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

Attendees and apologies

Advisory Group members

• Andrew Morris

• David Crossman

• Sheila Rowan

• Chris Robertson

• Mark Woolhouse

• Angela Leitch

• Jim McMenamin

• Tom Evans

• Stephen Reicher

•  Aziz Sheikh

• Devi Sridhar

• Jill Pell

Invited attendees

• Mary Black

Scottish Government

• Roger Halliday
• Niamh O’Connor
• Richard Foggo
• Daniel Kleinberg
• [Redacted]
• [Redacted]
• Audrey MacDougall (deputising for Roger Halliday)

Secretariat

• [Redacted]

Items and actions

• minutes
• summary note

Minutes

Welcome and apologies

Chair welcomed all group members. [Redacted] deputising for CMO and [Redacted] deputising for [Redacted]. The Chair welcomed Richard Foggo to the group.

Apologies – [Redacted]

Minutes, action points, Chair update

Chair confirmed actions from the last meeting. He informed the group he had met with FM earlier that day and that the Advisory Group would be writing to First Minister, in partnership with lead policy Directors in Scottish Government, in the future with recommendations.

Richard Foggo noted how evidence-based the policy response has been so far, noting the importance of continuing to use the evidence as we move through the coming stages.

Chair noted that we are moving to a point where the wider economic and social implications of COVID-19 are becoming apparent.

CSA update

[Redacted] noted her role as Chief Scientific Adviser engages her with different sectors in government to examine the impacts of COVID-19 across sectors. She can provide links in with other non-medical disciplines to establish the impact of COVID-19 (e.g. environment).

Action: Secretariat and chair to agree mechanism to distribute SAGE papers to the group and where papers can be stored.

SAGE update

Chair provided an update on SAGE.

Chair referred to SAGE discussion on testing using antigen and PCR testing. It was suggested in SAGE that the second phase of testing would consider how testing could be deployed in terms of case isolation and contact tracing. With regards to antibody testing industrial-scale tests are not yet available.

The chair noted the Office for National Statistics (ONS) paper that had been circulated, in which early modelling is beginning to be underway to consider excess deaths from COVID-19 as well as from additional pressure placed on the healthcare system, changes to healthcare activity and the impact of the pandemic on economic activity.

[Redacted] raised a question on the pause of routine care in the NHS and routine appointments done by phone and the need for guidance on this for practitioners. The chair commented that SAGE work on this was focussed mostly on quantifying the impact of this shift, particularly with regards to lack of presentation for issues such as acute cardiac issues.

[Redacted] noted the need to better understand the concerns of frontline health professionals such as PPE, and how to proactively address these.

The chair asked whether we are quantifying impact of displacement on other activities. [Redacted] indicated that this is being done through the Scottish Government Health and Social Care Analysis hub, in collaboration with partners including PHS. [Redacted] informed the team about the government’s hub structure and the connections between the COVID-19 corporate analytical team receives from other related teams, allowing them to engage and join up with other sectors.

[Redacted] noted existing knowledge gaps in remote care. He commented that data on new cancer diagnoses will have decreased due to paused screenings though this is likely to be reflected in a future upturn. Having health hubs monitoring deficits of usual business will help us manage the transition post-lockdown. [Redacted] noted that dips in care may require additional care later, or may lead to additional mortality.

The chair highlighted a further point from SAGE of rising concern on nosocomial transmission.  Nosocomial transmission rates vary between hospitals (eg UCLH 8%, Cambridge 20%). Work is underway in NHS England Trusts to establish best practice around this. [Redacted] noted that current SPI-M models are not set up to incorporate nosocomial transmission. [Redacted] also commented that there is existing concern from patients that they are at greater risk from COVID-19 in hospitals and this is become heightened once this information is made public. The chair noted the importance of nosocomial transmission and the need to establish potential consequences for Scotland’s hospitals and care homes.

[Redacted] asked whether discussions at SAGE considered exit strategies. The chair noted this would be discussed by SAGE the following day and the importance of the Scottish Government being directly involved in these discussions. The chair expressed his appreciation for the comprehensive work done in Scotland thus far and thanked Daniel for his work on this.

Richard Foggo offered to provide updated to the group on topics such as nosocomial transmission. He noted the Scottish Chief Nursing Officer and National Clinical Director sit on the nosocomial group. [Redacted] mentioned that nosocomial transmission is also being incorporated into modelling.

The Chair welcomed [Redacted] who joined the call.

Action: Secretariat to link existing Nosocomial Transmission policy leads (CNO – Fiona McQueen) to existing activity reported via SAGE on best practice in managing COVID-19 patients in hospitals. 

Consequence of shutdown

The Chair thanked [Redacted] for the discussion paper shared. [Redacted] outlined that prior to COVID-19 life expectancy gains had stagnated. Current positive impacts of social distancing measures include improvements in emissions and road traffic accidents. The government’s interventions to flatten the curve have been important to reduce mortality but the negative economic impact will have marked negative impact on health and inequality. The paper included a number of recommendations for how to influence health and wider policy areas, taking the opportunity to address health inequalities that emerge from this. [Redacted] sought the group’s input on the paper’s recommendations.

[Redacted] asked about implications of measures terms of security and human rights (policing, police-community relations) and informal community organisation. [Redacted]noted the community strength started with Beast from the East with a large number of community resilience organisations being established after that. Community empowerment legislation is being driven through by local authorities and partners.

[Redacted] noted that SPI-M has inputs from a wide range of modelling teams, not just Imperial modelling and asked the chair whether a paper like [Redacted]’s has appeared at SAGE. The chair commented that the first paper to appear at SAGE had been the ONS paper.

[Redacted] noted that there is significant interest in points raised in the paper from groups such as academics and expressed the need to harness these interests and engage these groups to build solutions.

[Redacted] questioned whether papers shared in the group were aimed at shaping policy or commissioning further research. [Redacted] and Richard Foggo noted that government is considering points raised in the paper and expressed that the paper should feed into broader thinking. Richard Foggo noted the impact of language – speaking of balancing rather than trade-offs.

[Redacted] noted that paper aimed to stimulate thought. [Redacted] commented that while long term issues are clearly incredibly important, there are urgent issues also to address. In the last week of full reporting there were almost 800 care home outbreaks in England. It is important that we address the issues of today as well as tomorrow.

Action: group members to consider contacts that can support in fleshing out the paper and its practical recommendations.

Action: Scottish Government to ask SAGE secretariat to include Scottish representation on the group looking at the long term consequences.

Exit strategy

[Redacted] discussed exit strategies in connection with modelling noting that SAGE has only begun looking into this and is only starting to model exit strategies. [Redacted] expressed his concern that models do not currently incorporate shielding and questioned whether the top-down models no longer had the same level of utility.

[Redacted] asked to note that as we start to talk about exit strategies and shielding the World Health Organization recommendations state that lockdown should be maintained.

[Redacted] noted that logistics modelling includes care homes.

[Redacted] commented that we don’t yet know who we would need to be shielding, commenting that latest information suggested body mass index was an important risk factor. [Redacted] raised the option of a test-trace-isolate strategy with border control.

 The chair asked Richard Foggo to comment on the support the group can offer Scottish Government. Richard Foggo explained that Scottish Government has begun to map out different scenarios and consider the feasibility of these. He noted that there are various layers of decision making and evidence is needed at all layers.

[Redacted] stated that we don’t know what resources we have which makes it difficult to plot scenarios around testing. [Redacted] endorsed this. [Redacted] reemphasised that advisors should try their best to provide government with the data and information to make these decisions.

Action: Chair to follow-up with Richard Foggo offline to see how this group can best support decision making.

Germany

[Redacted] commented that a member of the German advisory group will join next week. Asked to get information on testing and numbers to enable the group to make better recommendations.

Action: Secretariat and Chair to include German advisory group member Q&A in upcoming agenda.

Scottish Modelling

[Redacted] updated that Health Protection Scotland were looking at modelling analysis around excess mortality. This will now incorporate real-time hospital data.

[Redacted] asked about patients admitted who end up in intensive care and how we planned for capacity. [Redacted] replied that current actuals in Scotland for COVID-19 patients requiring ICU are lower than predicted.

Data Taskforce

[Redacted] shared data including real time number of shielded patients. Work is also being done with the symptom tracker app that now has 120,000 users in Scotland allowing hotspots to be identified.

The chair outlined a call with the ONS discussing data they can provide and noting that this will allow multiple data dimensions to be overlaid. Significant challenges remain in Scotland in relation to data flows, data sharing and information governance

[Redacted] noted additional points needed to understand compliance: if people are compliant, why they are or aren’t complying and what would help people comply?

Reactive data collection could be done in a participatory manner.

Action: Chair to work with [Redacted], and Caroline Lamb on drafting key recommendations to CMO and Ministers in relation to the Taskforce.

Testing

[Redacted] noted the appointment of Annabel Turpie, Scottish Government Director of Testing. [Redacted] acknowledged that a particular difficulty with testing lies in delivery.

[Redacted] asked about serological testing. [Redacted] noted that the previous tests were not sufficiently accurate. [Redacted] asked about impact of testing on compliance noting that current language implies that once you are tested you will be able to return to business as normal. The issue of private testing and the impact on compliance was mentioned.

[Redacted] reiterated the importance of validity and accuracy, noting the significant risk presented by false-negative healthcare workers coming into contact with at-risk patients.

Next meeting

16:00 to 17:30 on Monday 13 April. Chair highlighted testing, nosocomial infection, coherence of data, and how the group supports the wider policy landscape as important issues going forwards. Going forwards, Chair suggests deep diving into issues for meetings.

Summary note

1. The Advisory Group discussed current gaps in knowledge to be addressed, including data on transmission in hospitals and the impact of the pandemic on non-covid related presentation and treatment.
2. The Advisory Group discussed the potential for unintended consequences of measures taken to counter the spread of COVID-19, noting the need for additional evidence in a number of areas. Group members discussed current research underway to better understand the potential health impact of Non Pharmaceutical Interventions on a range of health outcomes.
3. The group agreed to feed into UK-wide discussions, including consideration of exit strategies, and to consider how the research gaps identified could be addressed.
4. Updates were provided to the group on ongoing work on testing capacity, the newly-established data taskforce, and ongoing refinements to modelling.