Scottish Government COVID-19 Advisory Group minutes: 30 December 2020

Attendees and apologies

Advisory Group Members:

• Andrew Morris
• Marion Bain
• Harry Burns
• Dave Caesar 
• David Crossman 
• Tom Evans
• Nick Hopkins 
• Jim McMenamin
• Stephen Reicher
• Jacqui Reilly 
• Chris Robertson 
• Sheila Rowan
• Aziz Sheikh 
• Gregor Smith 
• Devi Sridhar 
• Carol Tannahill 
• Mark Woolhouse

Invited attendees:

• Cat Carver

SG:

• Andrew Bracewell 
• Richard Foggo 
• Joe Griffin
• John Harden 
• Daniel Kleinberg 
• Audrey MacDougall 
• Marion McCormack 
• Niamh O’Connor
• Elizabeth Sadler

Secretariat: [REDACTED]

Items and actions

The Group met to discuss new SARS-CoV-2 variants, in particular Variant of Concern 202012/01. Key published documents include the NERVTAG minutes of their meeting of 18 December and PHE’s technical briefing document of 21 December, updated 28 December on the same novel variant.  The group also had access to the meeting papers of SAGE 74.

The group noted the materials placed before SAGE 74 and that the most recent modelling provided by SG Covid analysts was aligned with similar models run by other Groups, reflected in the consensus position of SPI-M, NERVTAG and SAGE.

The group discussed the state of the epidemic: viewing this as a significant variant that will raise issues globally – the ‘Kent’ variant has rapidly become an issue across much of the UK. PHS data shows a likely rapid move to near-dominance within Scotland.  From the proportion with the surrogate marker (S gene dropout) it has become clear this is a good proxy marker for the new variant (97% association with VOC202012/01). Across the UK this has allowed teams to document increased transmissibility as it established dominance across SE England (and now this variant in Cumbria – may explain D&G issues).  Now in Scotland data suggests 48% of cases are the new variant, which is present in all but two of our Boards (the islands).  

There are still questions raised about basis of transmissibility – SAGE 74 concluded need more time to be clear on questions such as viral load etc. The group’s general view was that, while compliance might be lower and transport survey data still shows a lot of movement compared with March/April, the growth is being driven by the new strain. A minority view was that this is too pessimistic.

SG Covid Modelling and EAVE2 data sombre. On the basis of increased rates of transmission for the new variant (two models 50% and 70%) very hard to keep R<1 even with full restrictions. There are different views on SAGE of how significant schools are in driving transmission – from modest (R of about 0.1-0.2 to more significant R of 0.5, but new models show little or no headroom). Appears to agree with other modelling groups – suggests very small parameters for control with schools open. EAVE2 work suggests significant pressure on NHS Scotland from mid-January.

Discussion about maximising compliance – not social fatigue but a product of varying and unclear communication at UK level; a need to enhance support measures.

Generally, the existence of new variants is concerning. Requires a re-assessment of our strategies and scientific evidence suggests the following strategic issues to be important:

• Genomic testing needs to become systematized.  
• Data mapping, flows and linkage between COG-UK, PHE and other bodies needs to be addressed urgently.
• Surveillance, data on secondary attack rate (15% for new variant via 9.8% for ‘wild type’ – need to be able to stratify for different types of data – households, ethnicity, age groups).
• Genomic testing of waste water will add value in active surveillance of the pandemic.
• LFDs appear to be sensitive – but contingency of a return to PCR testing

    
The group noted the current position – that schools will re-open for vulnerable children and children of keyworkers next week. Current plan is to go to online learning for 11 January before return on 18 January but education subgroup will provide advice on this.

Notwithstanding this, a recognition that the harms of educational loss are significant and heterogeneous. Educational loss greatest in the poor. It is also relatively higher in younger children (and transmission thought to be lower in that group). Separately need to consider whether infection is greatest in multigenerational households (and possible intersectionality with ethnicity). Have to find a model for education that is sustainable and accounts for this harm, recognising that further and higher education can be done remotely in almost all cases and the needs for in person learning are much higher for children and younger children. Need to maximise measures to keep schools safe, including addressing concerns of parents and staff even if the perceived risk is less great than the actual risk.

The group reflected that the issue of transmissibility of the new variant is crucial. An unanswered question remains when we will have more information about how much more transmissible this variant is. There is also not much certainty about what the drivers of increased transmission are. For now, there appears to be a strong consensus that HE/FE should be kept remote and avoiding the movement of students to universities. There is also significant concern for younger age groups of the impact on their development from limiting social and educational contact. Compliance with NPIs needs to be reinforced to counter any decrease in this. Schools can only be low risk environments if community transmission remains under control. If prevalence increases there will be need for significant action around schools. In the short term there appears to be a need for an extension to remote learning and there is significant concern for vulnerable children and inequalities. There needs to be consideration of non-covid harms.  

The Chair reflected on the discussion, noting an opportunity is to map out the path to August/September. There is a duty of the group to reflect the risk from the new strain and the risk that control is in jeopardy and the likely impact this will have on the NHS. In the short term there may need to be different action taken in schools for the next 1-2 months. A common theme is that we should be intensifying measures that we know to work, increased emphasis on NPIs, use of testing, and include support for isolation. Vaccination of teachers is an issue that has been raised – this is important but the preserve of JCVI and policymakers. Beyond the school gates is a big issue as opening of schools may add pressure on R by linking  to behaviours and networks of transmission in the community. The key question is how to balance harms and include non-covid harms to education. 

The group will use its next meeting on 7 January to assess further how it will support medium to long term efforts to live with the virus. As part of that it will look at the concept of herd immunity, supporting isolation, vaccine behaviours and strategies and how different strands of activity will be used to work through 2021.