- 9 Sep 2021
Attendees and apologies
Advisory group members
- Carol Tannahill (Chair)
- Gayle Gorman
- Prof Marion Bain
- Dr Eileen Scott
- Prof Ian Rivers
- Prof Devi Sridhar
- Prof Julie Fitzpatrick
- Catherine Agnew
- Iona Colvin
- Prof Paul Flowers
- Gaenor Hardy
- Prof Chris Chapman
- Prof Brigid Daniel
- Dona Milne
Public Health Scotland
- Diane Stockton
- Cheryl Denny
- Liz Levy
- Daniel Kleinberg
- Andrew Drought
- Paul Fagan
- Sam Anson
- Judith Tracey
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.
Public Health Scotland (PHS) provided an update on an action from June to speak to Public Health England (PHE) about a comparison of the data on the return to schools in England (particularly in higher prevalence areas) without any face coverings and that in Scotland where face coverings were required. PHE said it wouldn’t be possible to make such a comparison because many schools in high prevalence areas in England did retain mask use – it was a local decision.
It was noted that the Royal Academy of Engineering has produced its report on ventilation and will be holding a teach-in session at which there may be some spaces for sub-group members to attend.
Action: sub-group members who would like to attend the teach-in session should get in touch with the secretariat.
Minute of meeting on 27 July
The minute was confirmed as an accurate record of the meeting.
Update on the return to school/ELC settings
The feedback from the members of the COVID-19 Education Recovery Group (CERG) on the return to school so far has been largely positive. There were still some lingering concerns around staff wellbeing, the potential impact of the change to the contact tracing/self-isolation arrangements, and the safety of unvaccinated staff but, on the whole, the professional associations agreed that the return had been carried out on a steady and safe basis.
There was a similar picture from ELC settings, with some anxiety about staff safety, particularly as staff tend to be younger in the ELC sector so a higher number of staff will not yet have received both doses of the vaccine.
The sub-group noted that the revised guidance to support the return to school had been incredibly helpful. The guidance was complex in parts, but on the whole it had been invaluable in supporting schools to reopen safely.
Review of evidence
The sub-group considered the latest data on the state of the epidemic. There had been a sharp increase in case numbers with 4,323 new cases reported on 24 August. There was an increase in the 7-day case rate in all population groups, but this was most marked in the young adult age groups (16-17, 18-19 and 20-21). Deaths remained low in all age groups. 90.8% of the adult population have now been vaccinated with one dose, and 78.9% have received their second dose.
The number of patients in hospital and admissions to ICU had decreased in the week to 15 August, although there had been an increase in the number of cases. There were 41 registered COVID related deaths in the week to 15 August, with the Delta variant remaining the dominant strain in Scotland.
In discussion, sub-group members said that they had expected an increase in the number of cases when restrictions were eased on 9 August, but the increase was higher than anticipated. It reinforced the need for a cautious approach to the reopening of schools, and the sub-group would need to keep a close eye on the data over the next few weeks before making any further decisions about changes to mitigations in schools. More information was requested about paediatric and adolescent hospital bed capacity, particularly if there is an increase in other viral illnesses such as RSV over the winter.
Action – Secretariat to send sub-group members an interim surveillance report in the week beginning 30 August, so that members are not waiting until the next meeting on 7 September for an update on the data.
PHS gave a brief update on the research review of COVID-19 in children and young people. The evidence base about children and young people’s role in the transmission of COVID-19 continues to develop. In the latest update from the National Collaborating Centre of Method and Tools ‘Living Rapid Evidence Review’ lower age was found to be associated consistently with a decreased risk of transmission in school settings. A lower risk of transmission was found to be associated with mask wearing in secondary schools, while the evidence for mask wearing in primary schools was more mixed. However, it should be noted that, in the main, studies were carried out before the more transmissible variants of the virus became predominant, and vaccination programmes had been rolled out in the general population.
Mitigations in schools and ELC settings
The sub-group discussed when it might be possible to move to baseline mitigations in schools and ELC settings. Given the current data on the state of the epidemic, it was too early to draw firm conclusions about when that change might take place, however the sub-group was asked to consider the factors it was likely to wish to take into account when providing advice on a potential move to baseline mitigations in the future.
In discussion, the following points were made:
- the sub-group needs to be appraised of any issues with the current mitigations, particularly around CO2 monitoring, and testing. An understanding of implementation issues, and how advice and support might be targeted, will be important
- agree that it is too early to make any decisions on whether the move to baseline mitigations can go ahead after 6 weeks. It is important to remain cautious until more data is available on the impact of the removal of restrictions for wider society on 9 August, as well as the return to schools
- it will be important to have clear messaging around the rationale for any changes to the mitigations in schools
- the focus should be on potential health harms rather than simple case rates. Case rates are becoming a much less good indicator of harm than they were before the vaccination roll-out.
- there is a need to continue to differentiate between different kinds of visitors to schools. When considering whether visitors should be allowed, the priority should be given to those that are necessary to support children and young people (CYP), or the running of the school, and should be appropriately risk assessed
- parents evenings had worked well on a remote basis, and there should not be a rush to move back to having large groups of parents and other visitors within the school estate when the current arrangements have proved so effective
- the question of when visitors can return to schools should also form part of the wider discussions taking place on vaccine assurance or certification in other parts of society. Testing will also have an important role to play in providing assurance
- appropriate ventilation remains a key consideration particularly in the run up to winter months when opening windows in schools may be less feasible
- there remains a need to think about the issue of CYP being subject to measures that do not apply to wider society. Schools are a more controlled, and consequently safer, environment than many other parts of society, and it is important that CYP do not have a negative experience of education which could have a longer term impact. There is a fundamental question of whether the rights of CYP are being considered fully, in line with the Convention on the Rights of the Child
- for the most part, CYP are required to go to school, whereas they are not required to e.g. visit a soft play area or a cinema. Therefore, CYP have a right to feel safe when they attend school, and the continued mitigations help to achieve that. This is particularly pertinent to clinically vulnerable CYP, who rely upon others complying with the COVID restrictions in order to enable them to participate in society, and that includes attending school
It was suggested that the need for teachers to wear face-coverings in the playground could be relaxed, particularly for primary schools, as the risk of transmission out of doors was greatly reduced. It was clarified that the current guidance on reducing risks in schools does not specify that face coverings are required to be worn outdoors by teachers.
Action – the issue of baseline mitigations would be discussed again at the next meeting of the sub-group when more data would be available.
Future of the sub-group and forward workplan
The sub-group discussed the need to take stock and consider its role one year after it had been established. It was clear that the sub-group would need to continue to work in COVID response mode for a period longer – to monitor the data, support the return to school in a sustainable way and to advise on ongoing baseline measures/level of mitigations.
In the medium to long term, there are a number of different areas of work that might benefit from the advice of the sub-group, some of which could bring a significant change of focus and mode of working. Before developing these further into a set of propositions for future work, the views of members were sought on the future role of the sub-group, how it might operate going forward, and where it might best contribute.
In discussion, the following points were made:
- it has been invaluable to have the group as a sub-group of the main COVID-19 Advisory Group. It provided a wider dimension to the public health considerations of the main Advisory Group and allowed a clear focus on the needs of CYP and of education
- the value has been in the interdisciplinary nature of the sub-group, which has allowed consideration from experts in education, early learning and development, and children’s services, as well as clinicians, and experts in public health, behavioural sciences and statistical modelling. In the absence of the sub-group, where would that wider consideration take place?
- the issue of future pandemic proofing is key. We need to look at what we have learned over the last 18 months and use that to plan and ensure we are better prepared for any future pandemics that may emerge. The lessons learned should help us to be more confident and bolder going forward
- there should be some consideration of third sector children’s organisations in any future work
- there are still a lot of issues around behavioural and cultural change, where the sub-group has not yet been able to advise fully on what might be achieved
Action – sub-group members to send any further thoughts on the future of the sub-group to the secretariat. The issue will be brought back to the meeting planned for 21 September.
Date of next meeting
The next meeting will be held on 7 September.