decision for children to return to the classroom is safety inside the school environment but also the wider impacts of schools being open on the R number. It is likely that school environments are safer than those where children may mix outside schools. Secondary impacts of the return of schools can be, for instance, the greater mixing or return to work of adults once children return to school. Mitigation measures should also be in place in workplaces, including environments such as nurseries, to prevent transmission between adults. 

The group considered international examples with countries such as France where schools have remained open despite rising cases. It was acknowledged that new variant cases still make up a much smaller proportion of total cases in France. 

The Group noted that the Scottish Government has stated that the return of schools is a top priority. 

Beyond schools, the importance of a multi-factored response was stressed, including adequate self-isolation support, the need to ensure the robust safety of spaces such as workspaces and schools, and continued adherence to non-pharmaceutical interventions. The group briefly discussed vaccines, noting that their impact on transmission is not yet known. Currently pressures on the NHS are expected to ease in the next month but that should not signal for the premature release of restrictions. Current data shows significant mortality and morbidity in the under 65s. There are risks of optimism bias around population immunity. It is important to ensure we do not go into next winter in the same position as this winter. 

CO-CIN: significant mortality and morbidity in those under the age of 65 and need for long term care, particularly in middle-aged women. 

Action:

• Secretariat to share SAGE paper on covid security in the workplace and at home
• David Crossman, Andrew Morris, Daniel Kleinberg and Gregor Smith to meet to finalise plans for deep-dive
• David Crossman to share draft slide the with Secretariat

Actions of previous meetings

The chair asked the group for their final comments on travel advice. No additional comments from the group. 

SAGE update

The group was updated on discussions earlier that day at SAGE. 

Subgroup updates

The nosocomial group will meet next Friday. Information from the last meeting was shared. Risk analysis work to date indicates nosocomial infections are primarily driven by positivity rates in in-patients (which is dependent on community transmission) and the length of stay (totality of exposure). Transmission dynamics are complex and include community importation, healthcare workers to healthcare worker and patient to patient. Analysis of PHE indicates that expected nosocomial incidence was much higher than what was actually observed. This suggests IPC measures had a significant impact at UK level. Enabling adherence to these measures is key to nosocomial infection prevention and control and a new subgroup, focussing on behavioural insights relating to this, has been established

AoB

The Secretariat will pull together our existing sources of international learning in government (SAGE, ICJU) but also ask group members what governmental or non-governmental networks they are part of. Mapping these out may provide the group with a role of bringing learnings from these into government.