- 21 Oct 2021
Attendees and apologies
Advisory group members
- Linda Bauld (chair)
- Prof Marion Bain
- Prof Brigid Daniel
- Prof Julie Fitzpatrick
- Prof Paul Flowers
- Gayle Gorman
- Gaenor Hardy
- Dona Milne
- Prof Ian Rivers
- Prof Devi Sridhar
- Dr Eileen Scott
- Prof Chris Chapman
- Catherine Agnew
- Iona Colvin
Public Health Scotland
- Diane Stockton
- Audrey MacDougal
- Mick Wilson
- Natalie McLaughlin
- Marianne Emler
- Sam Anson
- Judith Tracey
Items and actions
The meeting was chaired by Linda Bauld, who has taken over as Chair of the sub-group from Carol Tannahill. The Chair welcomed members to the meeting and provided a brief update on actions from the previous meeting.
Minute of meeting on 21 September
The minute had been cleared by correspondence and published in advance of the meeting.
Review of evidence
The sub-group considered the latest data on the state of the epidemic. Case rates were declining across all age groups, with the overall 7-day rate of positive cases decreasing overall across 2-17 year olds. The R rate was below 1, and 87% of the adult population were now fully vaccinated (92% of teachers) with 72% of 16-17 year olds, and 26% of 12-15 year olds, having received their first dose of the vaccine.
Admissions to hospital and ICU have decreased overall, with the chance of being hospitalised being 3 to 4 times higher for those who are unvaccinated (depending on age). In the three weeks to 29 September, the average number of hospitalisations of children and young people had reduced across all child age groups (age 2-17).
PHS noted that there was no new evidence on transmission in under 5s to share with the sub-group at present. However, a 3-week consultation with ELC is being undertaken by the Scottish Social Services Council (SSSC), so it would be more appropriate for the sub-group to return to the topic once the analysis of this data is available.
Action: sub-group to return to the topic of transmission in the under 5s once the data analysis is available.
School absence analysis
The sub-group received an update on current school absence data, which showed a continued decrease in COVID-19 related absence in the two weeks up to Wednesday 29 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. No schools were closed because of COVID-19.
Mitigations in schools and ELC settings
Following on from the discussion at the previous meeting, the sub-group considered whether the current evidence supported any change to the mitigations in schools and ELC settings after the October holidays.
The sub-group was reminded of its advice from August 2021 that in order to balance ongoing COVID-19 mitigations in schools and ELC settings with other harms, e.g. to children and young people’s education and wellbeing, mitigations should remain in place for no longer than is necessary based on the state of the epidemic and evidence about risk.
In discussion, the following points were made:
- education stakeholders had requested as much stability as possible with the guidance going forward (on the basis that small, frequent changes are time-consuming and resource-intensive to implement)
- the rate of vaccination amongst 16-17 year olds was very high, and the numbers of 12-15 year olds having received a first dose was increasing rapidly
- the declining case rates across all age groups, and the effectiveness of the vaccination programme in reducing the clinical harms of the virus meant that, on balance, the wider harms of some of the mitigations in schools became more significant
- given the current evidence, health protection teams would be comfortable with reducing some of the mitigations in schools, particularly those that have an impact on the wellbeing of children and young people
- while the evidence demonstrates that face coverings are effective in reducing the transmission of coronavirus, it is difficult to isolate the effects of an individual non-pharmaceutical intervention from those of other control measures, particularly when considering that children and young people will be mixing with their friends regularly outside of school without wearing face coverings
- headteachers were reporting that compliance among young people with wearing face coverings was variable, and enforcement was having an impact on the relationships between pupils and staff
- there was a need to move away from asking children and young people to take responsibility for complying with specific restrictions, and look more closely at what can be done to make the environment safer via e.g. improved ventilation
- it remains the case that children and young people as a group have relatively low risk of direct COVID-19 harm, but relatively high risk of wider – and long-term – social, educational, economic, and wellbeing harm. Some of those harms may have fallen disproportionately on children and young people from disadvantaged backgrounds
- further advice was needed from JCVI on second vaccine doses for 16-17 year olds in particular, and in due course for all 12-15 year olds, in line with other countries
Sub-group members agreed that, given the continued success of the vaccination in weakening the link between cases and severe harm, the high vaccination uptake across the population, and the current programme to vaccinate 12-17 year olds, as well as the ongoing decline in case rates, the time was right to more closely align the mitigations that apply in schools with equivalent requirements in other parts of society.
The removal of face coverings for secondary school pupils while seated in class should be a priority, given the potential impacts on learning and communication, and because of the reported discomfort some young people experience as a result of this mitigation. However, secondary aged young people (and staff in primary and secondary schools and ELC settings) would still be required to wear face coverings when in communal areas or when moving around the building. The sub-group advised that staff should also continue to maintain at least 1 metre physical distancing from other adults (and between adults and school aged children and young people wherever possible) in line with the requirements for other workplaces.
The sub-group also advised that restrictions on assemblies (including those for religious observance purposes) could be removed on the basis that a cautious approach should continue to be taken and that current arrangements (e.g. digital assemblies and online/telephone parents’ evenings) could continue to be the default option, based on the individual requirements of each school. Schools should, therefore, consider the numbers that can be safely accommodated for the purpose of assemblies/parents’ evenings within the school estate.
Most other baseline mitigations should be maintained in schools (including physical distancing, improved ventilation, good hand and respiratory hygiene, enhanced cleaning, and asymptomatic testing) in order to stop the virus resurging and to protect those who do not have protection from vaccination. This set of mitigations would remain appropriate for the longer term.
In line with these changes, ongoing emphasis should be placed on the remaining mitigations. In particular the importance of measures to increase ventilation and the continued need for asymptomatic testing.
The sub-group also felt it would be important to begin to devolve more autonomy and flexibility of decision-making to local authorities and schools. However, in the event of a significant local outbreak, schools may be expected, and supported, by their local health protection teams to reintroduce mitigations, such as face coverings
Action: the sub-group to publish more detailed advice on the mitigations in schools following the October holidays.
Children and young people on the highest risk (shielding) list
The sub-group discussed the proposal, agreed in July 2021 by the four UK CMOs, that all children and young people under the age of 18 should be removed from the highest risk list (previously known as the shielding list) in light of the extremely low risk of serious illness and mortality in this age group. Scottish Ministers had decided in August 2021 not to make the change at that time due to the rising number of cases, particularly in younger age groups. This was not a reflection of the evidence of risk, but rather a question of appropriate timing. Since then, the sub-group heard that both the UK and the Welsh Governments had pressed ahead with the removal of children and young people from the clinical high risk list.
The sub-group felt that the current evidence of low risk of poor outcomes from COVID-19 in children and young people, including those on the highest risk list, coupled with the evidence of wider harms due to shielding, supported a recommendation to remove children and young people from the highest risk list.
Date of next meeting
The next meeting will be held on 19 October.