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

Attendees and apologies

Advisory group members

• Andrew Morris
• David Crossman
• Graham Ellis
• Tom Evans
• Julie Fitzpatrick
• Nick Hopkins
• Audrey MacDougall
• Jim McMenamin
• Jill Pell
• Stephen Reicher
• Jacqui Reilly
• Chris Robertson
• Aziz Sheikh
• Gregor Smith
• Devi Sridhar
• Nicola Steedman
• Mark Woolhouse

Invited attendees

• Cat Carver
• Linda Bauld

Observers

• Graham Foster

SG

• Daniel Kleinberg
• Jason Leitch

Secretariat: [Redacted]

Items and actions

Welcome

The Chair welcomed group members. The Chair noted that Carol Tannahill will be retiring from her role as Chief Social Policy Advisor at the end of September. The Chair thanked Carol Tannahill for all her work on the COVID-19 Advisory Group and as chair of the subgroups on Education and Children’s Issues and on Universities and Colleges.

Minute and Actions of previous meetings

The minutes from the previous meeting will be published on Friday 10 September.

Public inquiry – overview

Ian Donaldson provided an introduction on the upcoming inquiry into COVID-19. Ministers have made a commitment for a statutory inquiry into the handling of COVID-19. This will be led by a Judge and start by the end of 2021. This inquiry will also seek to collaborate with the UK Government inquiry. The UK Government has also made a commitment for an inquiry into the handling of the pandemic. That inquiry will start in the spring of 2022.

Further details on the Scottish inquiry have been published on gov.scot..

Group members noted the importance of ensuring lessons are also drawn from the experience of the C-19 Advisory Group throughout the pandemic to inform future pandemics preparedness.

State of the pandemic

Domestic update

Jason Leitch provided a brief overview of state of the pandemic from the Scottish Government’s perspective, noting the increase in cases that has taken place in the past few weeks and the decision not to re-impose restrictions at this stage. At the same time as the C-19 Advisory Group meeting, a motion was being debated in the Scottish Parliament regarding the introduction of vaccine certificates in specific settings.

The situation is different in each of the four nations, with hospital capacity coming under strain in Northern Ireland, Wales, and Scotland but not currently to the same degree in England.

The group noted the JCVI advice on vaccinating 12-15 year olds and the current work of the UK Chief Medical Officers to provide further advice on the vaccination of 12-15 year olds. It was noted that with the current level of COVID-19 present in the population and with the disease now being considered endemic, it is likely many individuals will catch COVID-19 at some and possibly multiple instances in their lifetime. This is likely to continue to present challenges, particularly in terms of hospital and ICU capacity. The group noted the significant pressure facing frontline health and social care staff and the importance of taking this into account in plans for health and social care delivery.

Group members noted that Covid measures have generally been described as restrictions. Moving forward many measures may be more appropriately described as protections, similar to those in place in industries to regulate the production of goods and the delivery of services for consumer safety. Public engagement is taking place across industries to support enhanced levels of protection. The group acknowledged the important work carried out by environmental health officers. Targeted communication continues with different population groups.

R in Scotland is between 1.2 and 1.5. The growth rate is between 3 and 7%, a slight decrease from last week. Cases might currently be plateauing, with hospitalisations rising. Looking ahead, pressure on hospital beds will continue to increase as cases already in the system develop. Test and protect capacity continues to be under strain. Waste water analysis currently indicates that there may be a higher level of cases than is being seen from PCR testing results. Usually, waste water and PCR case levels track each other. Work is ongoing within the Scottish Government to understand the reasons behind this discrepancy. The relationship between detected cases and true cases is still difficult to assess, as seen when comparing test data and ONS survey data, though it is likely the ratio is the lowest it has been in the pandemic. Case numbers are currently very volatile. The importance of surveillance was stressed, including through continuing to encourage the use of twice weekly lateral flow tests in the wider population. The group noted the importance of continuing to consider how to attenuate the risk given current case numbers and rising pressure on hospitals.

Modellers noted that there are significant challenges to building COP26 into modelling long term, given the exceptional nature of this event. Group members considered the level of interaction between attendees and the wider population and the impact fringe events and protests during COP26 may have on the course of the pandemic in Scotland. Data is showing variable impact between events, for instance when comparing the impact of the Euro 2020 and Silverstone. It is important to recognise the heterogeneity of events. COP26 will present unique challenges and the group noted the importance of recognising the potential scale of risks posed by this event and the pressure this could add to the system. 

The Group reiterated previous advice, and that of SAGE, of the importance of acting early to slow a growing epidemic. Early, less disruptive interventions may reduce need for more restrictive measures and avoid an unacceptable level of hospitalisations. Late action is likely to require harder measures.

[Redacted]

SAGE update

The group was given an update of the discussions that had taken place at SAGE earlier that day. Data from Scotland was considered at SAGE in a discussion of why the trajectories across the 4 Nations are different and what the causes of increased case rates in Scotland as this does not appear to be being primarily caused by schools.

International update

There are three key issues emerging in discussions with international counterparts. The first is to consider in the context of high vaccination coverage, what the key metrics are to consider and when the situation would allow the end of the acute phase of the response to the pandemic; secondly, whether to vaccinate children and the impact of the rise of cases in children; and thirdly, whether boosters are needed for vaccination against COVID-19 and what the evidence base is for these. The group recognised the importance of continuing to engage in international scientific forums.

In countries where vaccines are widely available, there appears to now be consensus internationally to avoid future lockdowns as much as possible, and continuing with vaccination, testing and contact tracing efforts.

Early WHO data comparing impact of different vaccination programmes across the EURO region. When comparing observed and expected rate of infection, vaccination programmes that have had maximal benefit in terms of deaths averted are those with the highest uptake. The group noted the high vaccination coverage of 18+ in Scotland and the importance of continuing to encourage uptake in those who have not yet been vaccinated.

The group briefly discussed paediatric hospitalisations, where there are concerns that pressure from flu, respiratory syncytial virus (RSV) and COVID-19 could place significant pressure on hospital and ICU capacity.

Subgroup updates

Universities and colleges

This group will meet next week.

Education and children

The education and children’s issues subgroup met earlier this week. The subgroup noted the steep rise in COVID-19 infections in children. The group discussed the current approach to contact tracing and mitigations in school.

Nosocomial

The last meeting of the COVID-19 nosocomial review group (CNRG) considered that the nosocomial risk currently remains low, despite higher transmissibility risk with Delta and increased COVID-19 hospitalisations. The subgroup undertook a deep dive into hospital data and provided advice to CNO on all the required caveats in interpreting these data. The work of the sub group work on infection control in the built environment was completed, with future work underway by a new NHS NSS group on how to optimise ventilation in hospitals. Work is ongoing on IPC respiratory pathway guidance for this winter. Work from the CNRG subgroups on behavioural insights and on future preparedness will be reported at the next meeting on 17/9/21.

The Chair noted the quality of outputs from the subgroups and thanked their chairs for their work.

AoB

The group will consider whether to meet again in a fortnight, based on emerging data.

The Group noted that talking about the harms and pressures on different parts of the system can seem abstract but the scale and intensity of the impacts of pressure on parts of the system would have greater salience when spelled out.