Attendees and apologies
Advisory group members
- Andrew Morris
- David Crossman
- Mark Woolhouse
- Chris Robertson
- Aziz Sheikh
- Devi Sridhar
- Jill Pell
- Stephen Reicher
- Tom Evans
- Mary Black
- Tom Evans
- Jacqui Reilly
- Nicola Steedman
- Roger Halliday
- Sheila Rowan
- Jacqui Reilly
- Angela Leitch
- Mary Black
- Niamh O’Connor
- Richard Foggo
Items and actions
Welcome and apologies
Chair welcomed [Redacted] who is observing the meeting today for the discussion on Test and Protect.
Apologies – [Redacted] and [Redacted] who are attending a deep dive session. [Redacted] joined the meeting during the Test and Protect discussion.
The Chair noted the importance of the group responding to science advice requests from government, alongside the importance of proactively shaping agendas around items for which new evidence is emerging. The importance of noting the strength of evidence when submitting advice to Ministers was reiterated. The Chair reinforced the values of the group: transparency, respect, humility in its’ support to government.
Action: Secretariat to contact SAGE to get information on the professional support available to group members.
Minutes and actions
All group members were content with minutes.
Quarantine for travellers will be picked up next week as will a further discussion on care homes.
Zoe app information was circulated. There have been questions in government about the quality of Zoe data. The Zoe app is unique in that it provides a population based picture. There is potential for this to be linked with NHS24 data as part of an early warning system to localise increases in the population reporting symptoms. The group expressed their interest in getting input from counterparts in Wales who use this data, in order to better understand the utility of this dataset.
The Scottish Government has set up a new expert group to examine the impact of COVID-19 on ethnic minority communities in Scotland. Group members agreed that it is important for these issues to continue to be considered in depth.
The Welsh government has released in a risk assessment algorithm for healthcare professionals. The BMA have also asked to stratify healthcare professionals. The Scottish Government will need a position on this.
The level of ethnicity data in Scotland is not as detailed as that available in other parts of the UK. In order for greater analysis of data on COVID-19’s impacts on ethnic minorities to be undertaken, NHS data would need to be linked with census data.
The Chair thanked members for their contribution at Cabinet last week.
Action: Secretariat to contact the new expert group secretariat to organise for minutes to be shared with this group.
Action: By Monday, [Redacted] will formulate four to five bullets on our advice for ethnic minorities.
Action: Chair to contact colleagues in Wales who use Zoe data.
Test and Protect – testing strategy
Many tests in symptomatic people. Challenges to testing people who do have COVID-19 rather than general respiratory symptoms. Vital that those who are symptomatic are tested.
Group members noted that there may be a need for greater public information to highlight that testing is now actively encouraged, as there may be public confusion after mass testing was halted earlier in the pandemic There may also be a need for communication to address a gap between what people think testing can do and what its uses are in practice.
Symptoms – likely to be missing people who do not have the main symptoms. We could widen testing to one of any of the 14 symptoms, though perhaps not feasible to widen testing to all groups. Case definition may need to evolve to avoid missing those who have other symptoms.
Need to be careful about testing asymptomatic cases- risk of non-compliance in those who are asymptomatic with negative tests. If we are testing asymptomatic contacts, should focus on highest risks which are household contacts.
Currently we have excess capacity – there is a risk we will lose this when flu season comes around. Capacity is there to be used. Increased testing in care homes will also impact this. It was noted the term ‘excess capacity’ implies this is negative.
Finding people and getting people tested early is a big challenge. The group asked whether there is comparable data in Scotland that can help tell us where there are leakages.
Groups priorities for testing – Data needed on the number being tested in each group; how quickly are results obtained; projections for how many people in each group will need testing.
Issues are about infectivity – some can shed the virus for several weeks after they had symptoms. Challenge is that there is not much data on this. A few papers have recently come out on this, clear this can go on for seven days and peters out after 15 days. Not clear what impact being symptomatic has on this.
Choices will need to be made – The PCR test is a good test to identify cases but we don’t know how to use it as a screening test.
Combining testing with serology may have utility in knowledge generation (e.g. SIREN study). If we have data with serology and testing we will be able to generate our own data and intelligence.
Scientific advice is needed on the most effective use of testing.
The terms asymptomatic testing may not be good to illustrate what we discuss – active case finding may be better suited.
Action: [Redacted], Chair of testing sub-group, to finalise scientific recommendations for most effective use of testing for consideration by group next week
CMO Letter - traffic-light signalling
Local level information would allow shielded populations to assess risk at local-level. Schools would be able to operate more smoothly in areas with low risk/cases. Also provides a steer to local authorities so they can focus efforts in at risk areas. For the CMO letter, it is important to include what useful actions can be taken when information is given to local areas. The health board size in Scotland may not be suited to traffic light signalling due to the size of some of them. County level may be more appropriate, similar to departments in France.
Action: Group members to provide final comments by Sunday evening, with the aim of creating final draft on Monday.
Advice for the Cabinet Secretary
It was noted that these questions were also put to Public Health Scotland colleagues and some work is underway with their teams on this.
In health and social care settings, there is more alignment but use in the wider community setting and in those of a certain age are less unanimous.
Health and social care settings
In medical settings the use of masks is widely accepted as beneficial.
There are important procurement needs to be tackled if medical masks are recommended. The strength of the evidence and information on the degree of benefit to these groups needs to be considered first. Practicalities are important though the group should not limit advice based on this. The longevity of measures also needs to be considered – when would we recommend people to cease use of masks.
Face coverings/masks should be worn indoors where it is not feasible to socially isolate. There is perhaps a lack of appetite in Scotland for mandating on this. There is limited merit to recommend use in general settings. Touching masks may also increase risk.
Behavioural science – when people talk about cultural differences this is not as clear cut. In China, use of facemasks was mandated in the 1940s and 1950s through political action. At a UK level there is a risk that there is the public perception that measures are increasingly relaxed. The wearing of masks would be a clear public symbol that the population needs to continue to adhere to measures. In Asian countries the wearing of masks can be seen as an act of social responsibility towards those in our community. Messaging is key here. A distinction between legislation and enforcement must be draw – legislation is a powerful measure to signal the importance of adherence.
If recommending masks, these need to be made available, ensuring that those who need them have access to them and are not restricted in their access to services (shops, transport) because of a lack of access.
The science tells us what masks will protect from. There is limited knowledge about what the benefit will be in non-medical settings. The best evidence is coming from mechanistic studies.
Action: Chair and [Redacted] to work on answers to questions for the Cabinet Secretary. A draft will be posted in Slack by 12 midday tomorrow.
Coordinated expert advice between evidence groups across different spheres of government is something which is becoming an increasing focus for SAGE and for Scottish Government advisory groups.
The discussion did not include this item today.
Items and actions
- The Advisory Group discussed the data sources that may have potential for monitoring early warning signs of new outbreaks at local level. Additional work is needed to better understand the data available and how this can be leveraged by authorities.
- The group welcomed the creation of the Scottish Government expert group to examine the impact of COVID-19 on ethnic minority communities in Scotland. The Advisory Group will continue to consider emerging scientific evidence on the effects of the virus on ethnic minority population and support the new expert group.
- The current challenges with testing were discussed. Group members considered current testing capacity and the testing strategies for different groups, including symptomatic cases and the role of active case finding in certain contexts with asymptomatic cases. As part of the government’s Test and Protect programme, the group discussed the importance of testing those with a high degree of exposure to covid-19 cases, particularly individuals in the same household.
- The group noted the risk of non-compliance to self-isolation measures from those who are asymptomatic and test negative to covid-19, but reinforced the importance of adherence to prevent further community transmission.
- It was noted that covid-19 can cause a number of symptoms in addition to the main symptoms of a high temperature, a new or continuous cough and loss or change to your sense of smell or taste.
- Discussions on the use of face coverings in health and social care, and community settings continued.
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