- 26 Jul 2021
Attendees and apologies
Advisory Group members:
- Prof Carol Tannahill (Chair)
- Prof Marion Bain
- Dr Eileen Scott
- Gaenor Hardy
- Dona Milne
- Prof Paul Flowers
- Prof Devi Sridhar
- Prof Julie Fitzpatrick
- Prof Brigid Daniel
- Prof Chris Chapman
- Iona Colvin
- Prof Ian Rivers
- Catherine Agnew
- Gayle Gorman
Public Health Scotland:
- Diane Stockton
- Dr Mairi Stark
- Marianne Emler
- Mel Giarchi
- Andrew Drought
- Sam Anson
- Judith Tracey
- Judith Clark
Items and actions
The meeting was chaired by Carol Tannahill. The Chair welcomed members to the meeting and provided a brief update on actions from the previous meeting.
The Chair welcomed Professor Julie Fitzpatrick, the new Chief Scientific Adviser for the Scottish Government, to her first meeting as a sub-group member.
Minute of meeting on 1 June
The minute was confirmed as an accurate record of the meeting, with one query from Diane Stockton to be resolved by correspondence.
Review of evidence
The sub-group considered the latest data on the state of the epidemic. The number of confirmed cases of COVID-19 had increased in the week to 9 June, with R between 1.2 and 1.4. The sharpest rise in cases per 100,000 for school-aged children in the week to 6 June had been in the 16-17 age group. 30% of reported cases were now in the under 20s age group, as the success of the vaccination programme continued for older age groups. 30% of 18-29 year olds had now received their first dose of the vaccine, with another 30% registered to receive their first dose.
The number of patients in hospital and admissions to ICU had increased over the last week, and registered COVID related deaths had remained the same (8) in the week to 6 June, with the Delta variant now being the dominant strain in Scotland. The overall number of cases and test positivity across all child age groups increased. Relatively high pupil case rates were seen in Dundee City, Renfrewshire, South Ayrshire, East Ayrshire, City of Edinburgh and Glasgow City. The numbers of children in hospital who had tested positive for COVID-19 were discussed, with it being noted that these children are not necessarily in hospital due to COVID-19, as there is a lag in the data for this.
Impact of COVID-19 on children and young people
The sub-group received an update on COVID-19 in children and young people (CYP) with a focus on long COVID-19. Estimates from the ONS suggest that 1.7% of the population in Scotland may be experiencing some form of long COVID-19 as of 2 May. However, the likelihood of self-reported long COVID-19 was lower in children aged 2-16 years old than in adults. Very few studies included CYP as a distinct population, this may be because most children are asymptomatic, so are theoretically less likely to experience long term symptoms. There are some current studies looking specifically at long COVID-19 in CYP which will be of interest to the sub-group when results are available.
The sub-group discussed emerging evidence of educational and other harms linked to COVID-19. Concerns were expressed regarding reports of increases in cases of anorexia, self-harm and suicide among CYP. Sub-group members noted that the wider impacts and harms of COVID-19 may be more of a concern than long COVID-19 in relation to CYP. The Children and Families Collective Leadership Group has been looking at this, including wellbeing needs and where early intervention is needed, and will share a paper with sub-group members shortly. It was also reported that there is a CYP public health group currently considering this issue, and sub-group members were interested to hear the outcome of this work.
- sub-group members to highlight any issues they feel it would be helpful for the Collective Leadership Group to consider to Iona Colvin
The following points were raised in discussion:
- in terms of infection, paraflu, croup and RSV can be worse for children than COVID-19
- need to consider how COVID-19 compares to other childhood illnesses in terms of lingering symptoms
- consider different age categories more when looking at COVID-19 in CYP. There will be different risks and impacts for 16-17 year olds compared to 0-5 year olds
- the importance of an holistic approach to CYP’s health and wellbeing was highlighted, including early intervention and not just considering crisis healthcare
- clear messaging to reassure parents and carers around the impact of COVID-19 on children will be needed as mitigations are relaxed
Reducing the need for isolation in children and young people
The sub-group discussed the issue of COVID related isolation for CYP. Given that transmission pathways and the risk to the education workforce will be further reduced by mid-August due to the expected vaccination roll-out, there may come a point where the harms of isolation for CYP (learning loss, wellbeing, etc.) outweigh the COVID related risks to child and adult health which isolation aims to mitigate. We know that COVID cases and isolations tend to be higher in communities that are already disadvantaged – so by continuing with the current approach to contact tracing and isolation in the new school year, we risk compounding inequalities.
There is already some flexibility for local public health teams to make judgements regarding who should isolate where cases are identified, but this could be explored further. It was noted that there is a wider contact-tracing review underway, and it will be important to ensure CYP needs are considered as part of this.
It would be important to take a 4 harms approach to any change to the isolation requirements. There was general support for a phased approach to reducing the isolation requirements for CYP, with evaluation at each stage. Options discussed included varying the approach by age group, reducing requirements for isolation where contact has been outdoors only, narrowing the definition of a contact, only contact tracing for symptomatic CYP, and test-to-release approaches. The issue of communicating a change was also discussed, particularly the need to inform parents and others about the potential issues and advantages of a change in policy. The PHE pilot looking at daily testing instead of isolation may also be of interest to the sub-group when results are available.
- sub-group to revisit discussions on testing at their meeting on 29 June
Mitigations in early learning and childcare (ELC)
The sub-group discussed the timing of changes to mitigations in ELC settings. It was proposed that settings should plan to implement changes by mid-August, though settings which are open over summer may wish to implement these changes earlier. Mitigations linked to capacity were highlighted as more urgent due to pending local authority place allocations for after the summer, whereas changes to other mitigations such as cleaning and visitor restrictions were less urgent. There was general agreement that all proposed changes could be implemented as suggested, with the caveat that these will need to be monitored and changed back if required. It was suggested that it may be helpful to implement changes during the school holidays, as this may mean that public health teams have more capacity to address any concerns associated with the changes.
The sub-group discussed the suggestion that mitigations in ELC are linked to case rates in CYP rather than local protection levels. Sub-group members agreed that case rates among CYP are less of a problem than case rates in the wider community, therefore mitigations should continue to be linked to protection levels for the moment.
The chair noted that they would be on leave for the next sub-group meeting, so Iona Colvin has helpfully agreed to step in as chair.