Scottish Government COVID-19 Advisory Group minutes: 28 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

• Mary Black

• Tom Evans

• Jacqui Reilly

• Nicola Steedman

• Roger Halliday

• Gregor Smith

Invited attendees

• Mary Black

Scottish Government

• Niamh O’Connor
• Graham Ellis
• Iain MacAllister

Secretariat 

• [Redacted]

Items and actions

• minutes
• summary notes

Minutes

Welcome and apologies

Chair welcomed Graham Ellis and Iain MacAllister to the group for today.

The Chair suggested moving meetings to once a week, with the group now meeting once a week on Thursdays, mirroring the changes in SAGE to move to once a week meetings on Thursday mornings.

Apologies – [Redacted]

Minutes and actions

The group noted their congratulations to the teams that have today launched Test & Protect in Scotland.

All action from the previous meeting have been picked up. Members were content with the minutes.

SAGE update

Reports of six outbreaks in schools in England, including three in special needs schools were discussed. Teachers appeared to be the sentinel cases in these. These are early data and more information is required.

The two metre rule was discussed and SAGE agreed they have no plans to change this.

R has become the focus but there is very little room for manoeuvre. The incidence of cases remains high (about 10,000 a day estimates at UK level). An effective contact tracing systems needs to be in place before more significant changes to lockdown can be brought in.

A discussion around occupations with higher levels of social contact and the greater risk these present. The link was also made between these groups and group that experience greater socio-economic deprivation.

Non-pharmaceutical interventions (NPIs) continue to be critical – a package of NPIs that includes physical distancing; hand and respiratory hygiene; face coverings. Enabling NPIs in workplaces may require actions such as not opening staff rooms and similar interventions as possible measures to limit transmission.

JBC – it is proposed that the decision about alert levels should be taken by the four CMOs, for public confidence. There may also in due course be different alert levels between UK nations and between regions within these.

Schools opening up – the advice from SAGE is for a full package of NPIs, coupled with fully functional test & protect needs to be in place. It was recognised that the we are at a key inflection point in the pandemic. R remains very close to one.

Some of the early reports of outbreaks in schools are not what might be typically described as an outbreak (e.g. teachers positive but no positive cases among students). The direction of transmission within these settings is still unclear. The group asked whether sequence data for this could be captured in Scotland. It will also be important to understand flows of transmission.

Test & Protect – the group considered the behavioural science challenges of encouraging those without symptoms to adhere to 14 days of isolation. Scotland made good decisions regarding work being done at local levels, including building up contact tracking using local experienced public health teams, and not relying entirely upon apps, for which there is limited evidence base on efficacy. Decisions were made based much more on evidence and local realities in Scotland. Test and protect could raise greater problems of adherence and trust than lockdown. There are multiple dimensions of adherence (testing, isolation) and these need to be considered individually. Test & Protect can be described as a leaky system, as people will be lost at each stage due to adherence and them not fitting criteria.

Serology – marrying epidemiology and outbreak data and serology will provide greater insight into the pandemic and transmission chains.

On a UK basis, hospital acquired cases continues to be an important area of focus.

Current incidence in Scotland – the current incidence rate in Scotland is estimated to be between 1000-2500 new cases per day for Scotland (confidence intervals are wide). 10,000 at UK level is at the lower level of what was estimated. The spread of new cases does not seem to be coming from care homes, suggesting there must still be significant community cases.

Action: The group to write a letter to the CMO outlining the current state of the science. This would include current evidence on incidence rate, lack of wriggle room with R, schools (NERVTAG data should be noted), the need to maintain our guard with transmission networks, testing capacity issue and who we test, and lastly but most importantly NPIs remain the most important control for this. The CMO noted this would be greatly appreciated. 

Face-covering - should the group revisit this to provide tighter guidance? Targeted guidance and measures to where these would have effect could satisfy both sides.

Care homes

The outbreak in care homes has been extremely challenging. The government is coming under pressure from groups who are finding isolation very difficult (e.g. those with dementia). The number of deaths has declined although the risk remains high. Can the group provide a steer on the circumstances under which some degree of visiting would be allowed?

Comparing schools and care homes we can compare:

• staff working there
• where they fit in the broader network and can contribute to R overall
• charges – children vs. elderly people. The risk is 10,000 fold greater with the elderly. 30,000 deaths in the UK have been in the over 75s whereas in under 15s there have been three deaths. It comes down to how we perceive risk but it may be difficult to open up care homes when schools are not opening yet, despite them seeming that much safer

The impact of lockdown in care homes also leads to a high level of apathy and could perhaps lead to other health problems.

The costs of isolation are very great, though again the impact on others needs to be considered with care homes. Vast damage can be caused both by opening or closing. Putting the choice to visitors – with all agreeing, would allow some opening.

If it were possible to split homes between those who are happy to allow visitors and those who aren’t then there may be a way around this, though creative setups would be need this. The context is important and it may be a decision to be made on a case by case basis at care home level. Care homes are very heterogeneous across Scotland.

Do no harm is a founding principle – although in this case we are balancing harms.

Government are currently doing scenario planning. Pressures are clinical, human, financial, legal. Legal expertise into forcing compliance with isolation would be useful and becomes increasingly important as the group looks into more and more complex issues.

More data on transmission within care homes would allow a more informed decision about opening these up.

Overall position from the group would be to proceed with extreme caution. Science may not provide all the answers here. Modelling around enhanced shielding may be particularly important in the future. 

Action: Advice to commission from Scottish Government due Monday 1000

Scottish COVID-19 Data and Intelligence Network and links to JBC

Data task force from the C-19 AG has been launched. 20 de-identified datasets are available for research from today. Many of these are being updated daily. Census data will follow soon.

Efforts focus on privacy, partnership, ensuring a link with the JBC.

This will provide access to data and will help decision makers reach decisions quickly. Now that this is available it would be good to think about specific consumers of data and intelligence, what questions we want to answer with it and what other data we may need. Also need to consider how this data as infrastructure can support decision makers at the local level.

Key challenge is to demonstrate utility – these have been largely drawn from the discussions of this group and questions should continue to be captured.

Action: Information on the taskforce to be shared by [Redacted].

Action: Secretariat/Chair to circulate JBC papers from SAGE today.

AOB

The REACT-SCOT paper was discussed – the categories of people being at high risk is discussed within these. This will be used by the team in the response to the advice request on care homes.

Another paper showing health board level covid data was discussed – includes data on health boards and the trajectories of different health boards. The second part of the paper is a modelling exercise to show the length of time to reach a desired level of incidence.

The Cabinet Science briefing will take place tomorrow.

Summary notes

The Advisory Group discussed the latest evidence from SAGE, including:

• the latest data on R, noting that there is not a great deal of room for manoeuvre at the current level
• occupations with higher levels of social contact and the greater risk these present. The group noted a degree of overlap between these occupations and groups that experience greater socio-economic deprivation

The Advisory Group discussed the outbreak in care homes, which was acknowledged to have been extremely challenging. The group noted that deaths are now decreasing but that the risk to this group remains high, with a risk of death for elderly people significantly higher than for the young. It was noted that this risk must be balanced against the harms for this group of measures introduced to reduce transmission risk such as restrictions on visitors. 

The group discussed the work of the data task force, noting that work was progressing on both developing the data infrastructure and data feeds on key indicators to provide an early warning system of any increases in transmission as restrictions change.