- 29 Sep 2021
Attendees and apologies
Advisory Group Members
Carol Tannahill (Chair)
Prof Marion Bain
Prof Brigid Daniel
Prof Julie Fitzpatrick
Prof Paul Flowers
Prof Ian Rivers
Prof Devi Sridhar
Prof Linda Bauld
Prof Chris Chapman
Dr Eileen Scott
Public Health Scotland
Items and actions
1. 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.
Minute of meeting on 7 September
2. The minute was confirmed as an accurate record of the meeting.
Review of evidence
3. The sub-group considered the latest data on the state of the epidemic. Case rates were declining overall, with a slight increase in the 7 day case rate for 16-17 year olds. 91% of those aged 16 and over have now been vaccinated with one dose, with 83% of those aged 16 and over having received a second dose. It was reported that 95% of teachers have now received their first dose of the vaccine, with 92% having received a second dose.
4. The number of patients in hospital and admissions to ICU had increased in the last week, and it was noted that it will take time for any decrease in case numbers to impact these figures. Although the numbers of children in hospital who had tested positive for COVID had increased, new admissions were decreasing, and it was expected that child hospitalisations will start to decrease given the decrease in case numbers. There were 76 registered COVID related deaths in the week to 12 September, with the Delta variant remaining the dominant strain in Scotland.
5. It was noted that the latest data from England (published on 16 September) showed no significant increase in cases following the return to school, but that it was still early for any effect of school return to show in the data as the data presented only included one week since most schools returned there. ONS estimate that Scotland has the highest case rates across the 4 nations, but there is significantly more testing being undertaken in Scotland, which makes comparisons challenging. It was also noted that there are significant variations in case numbers across different areas of England.
School Absence Analysis
6. The sub-group received an update on current school absence data, which showed a significant decrease in COVID-19 related absence in the two weeks up to Wednesday 15 September, though COVID-19 related absence remains high. It was estimated that if the previous self-isolation policy was still in place, these absences would be substantially higher. It was also noted that over 60% of schools in Scotland have between 0 and 1 pupil cases, with only 1% having 20+ pupil cases (although noting that this linkage had caveats), indicating that it is a minority of schools which are dealing with large incidents.
Mitigations in schools and ELC settings
7. The sub-group discussed whether the current evidence supported any move to either strengthen or ease current mitigations in schools and ELC settings, or if the current mitigations should remain in place at present.
8. In discussion, the following points were made:
- education stakeholders had noted a desire for stability and avoiding any significant changes to guidance where possible to ensure ease of implementation and compliance.
- it would be helpful to give an early indication of what the sub-group is likely to advise at their next meeting, in order to allow education settings and public health teams to plan for any changes.
- greater local discretion for education settings may be beneficial in some cases, however it is important that this does not result in a disproportionate risk assessment burden for staff. It is also helpful to avoid significant inconsistencies between settings, which might lead to confusion due to variations in local risk appetite.
9. Sub-group members agreed that it was important to wait for further data before easing mitigations, but on the basis of current trends it was likely that at their next meeting on 5 October they would advise a move to baseline mitigations following the October holiday. If easing mitigations, the removal of face coverings for secondary school pupils while seated in class should be a priority. However, it was suggested that the sub-group would be likely to advise continuing current advice on asymptomatic testing and self-isolation, as well as the wearing of face coverings when in communal areas and moving round the school building in secondary schools until case rates have reduced further.
10. Action – the issue of baseline mitigations to be discussed again at the next meeting of the sub-group.
School visitors including parents
11. The sub-group discussed its advice on visitors to schools, including parents and spectators at school sports. It was noted that guidance from SportScotland, which applies to club sport, permits spectators subject to risk assessment, and that this approach may also be appropriate for schools.
12. In discussion, the following points were made:
- given these activities mainly involve adults mixing, there is a similar level of risk to mixing in wider society, which is already permitted.
- on that basis, mitigations will still be required, including the wearing of face coverings in indoor public spaces, and particular attention should be paid to avoiding mixing in communal indoor spaces.
- parents may find meetings about their child’s wellbeing, progress and behaviour more challenging when conducted virtually compared to in person.
- some community-based interventions and community learning and development programmes are not able to operate at the moment due restrictions on using school premises. These were deemed to be particularly important in terms of wider wellbeing benefits to children and young people.
13. The sub-group advised that restrictions on school visitors could be relaxed, including for spectators at schools sports, parental visits, parent councils, and use of community facilities. The appropriate mitigations for these activities should mirror restrictions in wider society. Visits related to wellbeing, progress and behaviour of children should be prioritised.
14. The issue of school assemblies, particularly for religious observance purposes, was also discussed with the following points being made:
- it was noted that communal worship is permitted in wider society, though some restrictions such as the wearing of face coverings remain in place, and it is advised that risk assessments are conducted.
- while large gatherings still present a transmission risk, in most cases these assemblies will not involve whole school gatherings due to space constraints, but will take place as lower/upper school or year group gatherings.
- additional risks associated with group singing should also be considered when schools are making decisions regarding assemblies.
15. The sub-group advised that assemblies for religious observance purposes can take place, but with the understanding that there is still an associated risk of gathering together in large groups. This advice reflects that these gatherings can now take place in wider society and recognises the role of religious observance in the curriculum. It is for Learning Directorate officials drafting guidance to determine what framework is used for this in terms of numbers, physical distancing, singing, etc.
Close contact and self-isolation policy in Early Learning and Childcare (ELC) settings
16. Sub-group members discussed the current self-isolation policy for close contacts under 5 years old, who are not required to take a PCR test (provided they have no symptoms). This was added to the agenda in response to concerns expressed from the childcare sector (in particular from childminders) that these children can attend settings even if their household members have tested positive. The Scottish Childminding Association (SCMA) has expressed concerns that the current policy presents health and financial risks to childminders and suggested that children with a positive case in their household either have a negative PCR test or self-isolate for 10 days.
17. In discussion, the following points were made:
- the group recognised that there are already fewer mitigations in ELC settings compared to schools, for example regarding face coverings and physical distancing. Childminders may also be more likely to fall into older (and therefore higher risk) age categories than other members of the ELC workforce.
- however, protection received from vaccination of adults forms a significant part of the basis of the rationale for the current self-isolation policy. Additionally, the risk of very young children contracting COVID-19 remains low, and it may be very difficult for under 5s to tolerate testing repeatedly. It is also important to note that children are likely to present a lower risk of transmitting COVID-19, and that the risk of transmission from child to child and child to adult is low within childcare settings when mitigations are in place.
- current Test and Protect guidance notes that children under 5 are “encouraged but not required to take a PCR test”. However it is important that communications and guidance around this are clear to ensure consistency and avoid confusion.
- it may be helpful to consider wider literature on transmission in under 5s, including further international evidence and any data on household transmission if available, given that childminders often operate in family homes.
18. Sub-group members agreed to maintain the current advice on contacts and self-isolation for asymptomatic under 5s in ELC, emphasising that vaccination is the main protective measure for adults, but to further explore the evidence base relating to these very young children for discussion at their next meeting. This will ensure the sub-group position remains informed by the latest evidence on transmission in this age group, and the rationale for the policy on close contacts aged under 5 can be kept up-to-date to aid confidence with the sector.
19. Action – Sub-group to review the evidence on transmission in under 5s at their next meeting.
Further support for schools with ASN pupils
20. The sub-group received an update regarding outbreak management support for schools with pupils with additional support needs (ASN), and considered whether or not any further guidance was required.
21. In discussion, the following points were made:
- there is no statistical evidence of increased transmission in ASN settings compared to mainstream settings in Scotland, however this analysis does not include staff. It is plausible that close working in these settings may result in increased transmission risk for staff.
- it was noted that there is already additional guidance around PPE and individual risk assessments for pupils and staff where appropriate.
- there are already good relationships in place between ASN settings and public health teams, and there is a lower threshold for public health outbreak intervention in ASN settings in light of the higher risk present.
22. The sub-group agreed that no new guidance is needed in relation to contact tracing and isolation policy for ASN pupils. However, further work could be done on clinical vulnerability for individuals during outbreaks, both in ASN and mainstream education settings, as well as to consider what PPE could be used in ASN settings to reduce risk.
23. Action – Public Health Scotland and ASN policy colleagues to work further with sector representatives to address the issues raised and improve the advice offered in existing guidance as necessary.
24. The members of the sub-group wished Carol Tannahill a happy retirement on her last meeting as Chair of the sub-group. Sub-group members expressed their thanks and admiration for Carol’s invaluable work not only as Chair of the sub-group, but also across the wider Scottish Government, which will be sorely missed. Carol handed over to Linda Bauld, who will take over from Carol as Chair of the sub-group.
Date of Next Meeting
25. The next meeting will be held on 5 October.