Attendees and apologies
Advisory group members
- Marion Bains
- Harry Burns
- David Crossman
- Tom Evans
- Roger Halliday
- Angela Leitch
- Andrew Morris
- Jill Pell
- Jacqui Reilly
- Chris Robertson
- Sheila Rowan
- Aziz Sheikh
- Devi Sridhar
- Carol Tannahill
- Mark Woolhouse
- Daniel Kleinberg
- Lesley Sheppard
Items and actions
Welcome and apologies
The Chair noted apologies from Nicola Steedman and Jim McMenamin and welcomed Colin Ramsay, who was attending in his place. The Chair also welcomed Lesley Sheppard and [Redacted], who were joining the meeting as observers.
Minutes and actions of previous meeting
There were no comments on the minutes. The Chair thanked members for taking forward advice on testing and ethnicity and noted that the group may be asked for a view on issues related to care homes which are being considered by the Nosocomial sub group.
Carol Tannahill, chair of the sub group, gave an overview of the group’s remit and the discussions at their first meeting the previous day. Members noted the importance of monitoring and having the right surveillance data in place, the value of international experience and agreed that advice needed to take account of the balance of risks. Communication of those risks needs to be clear, with the science and balance of risks explained. One of the ways to spread social norms is through children and schools can be a positive way to spread safety messages. There was a clear consensus amongst the group of the benefits of making a clear statement to the public.
Advice to First Minister and deep dive
The group agreed that the draft advice on physical distancing and superspreading did a good job of emphasising the different points, keeping balance and focussing on the science. The role of the group is to advise on the science and balance of risks and the advice needed to make clear recommendations.
Overall, the science hasn’t changed. Without a vaccine, physical distancing is one of the best tools to reduce risk. Reducing from two metres means a higher risk that transmission will occur but there are ways to reduce that through hygiene, barriers, masks and time of exposure.
Need to acknowledge that the context is different from previously with reduction in infections in Scotland reducing the contextual risk of infection. That should remain the case with good quality data and monitoring helping ensure that Test and Protect is effective in containing outbreaks.
Important also to understand that risk is very heterogeneous – need to be much more careful with grandparents than with grandchildren and there are major differences between indoors and outdoors. Time is important, especially indoors, as it tends to increase number of exposures. This heterogeneity is important; it means that blanket measures do not work and makes advice more difficult as risks are really not straightforward at all.
Two young adults meeting outdoors will be at significantly less risk compared to an elderly person meeting their family indoors. The risks are many times (orders of magnitude) higher in the latter case. A single set of simple advice cannot cover both and there are dangers in compromise – increased risk for those needing more protection and increased inconvenience for those who need lower. Known risk factors for morbidity as well as mortality are also important, for younger people as well as older.
Clarity of message is important - there is a need to be clear about specifics of any changes and the advice should be applied consistently. Important that any changes do not signal that we are ‘back to normal‘ as that could have a disastrous impact on compliance. Very clear from outbreaks elsewhere that there are risks in lifting restrictions which will have to be managed. Messaging should help people think for themselves about the risk factors if people are to take responsibility for their own safety.
The advice on superspreading needs to be clear that this is about ‘roles’ and not the person. The narrative should be clear that it can be driven by environmental factors and social factors. It was also important to be clear about definitions of superspreader, outbreak and cluster.The group discussed arrangements and final preparations for their meeting with First Minister the following day (subsequently re-arranged for the following Monday), which was to provide advice on physical distancing and testing.
The group noted that the epidemiological situation was changing around the world. UK legislation discussed at a previous meeting was now place. The group agreed that quarantine arrangements made most sense where infection rates are low and they can act to protect against import from high infection areas. It was important to understand the evidence on the number of imported cases to Scotland and where they came from. At the time of discussion there were around 110 new daily infections and 1400 infectious people, though this was a changing picture. The effect of overseas travel is generally very small, and even less so at present, given current restrictions. Things will be likely to change when restrictions are eased. Flight manifests can be difficult to access and do not provide all the data that might be desirable e.g. on seating. In practice, the main source of risk is likely to remain visitors arriving in Scotland by car or public transport.
CSA noted that discussions about SAGE’s role on coronavirus were continuing, recognising that it was an on-going need rather than an emergency response.
The Chair noted that the main points are that key measures on nosocomial infections are improving and NSO data shows infections at a low level. Cabinet Office have commissioned work on reducing rate of infections; there is acknowledgement that a return to ‘normal’ could have negative repercussions; regional triggers are being developed, as is a behavioural sitrep. There is also modelling work being done on a ‘ready reckoner’, though the underlying calculations are very complex.
Future agenda items
[Redacted] spoke about the work of his Public Health Threat Assessment sub group. The group noted the importance of keeping abreast of the work of the sub group and discussed potential topics for discussion at future meetings, noting that planning issues relating to a potential ‘second wave’ were likely to be a matter for the Threat Assessment sub group.
- The Advisory Group discussed the first meeting of the sub group on Education and Children. The group noted the value of international experience and agreed that advice on the issues to be considered by the sub group needed to take account of the balance of risks and communicate those risks clearly.
- The group discussed issues relating to physical distancing and ‘superspreader’ events and locations. The group considered that the evidence remains the same: that proximity increases risk. The group noted the range of factors that needed to be taken into account when considering distancing in order to achieve a balanced views of the risks involved. The group discussed mitigations alongside distance.
- The group agreed that advice on the science and balance of risks needed would need to be supported by clear communication of the group’s recommendations and take account of the changing context of the incidence of the coronavirus in Scotland when considering risk.
- The group discussed the current rates of new infections and the different influences on that and the overall number of infections. The group noted that the risk of outbreaks arising from air travel was generally low and that travel restrictions meant that risk was at a lower level currently. Recently introduced quarantine arrangements for overseas visitors would help to limit that risk further through links with Test and Protect.
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