Scottish Government COVID-19 Advisory Group minutes: 9 July 2020

Attendees and apologies

Advisory group members

• Andrew Morris
• David Crossman
• Aziz Sheikh
• Mark Woolhouse
• Roger Halliday
• Carol Tannahill
• Harry Burns
•  Jill Pell
• Tom Evans
• Steve Reicher
• Gregor Smith
• Chris Robertson
•  Jim McMenamin
•  Jacqui Reilly
• Sheila Rowan

Invited attendees

• Mary Black

Scottish Government

• Daniel Kleinberg, [Redacted]

Secretariat

• [Redacted]

Items and actions

• minutes
• summary notes

Minutes

Welcome and apologies

The Chair welcomed [Redacted] who joined to observe the discussion on winter preparedness.

Apologies – [Redacted]

The Chair mentioned hot topics from the SAGE meeting noting the open letter to the WHO and the need for further clarity from the WHO on the issue of airborne transmission. The matter would need to be considered further by SAGE/NERVTAG before it might usefully come to the Group.

Minutes and actions

All group members were content with minutes. Testing will be revisited next week. [Redacted] has organised for the Public Health Scotland SitReps to be circulated.

Action: Secretariat to include testing in next week’s agenda.

Action: The Chair to share English SitReps with the secretariat for these to be made available with group members.

Winter preparedness

A paper was produced by Harry Burns for discussion today with the group.

Group members discussed the possibility of a coincidental outbreak for flu and COVID-19 this winter. It was noted that Australia has not so far encountered the expected volume of flu cases, possibly due to COVID-19 suppression measures as suggested by epidemiology data.

There will be an increase in the number of people concerned about COVID-19 symptoms who have a cold or flu. This is likely to place an added burden on testing and will need a clear strategy to ensure that primary care and testing are not overwhelmed by higher demand. Clear instructions will be needed for those phoning NHS24 with COVID-19 symptoms and testing will need to ensure that rapid and accurate results are delivered to those with symptoms. This will require multiplex testing.

Also important is that patients are not deterred from attending their GP surgery for non-COVID-19 health issues. 

The group discussed whether the list of those who receive the flu vaccine should be expanded. Groups that could be considered for inclusion are those aged over 50, and teachers. There may need to be procurement of additional flu vaccine supplies if vaccination is extended to additional groups.

It was noted that public misunderstanding around the flu vaccine persists.

Clear public communication will be needed to reinforce that vaccination is about protecting the NHS and appealing to a sense of public duty could increase vaccination uptake.

Covid symptom complex – this is being reviewed by the four UK CMOs.

Group members noted a paper being drafted by NERVTAG on respiratory viral infections and interactions with COVID-19. The AMS paper was discussed. The recommendations in the paper are in line with the group’s discussions.

Action: [Redacted] will contact Directors of Public Health and others to plan for the practicalities around preparing for winter and report findings in three weeks’ time.

Action: [Redacted] to share NERVTAG paper once this is available.

Data and intelligence for local outbreak management

Scenario planning for winter is being undertaken by the Scottish Government COVID-19 Analytics Hub.

A research service is being developed, bringing in granular data to enable public sector partners to raise questions to better understand the path of the virus.

A dashboard that brings together Test and Protect data to make it available to local contact tracing teams is now live. Currently this takes too long (36 to 48 hour in some cases) but also because information is inconsistent as it comes from different systems. Public Health Scotland and Health Boards are working on this.

Now in place are a range of early warning indicators that make information available at a relatively low level of geography. The Scottish approach focusses on allowing those who need the data to access it, to be able to build a local picture. The system went will be expanded with additional data later this month.

A challenge noted is that dashboards currently do not include epidemiological interpretations, it was noted that this would be a useful addition.

A forecasting model is being worked on that includes travel patterns and the interconnectedness of neighbourhoods. It should be ensured that data flows allow hospitals and care homes to access this. Data integration from a wide range of sources remains a challenge. Roger Halliday noted that he would like to seek input from group members to gain a better understanding of the relative risks of local covid-19 risks and other sociodemographic and situational risks.

The group briefly discussed using waste water sampling as part of early indicators, similarly to how this is done for polio. Analysis of sludge from sewage works has been promising and there is developmental work ongoing with to include this in future analysis.

Sequencing will be important to help provide epidemiological links between outbreaks.

The group was informed that the Scottish Government will begin working with the JBC.

The Chair noted that DELVE data scientists may be able to provide support with data integration. 

Action: [Redacted] to provide access to dashboard to group members.

Paper on risk

Local area COVID-19 risk is something the government is looking to make public. Input would be welcomed from group members to ensure the messaging is right on this.

The Chair asked how policy colleagues are discussing risk, noting that Wales has a taskforce that considers risk. The Scottish Government assesses the risk in relation to the four harms, as each review point is approach. This is then published on the Scottish Government website.

SAGE is discussing the concept of COVID-19 security – a scoring of different environments and the risk these present.

The group discussed the QCOVID algorithm, noting that it does not take into account background risk but a future iteration of the algorithm will hopefully include this. It is important to determine how this tool will be used by clinicians as the tool is not planned to be public facing.

The use of tools in the stratification of high risk groups and health and social care workers was discussed, noting that a Welsh Government tool for this is now live and used to determine whether patient-facing work should be carried out by individuals. The British Medical Association has asked for this type of tool to be implemented. The group noted that this type of tool will be needed in Scotland.

A tool to manage risk can be very valuable to clinicians, examples include tools used in cardiology. Tools such as these are effective at modifying behaviour and are particularly useful to show that you are being consistent in your actions across population when you can demonstrate that someone is above a risk threshold. It is important that interventions to mitigate risk are clearly articulated, along with the provision of resources for these.

Group members noted a forthcoming Public Health Scotland paper on this topic.

The durability of non-pharmaceutical intervention adherence was noted as a useful deep-dive.

Action: Secretariat to review final paper and prepare this to be shared within CMO.

Subgroup updates

Education subgroup – advice on physical distancing is scheduled to be published next week. The Education subgroup Chair commented that their group’s stance is less risk averse, particularly for older pupils than other UK nations.

School transport now being looked at – dedicated school transport should be treated as an extension of the school day.

ELC and childcare settings – subgroup view is that risk in these settings is very small and benefits of children attending these are significant. Lots of attention on what is being said about children being able to mix in different settings.

School outbreaks are actually more related to transmission that will have happened at home. An additional paper on schools is being drafted by SAGE.

Group members commented that risk communication is important on these issues. Risk is slightly higher for older children but absolute risk is still very low. Public perception also important, risk misconception is very high.

In the light of the earlier update on transmission and the relative position taken by the subgroup, [Redacted] asked if there was any view among group members that the approach taken by the subgroup could not be supported by the main advisory group. She received the Group’s ongoing endorsement.

CSA update

CSA is working with the education subgroup to draw together their advice on schools.

SAGE update

Airborne spread was discussed at SAGE.

Schools paper – discussion of practical issues in terms of school reopening. Bubbling no longer being used as a word – segmentation instead.

Symptoms in children are apparently slightly different than what they are in adults.

Schools transport modelling is being performed by the UK Government, with capacity expected to much lower than normal. Staggered starts are being considered in some areas .

For higher education, halls of residence are a distinguishing feature, along with high numbers of international students. If a student becomes ill, they should be encouraged to quarantine at university rather than go home and risk moving the virus to a new area.

Future agenda items

The Chair suggested testing and contact tracing would be on the agenda for next week.

Summary notes

The Advisory Group discussed winter preparedness and provisions that will need to be in place when flu season begins. The group considered the groups which are currently eligible for the flu vaccine and whether there may be benefit in additional groups receiving this. Part of the discussion touched on current public perceptions around the flu vaccine and the importance of clear communication supporting uptake. The possible impacts on testing for Covid were discussed.

Information on new and upcoming data dashboards was presented to the group. These dashboards aim to provide local health protection teams with a better understanding of the paths of the virus. The inclusion of early warning indicators at a low level of geography also supports this. There are some challenges around the integration of data from a wide variety of sources but work is ongoing to address this. 

The role of testing waste water and sewage was discussed. Currently waste water is used for monitoring of disease such as polio. Work suggests that there may be similar potential for covid-19 monitoring. 

The group noted that sequencing will continue to play an important role in providing the epidemiological links between outbreaks. 

The group noted the need for further research and clarity on the importance of different transmission routes of COVID-19. 

Last week’s discussion on risk and risk communication was continued. Group members noted the launch of the #We Are Scotland campaign. As policy is developed it will be important to distinguish between relative and absolute risk for different groups. 

The group received updates from its subgroups as well as from group members attending SAGE. The group will continue to support the Education and Children’s issues subgroup as it finalises advice on schools.