Scottish Government Covid-19 Advisory Group minutes: 7 September 2020

Attendees and apologies

Advisory group members

• Andrew Morris
• Stephen Reicher
• Chris Robertson
• Sheila Rowan
• Tom Evans
• Jacqui Reilly
• David Crossman
• Mark Woolhouse
• Nicola Steedman
• Roger Halliday
• Aziz Sheikh
•  Jill Pell
• Harry Burns

Invited attendees 

• Mary Black
• Cat Carver

Scottish Government

• Daniel Kleinberg
• [Redacted]

Secretariat

• [Redacted]

Items and actions

• minutes
• summary notes

Minutes

Welcome and apologies

The Chair welcomed group members. He also welcomed [Redacted] from the Scottish Government who is observing today. The Chair expressed his thanks to Sheila Rowan who is serving as Chair of the education subgroup while Carol Tannahill is away. 

Apologies – [Redacted].

Chair’s update

The group was given an overview of the review of the advisory group that was undertaken between the secretariat and the Chief Medical Officer. The Chief Medical Officer and Ministers noted that they are grateful for the advice they have received from the advisory group and expressed their desire for the group to continue to meet. They were supportive of the group moving to fortnightly meetings and recognised the huge voluntary contribution of group members.

Group members noted that it would be helpful to communicate to institutions the contributions being made by group members. The time pressures facing group members who juggle multiple commitments were noted and any way to ease these would be welcomed.  Daniel Kleinberg noted that that had been one of the CMO’s requests.

The Chair welcomed these comments, noting that the group will continue to aim to add value and working as a complement to SAGE. Changes to the structure and flows of scientific advice in the UK will continue to be observed and it will remain important to ensure information from these feeds into this group and the Scottish Government more broadly.

The Chief Medical Officer had also suggested some additional topics that could be covered in a deep dive on immunology, reinfection & vaccines.  

Action: The Secretariat to consider the terms of reference and whether these need updating.

Action: The Secretariat to organise for letters to be sent to group members and their employers recognising their contributions.

Minutes and actions

All group members were content with the minutes from the previous week.

CMO Review and Future Work Programme

Group members considered some draft topics for a Future Work Programme. Suggestions of topics put forward by group members were:

• impact on health system.
• the ‘4 harms’ and use of advice from this group by the Scottish Government
• BAME issues
• financial incentives and support for isolation
• waste water and the work being undertaken by SEPA. This can form part of a wider session on new methods of surveillance and monitoring the activity of the virus in Scotland
• inequalities and the impact of covid-19 on these
• travel and tourism, particularly ahead of expected travel at Christmas
• mass testing, which could also be a broader discussion of testing strategies, including targeted testing as an alternative option
• vaccine, which could be covered in a deep dive with Sir John Bell
• review evidence for interventions used in local outbreaks
• financial – what are the financial projections and the impact

The group then received a brief presentation on data from the EAVE study. Data from this study provides insights into changing patterns of the epidemic in Scotland.

• deaths and hospitalisation can be predicted based on patient data. This shows how the epidemic is changing
• the gender balance has changed, with a majority of positive tests now in men (55%); about 50% of positive cases are now in those aged 18-39 and the number of positive tests in those aged 65 and over has declined
• deprivation – in areas of low deprivation the proportion of positive tests has risen, the proportion in highly deprived population has remained consistent
• links with GP data allow for analysis of risk groups, with a greater number of positive tests in those with no other risk/comorbidities, and a drop in those with several comorbidities
• data shows the impact of risk factors and allows forward projections. Also allows to predict hospitalisation
• the upsurge in young adults means we expect to see some spill over into older age groups
• hospitalisation rates are not currently rising in many of the countries seeing a rise in number of cases. There is a suggestion that society is naturally shielding itself, with those most vulnerable still being very cautious

Important to note – previously we were only testing those hospitalised so this may have missed a large number of cases in young people. Serology testing done could be used as a proxy.

EAVE data will be shared with the Chief Medical Officer and SG colleagues.

Action: Secretariat to update workplan and circulate on SLACK, with the understanding that this workplan will be flexible.

Public compliance

The group discussed the issue of adherence to covid-19 guidance, which has been increasingly prominent in the media. Group members noted that compliance is not a homogenous issue and there are many reasons an individual might not comply with guidance.

Adherence – difficult to get data on as it is largely self-reported. For masks, data on use suggests it is extremely high. For self-isolation, only 25% of those symptomatic are reportedly self-isolating.

Literature on compliance points to the following key points:

• information: people think they are less at risk and their declining sense of risk is reflected by businesses such as pubs being open
• practicality: whether it is practical to self-isolate or quarantine, especially if you can’t afford it or don’t have the space for it

Moralising categories: This sets up conflicts and makes dialogue very difficult. If you set up those moral categories, these often lead people to accept that because they are not part of that category (e.g. those hosting large parties) they are not part of the problem. An example would be individuals who are unaware of exact guidance or slightly bend the rules but assume they are not at fault.

The group discussed the risk factors behind the recent increase in cases in Glasgow. Briefings from the First Minister have suggested these are large numbers of small gatherings, rather than small numbers of large gatherings.

Group members heard that work is underway to identify the location of transmission through spider diagrams, drawing on the work of contact tracing teams. The allow a more precise estimate of where transmission occurred.

Group members noted it is important to examine why an individual was infected – whether this was due to individual behaviour or poor practices of businesses.

Risks from students returning – risks can be managed on campus but are greatest when they are off campus and mixing in households. The shared sense of community can be harnessed to encourage compliance among students.

Quarantine is seen as a major imposition – making decisions based on compliance will provide increased justification any policy changes. Part of the challenge is the lack of data on whether people will comply with shorter quarantine with testing (e.g. 10 days isolation). This also highlights the importance of conducting research into the effectiveness of non-pharmaceutical interventions.

Action:Group members have until Thursday morning to provide comments on [Redacted]’s paper, before this is sent up to the Chief Medical Officer. Secretariat to provide support where needed.

Action: [Redacted] to draft a paper on compliance in the general population for next Monday.

Future deep dive

The Chief Medical Officer has noted his interest in planning a future deep dive with Sir John Bell on immunology, reinfection & vaccines.  

Subgroup updates

Education – group keeping an eye on emerging evidence with the support of Public Health Scotland with reviewing latest evidence. Communication around schools will be considered by the subgroup tomorrow.

PHTAS – the advice on vaccination and winter preparedness has been put forward and Harry Burns will meet with the Cabinet Secretary to discuss this.

Testing– the group is considering waste water testing and mass testing. The group has noted the need to clarify the purpose of mass testing needs to be made clearer.

Nosocomial group  - impact of two metre rule as a NHS remobilises, balance of harms for patient flow and activity have been discussed. A review of evidence around two metres took place. The group will next look into drug resistant infection, antimicrobial indicators, and ensuring healthcare settings are as safe as they can be going into winter.

The Chair noted the huge volume of high quality work done across subgroups.

Action:Secretariat to circulate final advice from PHTAS once this is completed.

SAGE update

HE/FE are big issues at SAGE. Adherence and low levels of self-isolation. R and growth rates being estimated with growth in the UK between 1-2% per day. Other topics discussed were: Concerns of importation, immunity, transmission in young people.

Official estimates of R – R estimates are historical. SPI-M does not believe that R is currently below one in the UK (lag indicator).

AoB

National core studies – enabling research across 5 major themes with data being central to it. Important that Scotland is at the table and for this group to be given updates.

Broader representation from Scotland needed on UKRI panels. There is a need for more clarity about the role of those on these panels in conveying information back to the Scottish Government.

Action: The Chair to keep the group updated on national core studies.

Summary notes

Officials conveyed that the Chief Medical Officer and Ministers continue to be grateful for the advice they receive from the advisory group. They also recognised the huge voluntary contribution of group members. Group members noted this and expressed their support for the group moving to fortnightly meetings.

Group members considered some draft topics for a Future Work Programme as part of a broader discussion of topics it will consider in the coming months. Group members agreed this would remain flexible to allow for urgent topics and new commissions for advice to also be considered. 

The group received a brief presentation on data from the EAVE study. Data from this study provides insights into changing patterns of the epidemic in Scotland. Further information on this study can be found on the Health Protection Scotland website. 

The group discussed the issue of adherence to Covid-19 guidance, which has been increasingly prominent in the media. Group members noted that compliance is not a homogenous issue and there are many reasons an individual might not comply with guidance. The group recognised the importance of dialogue with all population groups and the need to avoid looking to place blame on specific groups for the rising case numbers.

The group received updates on the work of the Education and Children’s Issues subgroup and the Public Health Threat Assessment Subgroup as well as the Testing and Nosocomial groups.