Scottish Government COVID-19 Advisory Group minutes: 9 December 2021

Attendees and apologies

Advisory group members

• Andrew Morris 
• David Crossman
• Linda Bauld
• Graham Ellis
• Tom Evans
• Julie Fitzpatrick
• Nick Hopkins
• Audrey MacDougall
• Jim McMenamin
• Jill Pell
• Nick Phin
• Stephen Reicher
• Chris Robertson
• Aziz Sheikh
• Devi Sridhar
• Mark Woolhouse

Invited attendees

• Graham Foster

Scottish Government

• Gill Hawkins
• Daniel Kleinberg
•  Arlene Reynolds.

Secretariat: [Redacted]

Items and actions

Welcome

The Chair welcomed group members and observers to the 57th meeting of the COVID-19 Advisory Group, noting that minutes of the previous meeting would be circulated for comment prior to publication. The meeting was to discuss the developing position on Omicron in light of the latest data.

The Chair noted that a readout of the previous meeting had been passed to senior officials and ministers

SAGE update

Group members provided an update from the SAGE 98 meeting and commented on the latest available evidence on the Omicron variant. The increased confidence in the doubling time of Omicron was noted, with this now understood to be between two to three days, if not shorter. The increased transmissibility and possible faster generation time of Omicron means that it is highly likely to cause a significant increase in cases as well as increasing workforce pressures due to the impacts of increased numbers of infections and self-isolations. This could also place critical services including healthcare and education under severe pressure. Urgent action is required to avoid a huge increase in Omicron cases.

Considering data on Omicron, group members noted that preliminary data on immune escape and severity is emerging, with further data on antibody neutralisation expected to be available next week, along with estimates of vaccination efficacy for symptomatic cases. There are challenges in separating data on the effects of greater transmission and potential immune escape.

Group members highlighted the challenges of modelling possible trajectories of the Omicron variant and its impacts given the paucity of data currently available for parameters feeding into these. Modelling considered by SPI-M suggests a significant rise in hospitalisation in January, though it is uncertain when this would peak. Substantial nosocomial infections can also be expected, driven by the likely greater role of airborne transmission in nosocomial settings (and other vulnerable settings) for Omicron compared to Delta. The group noted the potential need to review guidance on the type of face covering required in different settings based on this.

The rate of increase in Omicron cases suggests that case based interventions could no longer be as effective, bringing in a need for broader population based interventions. The group noted that it will be important to consider both the sustainability of measures and the specific purpose of these in decisions to implement new protective measures.

Domestic update

The group was given a brief update on modelling by the Scottish Government. The conclusions from this are in line with those from SPI-M data. The group was then given an update on EAVE-II/PHS data. Early analysis of this based on symptomatic infection is showing protection following the third dose vaccine against likely Omicron reduced compared to levels of protection to Delta infection. This analysis will be repeated at regular intervals to increase certainty regarding these estimates. Estimates on vaccine effectiveness against hospitalisation in Scotland are at least some weeks off as few, if any, admissions to date are likely to be from Omicron infection. Further analysis, including analysis by vaccine status remains important.

The group commented that patterns from data in South African seem to be the same in Scotland. Booster vaccinations could still have a strong impact on the Omicron wave, though the extent of this is uncertain. The transmissibility of Omicron means that even if severity is no worse than for Delta it is still highly likely there will be a significant wave of cases. The impact this could have on workforce pressures in healthcare and other critical sectors was stressed.

The group acknowledged the challenge in communicating the current situation with Omicron with the public and the importance of clear and consistent messaging. It is important to provide tools to enable the public to mitigate their own risk, such as for instance the use of lateral flow tests, COVID-19 certification and of support for those required to isolate as a result of a positive test. Part of the current challenge is that while the absolute risk to individuals could decrease should Omicron infections prove to be less severe than Delta the population-level risks, including the pressure on the NHS have significantly increased with potentially severe consequences. The group recognised the importance of a joint strategy between the four UK nations, where possible, to increase the impact of and adherence to measures.

Group members noted the significant burden of harms that had arisen in the past from school closures and the importance of factoring these into any future decisions impacting the education sector. The group discussed the work of the JCVI on the vaccination of five to eleven year olds.

The group reflected on the course of the pandemic in 2022 and beyond. The group will consider this at a future meeting.

The chair summarised the discussing noting the following points:

1. We are in a very difficult point of the pandemic. The scientific confidence around the trajectory of Omicron has strengthened and the doubling time (two to three days) means we will see high cases numbers.
2. This wave will create societal pressure on the NHS and other workforces such as educational settings and the wider economy.
3. Huge uncertainty remains, further data will emerge on neutralisation and antibodies but scientific advice is that action should be taken now.
4. Substantial nosocomial infection can also be expected.
5. Models suggest a peak in hospitalisations between February and April, with worst case scenarios huge numbers of new admissions per day. Scenarios are not predictions.
6. A joint public health strategy around the UK should be considered to increase the impact of and adherence to measures, with financial support packages a part of that.
7. Daily testing in high risk populations may help mitigate the spread of Omicron whilst minimising workforce pressures from staff isolation. If daily Lateral Flow Test (LFT) testing were introduced consideration must be given to logistics as well as incentives and disincentives of this.
8. Firmer advice on face coverings/masks is advised in view of risk of aerosol spread.
9. Compliance and clear messaging around what we are trying to achieve.
10. Even a lockdown would merely delay a wave. A huge wave of infections will be seen and we must act now, being clear about what the objective of interventions are, whether these are sustainable and what the purpose of action is.

AOB

Meeting next week arranged for 17th but may need to bring forward in light of developments.