- 13 Jul 2021
Attendees and apologies
Advisory group members
- Andrew Morris
- Aziz Sheikh
- Nick Hopkins
- Devi Sridhar
- Dave Caesar
- Chris Robertson
- Stephen Reicher
- Mark Woolhouse
- Audrey MacDougall
- Nicola Steedman
- Jill Pell
- Carol Tannahill
- Cat Carver
- Daniel Kleinberg
- Arlene Reynolds
- Gill Hawkins
Items and actions
The Chair welcomed group members. The Chair noted the recently published work on thrombocytopenia and vascular adverse events by Chris Robertson and Aziz Sheikh in Nature Medicine.
Education subgroup update
The Group received an updated on the schools subgroup. The subgroup is considering what approach is proportionate and should be taken in the next school year in relation to COVID-19 and children.
Children appear to still be at low risk of severe disease, hospitalisation and death from the pandemic. The current approach of going in hard, quickly, is resulting in a significant number of children being absent from school due to self-isolation. The question of the strategic objective was raised. The health of children is one consideration, the impact of school transmission on the wider community is another, and the disruption of children’s education another. The Group agreed the importance of minimising disruption to schools and children’s education. Questions the subgroup will consider include the current case finding approach in schools, whether a level of circulation of the virus in schools can be considered acceptable, whether programmes such as test and release could be established in schools, and whether guidance on mask wearing and other NPIs might need to be further adapted for the new school year. The impact of long covid on children is not well understood, though it was noted that some clinics for long covid are now being set up in the United States.
In order for schools to remain open in a sustainable way up until now, the strategy has focussed on case finding and minimising transmission. This overall strategic objective may change going into the new school year, with added emphasis on the wider wellbeing and pedagogical needs of children. The subgroup will receive specialist paediatrician input at its next meeting.
The Group also received an update on the work of the new subgroup on universities and colleges which is working to provide advice into stakeholders for the next academic year. This includes thinking about what the appropriate mitigations will need to be if we move beyond level 0 by the late summer/early autumn. Priorities for advice for this subgroup including vaccination, student accommodation, testing and outbreak procedures, and the engagement with students and stakeholders.
As the vaccination programme rolls out for over 18s, the majority of students should have been offered their first vaccination in early autumn. Other programmes such as TestEd have been established to support the return of students. There may be benefit to establishing vaccination centres in locations that are very accessible to students to encourage uptake. Drop in sessions are already being made available to older age groups and these could be extended to younger age groups. Cross board vaccinations are also being established, which will allow students to get vaccinated in a location away from their GPs local area. While it was acknowledged that unregulated spaces will present significant challenges, the importance of shaping norms should not be overlooked.
State of the pandemic
There is still a lot of uncertainty about the impact of the Delta variant and the strength of association with hospitalisation and mortality. The pandemic is entering a new phase whereby a third wave is imminent yet the population has significantly higher immunity than previously. Some areas with high prevalence of the Delta variant, such as Bolton, are now seeing a plateau or decrease in cases. These appear to be outliers for now, and are exceptions to the national trend. The link between cases, hospitalisations and deaths is still not fully understood in this new context. Hospitalisation and deaths are lower, however, a larger proportion of cases now are in younger age groups. Vaccination is skewing the age distribution of cases being hospitalised, making it difficult to compare the situation with previous waves. Further data is still needed to determine whether hospitalisations will begin to increase exponentially once again.
Multiple models were considered by SPI-M looking at different scenarios over the summer. All scenarios modelled produced a sizable third wave. Delaying additional easing of restrictions would help flatten the curve and allow for a greater proportion of the population to be vaccinated but will not avoid a third wave. As the prevalence of the virus grows it will be more likely that vulnerable individuals will become infected.
Vaccines are very effective but not fully protective. Small differences in effectiveness can make a big impact and evidence now shows that these are less effective against the Delta variant than against the Alpha variant. Data shows that while those aged over 50 make up much smaller proportions of those hospitalised than previously, there are still some who are vaccinated but do still require hospitalisation.
Length of stay in hospital are becoming shorter. There is evidence that vaccines shorten the length of stay of people in hospital. Models looking at hospital admissions that were developed for the Alpha variant are showing that significant increases in hospitalisations can be expected in the current wave, with younger patients for shorter spaces of time, though there will still be some ICU use.
Scottish Government models using the latest data on the Delta variant show that, in the best case scenario, the level of hospitalisations may be manageable. These models were fed into SPI-M where group members were broadly in agreement. Significant differences exist between the best and worst case scenarios.
There has been success for some areas of the country which have implemented measures to control cases, including in Greater Glasgow and Clyde. These measures have restricted the magnitude of the increase, though it is uncertain whether this will be sustained. The uncertainty surrounding the Delta variant means that the impact of delaying easing of restrictions will be difficult to determine.
Reflecting on other countries that have widespread vaccination: in the US in areas with high vaccination the number of hospital cases has dropped significantly whereas it is maintained in others. Data from Israel also remains encouraging.
There was consensus in the group that while uncertainty prevails, we are now in a third wave with increased infections and hospitalisation but the future magnitude is uncertain. Delaying further easing of restrictions is likely to have a beneficial effect on hospitalisation but the extent of that is uncertain. A delay of at least 2 weeks should provide a clearer picture though this is also uncertain. It will be important for policymakers to consider the wider impact on the health service and health service recovery.
Group members asked whether there will be a move towards the introduction to quarantine free travel for those who are fully vaccinated, similarly to what is being introduced in Europe. Travel restrictions are currently being considered on a four nations basis. Concerns of equitable access remain and these need to continue to be taken into consideration in future discussions in this area. Ethical issues exist on both sides, given the impact on the economy of continued restrictions. Group members will consider drafting commentary on current status of travel in those with two vaccinations.
Advice on certification
The Group have received draft advice on certification. This will soon be shared with Ministers.
Action: comments to be shared with the Secretariat so the final draft can be sent to Ministers tomorrow.
Security: group members were given an update on how to handle security issues relating to their role on the group.