Scottish Government COVID-19 Advisory Group minutes: 2 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
• Angela Leitch
• Steve Reicher
• Nicola Steedman
• Chris Robertson Jim McMenamin
• Jacqui Reilly
• Devi Sridhar.

Invited attendees

• Mary Black

Scottish Government

• Daniel Kleinberg
• Michael Kellet
• [Redacted]

​​​​​​​Secretariat

•  [Redacted]

 

Items and actions

• minutes
• summary notes

Minutes

Welcome and apologies

The Chair noted apologies from CMO and Jason Leitch (who joined the meeting towards the end) and welcomed Michael Kellet and [Redacted] who were attending as observers. The Chair passed on CMO’s thanks for the group’s advice on BAME, distancing and superspreading as well as their participation in the Deep Dive.

The paper on publication of the Group’s advice was noted, highlighting that the Group’s advice on distancing and superspreading had been published earlier that day on the Scottish Government website. The secretariat will prepare a further paper on publication on any subsequent developments.

Minutes and actions of previous meeting

The minutes were agreed; the Chair noting that all actions had been delivered on.

Action: Niamh O’Connor to report back to the group on action taken on the group’s paper on Testing.

Age stratification for risk

The epidemiological data in the paper shows that age risk overall hasn’t changed, with the greatest risk being for the elderly. Age is also linked to severity of infection (shown by CO-CIN data - work is being done on this). Issue of aging is biological and age is much more important than other factors. There is a need to consider biological as well as epidemiological factors.

On gender, ECOSS shows a large number of women in 40+ age group being tested, possibly health & care workers. There is speculation that gender differences may be related to propensity for being tested but the reasons for the differences in outcome are not currently understood.

It was noted that there was some conflation in public discussion of the risk of getting infected vs the risk of spreading infection. Work being done in the EAVE-II study over the summer will help better understand morbidity. That depends on work being done on linking with hospital data. GP records are also being looked at.

As we understand more about risk factors we need to consider how we can use that to inform policy. The NERVTAG  protocol, which had been circulated, takes 100 factors into account and may be part of the answer. Work is being done on public communication with the intention of going live shortly. Once the code is released, work to validate the model’s use for Scotland can be done rapidly.

It was noted that COVID-19 had a severe impact on those living in poverty. That and the gender differences suggested some parallels with experience/treatment of women who have heart attacks. Local background risk is an important consideration but employment not currently factored in. Also, dose is an important predictor of outcome but algorithm doesn’t take that into account. These and other factors could be added to the algorithm as it is developed. Important to acknowledge different types of harm. Young are at low risk now but will be most impacted by long term impacts.

To make best use of this in the Scottish context there would be a need to use the algorithm to validate it and look to iterate it to develop it. It would also need work to integrate with existing systems. If the model could show the impact of modification of risk that could be a powerful tool, as it is for the cardiovascular calculator – this may be done later.

Communication and public understanding of risk

Mapping comparisons with other countries shows Scotland has been fairly typical of the  epidemic experience, showing an average increase trend and decrease trend. Now that we are emerging from lockdown at a similar point to that when we went in, what are the improvements? No vaccine as yet, but do have a functioning Test & Protect – will that be enough? We also have a better understanding of the virus and the risks, which partly explains behaviour change, but that knowledge has been very hard won.

Some things have not changed – the lower risk outdoors compared to indoors was discussed at the group’s first meeting - crowded beaches are bad visuals as there have been no recorded outbreaks of COVID-19 linked to a beach. The first meeting also discussed the much lower risk for children compared to adults. However, this doesn’t appear to be widely understood – a recent presentation at Moray House indicated that not all teachers understand the low risks to children and that COVID-19 is predominantly a disease of the elderly. Individual management of risks is important. SPI-B are concerned about influencing behaviour but the group needs to promote transparency and consider what information people need to make good decisions and adopt behaviours that will decrease the risk of second wave.

Perception of risk matters enormously; people will not follow onerous rules if they believe risk has gone. Some theory raises concerns that people panic if given too much information but pragmatic studies show that most harm arises from lack of information. That underlines the need to communicate openly and clearly. Trust is essential and bound up with sense that authorities are acting for and with the people. Coming out of lockdown is much more complex than going in. By and large young people have complied but will be most affected in long run. Generational equity is important, alongside race and class.

There is a need for risk to be understood – what the risk is and to who? Measures may not make sense at individual level but do at a community level. Compliance does not correlate with individual risk, but with community risk and can build on community norms (understanding what we should do combined with examples of what we do do). People avoid risk that loses them a ‘gain’ – need to make clear there is a risk that the gains of Lockdown could be lost. There is a need to be clear about issues around trust and equity, build on community norms, respect the public and present information in a useable way. The group acknowledged that Scottish Government communications at daily briefings appeared consistent with this approach.

Messages can’t be all population; young people react differently. Helpful to have role models and local people involved. We know from other public health campaigns that fear doesn’t work. Comms need to be really simple and really consistent, though people sometimes evaluate what they hear on the basis of what they want to do. Important to note that the significant reduction in cases in Scotland isn’t because of drugs but due to other activities.

SAGE are concerned about impact of pubs reopening. Group needs to consider how we move forward in a way that enables and empowers compliance with NPI measures to address risks of lifting Lockdown. Will look to pull together science on risk stratification, the useful tools (NERVTAG  and others) and the behavioural science components that we feel will encourage compliance. Baroness O’Neill’s work emphasises the need to be Honest, Reliable and Competent. Helpful to capture detail such as relative age risks 15 to 24, morbidity & viral load.

Action – Secretariat to commission a draft paper on risk issues to be brought to the next meeting.

Subgroup updates

The Chair of the Education & Children sub-group reported that their draft advice had been discussed at their second meeting and at the Education Recovery Group (ERG), where there was a warm welcome for the approach balancing COVID-19 risk with wider risk to children. A clear theme was the importance of public understanding of the science. The ERG, including parents’ representatives,  would welcome this being clearly set out. The group has started to look at school transport and will look to make the right links to make sure there is consistency with the science underpinning advice on public transport.

The Chair of the Threat Assessment sub group noted that today’s discussion on risk was very relevant to the sub group’s task of looking at the issues arising ahead of the winter. He noted the importance of a local public health focus and the need to be engaged with testing. Membership of the group would include an emergency planner, police and environmental health representatives as well as public health expertise. The message from the group’s discussion that identification with communal norms could be a more effective way to communicate with the public was important as taking forward the sub group’s work in a way that was supportive of developing a better Scotland was an important theme for their work.

The chair noted the importance of appropriate data being provided quickly to target local virus spikes and noted that the sub group should be well placed to empower that. The chair of the sub group agreed, noting the potential for an overly top down approach to limit local effectiveness when traditional test and trace is a proven and very effective community intervention.

CSA update

The CSA had been engaging with the Education sub group and ensuring that they had access to appropriate advice from SAGE on relevant matters. It was noted that SAGE had commissioned a universities paper and SPI-M are aware of a number of groups modelling Universities returning.

SAGE update

A note had been circulated to the group. Key issues were:

• the R number in Scotland was lowest across UK – though there are limitations on the use/reliability of R with low incidence
• there had been a big issue around data flows – eg Leicester – the JBC would be the main source of data in future
• there was a good paper on immunity but issues are complex and the science still developing
• the virus is mutating – strain D from China but G is now the most prominent in the UK – G is more transmissible but not more lethal - hand washing remains very important. Noted that Transmissibility would be discussed at Testing subgroup the following day
• there was a paper on the potential for disorder arising from a second wave

Future agenda items

The paper tabled was noted. In response to a question about contact tracing it was noted that the larger clusters came from nosocomial outbreaks, including the majority of those in Dumfries & Galloway which originated in a Carlisle hospital. There were some other imported cases that were being investigated. Routine reports were now being produced. The most exciting news seemed likely to come from advances in genetic serology.

Action: to arrange for appropriate data from regular reporting to be shared with the group

Action: group to consider receiving a presentation on this issue at a future meeting. The chair thanked [Redact] for making this offer.

The Chair noted that the BBC website has a link to the group’s advice on distancing and thanked the secretariat for assistance with publication of the advice.

Summary notes

1. The group discussed issues relating to risk. Age is a most significant factor, with the greatest risk being for the elderly. Age is also linked to severity of infection. There is a need to consider biological as well as epidemiological factors. Work is underway to better understand gender differences. Ethnicity and deprivation are also important issues. It was noted that there was some conflation in public discussion of the risk of getting infected vs the risk of spreading infection.

2. As more is understood about risk factors, it should inform policy. Tools being developed will assist with that. It is important that any tools developed at UK level are validated for use in Scotland as rapidly as possible and integrated with existing systems. Local background risk is an important consideration. Important also to acknowledge different types of harm. Young are at low risk now but will be most impacted by long term non-Covid impacts.

3. Individual management of risks is important and people need reliable information to make good decisions and adopt behaviours that will decrease the risk of a second wave. Pragmatic studies show that most harm arises from lack of information. That underlines the need to communicate openly and clearly. There is a need for risk to be understood – what the risk is and to who? Measures may not make sense at individual level but do at a community level. People need to be aware that there is a risk that the gains of Lockdown could be lost.

4. The group heard that the Education & Children sub-group had discussed their draft advice and briefed a meeting of the Education Recovery Group. A clear theme was the importance of public understanding of the science. The group also heard from the Chair of the Public Health Threat Assessment sub group and the Chief Scientific Advisor, as well as hearing feedback from SAGE. The group heard a report on the outbreak in Dumfries & Galloway and noted the importance of appropriate data being provided quickly to target local virus spikes.

5. The chair noted that the Group’s advice on distancing and superspreading had been published earlier that day on the Scottish Government website.