Scottish Government COVID-19 Advisory Group minutes: 4 June 2020

Attendees and apologies

Advisory group members

• Andrew Morris
• David Crossman
• Mark Woolhouse
• Chris Robertson
• Aziz Sheikh
• Devi Sridhar
• Jill Pell
• Stephen Reicher
• Tom Evans
• Jim McMenamin
• Mary Black
• Tom Evans
•  Jacqui Reilly
• Nicola Steedman
• Marion Bain
• Roger Halliday
• Sheila Rowan

Invited attendees

• Mary Black

Scottish Government

• Niamh O’Connor
• Anita Morrison

Secretariat

• [Redacted]

Items and actions

• minutes
• summary note

Minutes

Welcome and apologies

Chair welcomed Anita Morrison, joint Head of Health and Social Care Analytical Hub, Scottish Government.

Apologies – [redacted].

Publication of evidence

In order to improve transparency of the group’s work, the Secretariat will share a list of proposed documents for publication on the Scottish Government website. Seeking permission from authors for publication.

Zoe app has been in touch to ask if they can publish Scottish data. No objection noted, suggested that the data belongs to Zoe and Kings College London and they should do as they deem best.

Action: Secretariat to send email with document list to group.

Minutes and actions

No changes noted, actions have been completed.

CSA update

SSAC meeting today discussed, considering some broader and longer-term questions relating to COVID19.

SAGE update

Recap of some key points from SAGE:

• R may be slightly lower in Scotland than in the rest of the UK. As case numbers are lower now and plateauing it may be that R will come close to or even above one in areas of the UK.
• clusters of infections associated with particular settings – cluster tracing will be important, including backward tracing to find source
• immunology of COVID-19. The majority do get an immune response, including likely asymptomatic cases. Transfer of neutralising antibodies seems to protect against disease in animals, although does not prevent infection. Immune vs inflammatory response – care to be taken about the distinction in meaning
• ethnicity – some groups within BAME groups are more at risk than others. Occupational exposure and household size may be important. BAME people admitted to hospital seem to do worse than non-BAME with similar symptoms. Some will be due to co-morbidities. Occupational risk and relationship with ethnicity needs further consideration. Has messaging been good enough in these groups? Previous evidence suggested that these groups were equally motivated to comply with lockdown but were leaving the home more, perhaps due to economic necessity.. Need for proper support if people are required to self isolate was noted
• two metre rule – no evidence to change this. Distance is a continuum, two metre is not absolute
• face coverings for all in hospital including patients will be recommended, but consideration first needs to be given to other settings such as social care
• schools were discussed at NERVTAG – studies planned for the autumn on transmission. Noted that quicker set up would be desirable

Action: Secretariat to put quarantine for travellers on the next agenda.

CMO Letter

Key points of draft letter setting out brief summary of evidence on major issues discussed.

• testing strategy - could contacts be tested, rather than just asked to isolate for 14 days. Testing those without symptoms by using spare capacity should be approached with caution, the risk of false negatives could be unacceptably high.  Noted that Germany may be doing this in schools. Further groups are already under consideration, such as those coming into hospital for elective surgery, care home workers. May be useful for group to take a position on each group. Pre-test probability is low at the moment. Testing might be appropriate during winter season
• face coverings - should be clear about the strength of the evidence for different scenarios if the group is going to make a recommendation. Work may be needed to create more of a social norm and explain the reasons if this is desired
• messaging - has been confusing, media has spread some mixed messages about relaxation of lockdown, message from Scottish Government needs to be clear and consistent. Guidance to the media could be considered if harm is thought to be resulting from incorrect messages
• can we incentivise further – ‘protect your community, your community will thank and support you’
• high death rate and continuing lockdown in the UK noted. Even where evidence base is weak, it may be worth trying tactics that other countries have tried
• noted need to be clear about whether; (i)  the group is making recommendation based on evidence, and the strength of that evidence, that can be considered for policy; or, (ii)  whether the recommendation is for further research as the evidence is not strong enough to base policy on

Action: Group to give feedback on Slack, noting areas of agreement and areas where difference of opinion should be flagged. Aim to send to CMO by 11 June 2020.

BAME outcomes

Latest data shared. Of healthcare professionals who have died 61% were from minority ethnic groups. Disparities in death rates, not just for COVID-19, have been known about for some time – data is clear that this is a problem. Are there any protective measures the group can recommend?

• PHE report was published today online
• background of inequalities has been highlighted by the pandemic
• practical recommendations might be of value , even where evidence base is weak. – It was noted that the BMA are considering the suggestion that BAME healthcare workers, in particular, should not work on COVID-19 wards due to increased risk. Where co-morbidities such as diabetes are present, this may well be supported by the evidence
• individual risk groups which take into account a number of factors would help this; for example, proper PPE, particularly N95 availability

Action -[Redacted] to pull together a paper outlining evidence and recommendations which may be supported by the evidence.

Cabinet briefing

Preparatory discussion on who will lead which areas of Cabinet briefing tomorrow. It was agreed that the majority time should be dedicated for discussion.

Summary note

1. The Advisory Group discussed SAGE topics, including:

• clusters of infections associated with particular settings, noting that cluster tracing will be important, including backward tracing to find source cases
• latest immunology, which suggests that the majority of those who have been infected do have an immune response. It is still uncertain how long this response will last or the degree of protective effect
• the two metre rule. The evidence does not support changing this, but it should be noted that the effect of distance is on a continuum

2. The group considered potential uses for additional testing capacity, including whether contacts of known cases could be tested even if they have no symptoms, and whether random testing could be carried out within certain groups. This is being done in some other countries, but some members of the group raised concerns about the likely rate of false negative diagnoses given the current low prevalence in the general population.

3. Face coverings in enclosed public settings were discussed, noting that this has been made mandatory in some other countries.

4. The group noted that media messaging about the easing of lockdown has been mixed and there is a potential for confusion. The group agreed that messaging from Scottish Government should continue to be clear and consistent.

5. The group discussed Black and Minority Ethnic (BAME) risk and outcomes, agreeing that this is an important issue. The group noted that a background of inequalities has been highlighted by the pandemic and that there are interactions between ethnicity and other risk factors which must be taken into consideration.