- 14 Jun 2021
Attendees and apologies
Advisory group members
- Andrew Morris
- Dave Caesar
- David Crossman
- Tom Evans
- Nick Hopkins
- Audrey MacDougall
- Jim McMenamin
- Jill Pell
- Stephen Reicher
- Jacqui Reilly
- Chris Robertson
- Sheila Rowan
- Gregor Smith
- Devi Sridhar
- Carol Tannahill
- Mark Woolhouse
- Cat Carver
- Gabe Docherty
- Claire Cope
- Stephen Holgate
- Daniel Kleinberg
- Marion McCormack
- Arlene Reynolds
Items and actions
The Chair welcomed group members, SG observers, and Stephen Holgate and Claire Cope who will present ongoing Academy of Medical Sciences (AMS) work on winter 2021/22.
The minutes of the previous meeting have been circulated for comment.
AMS – COVID-19: winter 2021/22 and beyond
The Chair noted the important work the AMS carried out for predictions regarding winter 2020/21. Stephen Holgate and Claire Cope presented the work of the AMS in this area.
The AMS conducted extensive work last year culminating in the release of the report Preparing for a Challenging Winter 2020-21. This work was intended to support guidance for health and social care across the UK to support the response against the worst case scenarios for the virus. The report had predicted a resurgence of COVID-19 cases over winter and the vulnerability of the health and social care system to respond to this. Alongside this, the backlog of non-covid care featured prominently. The predictions for winter 2020/21 had predicted a resurgence of influenza which turned out not to be the case.
The report included four areas of focus for prevention and mitigation strategies
- Minimising the transmission and impact of COVID-19 in the community;
- Organising health & social care to maximise infection control and ensure COVID-19 & routine care can take place in parallel;
- Improving public health surveillance for COVID-19, influenza and other winter diseases.
- Minimising influenza transmission and impact.
The worst case scenario turned out to be worse than anticipated, partly due to increased transmissibility due to the factors including the circulation of the B.1.1.7 variant, inequalities, and changes in behavioural patterns.
The AMS has been asked to produce an additional report looking ahead to winter 2021/22 which will reflect on the challenges of winter 2020/21 and set out outstanding uncertainties and priorities for action:
- identify the challenges to health and the health and social care infrastructure this coming winter
- set out outstanding uncertainties and priorities for action
- explore the transition from pandemic to endemic COVID-19
This will most likely consider issues related to COVID-19 variants, long covid, Test & Protect, vaccines, prophylaxis and treatments, health and social care structures, vulnerable populations and concomitant winter diseases. In addition, the AMS will undertake a programme of public and patient engagement to feed their views into the development of the report.
Tools such as developing multiplex testing are likely to be considered. Group members noted that predictions indicate that ‘normal’ respiratory viruses such as influenza are likely to resurge, having been largely absent this winter. The absence of influenza this winter is likely attributable to the success of the vaccination campaign alongside the impact of non-pharmaceutical infectious such as the use of face coverings and hand hygiene.
Group members provided input on the upcoming report, noting that the devolved health infrastructure and decisions in Scotland is an important difference to be recognised in the report. Differences between the four nations, including in public engagement and the level of uptake of non-pharmaceutical interventions are important to recognise. Public engagement will need to take into account the different stage of the epidemic response which could exist between Scotland and other UK regions. University return in Scotland and across the UK can present specific challenges as was seen in the autumn 2020, including the large movement of students and the integration of these into local areas.
The duration of immunity from vaccines is not yet known, though so far reinfections seem rare. A key question remains whether the population is moving towards herd immunity as well as the duration of immunity. Alongside this, the question of vaccination children will be important to consider, once data on the safety and efficacy of the vaccine in this population has been considered by regulators.
Group members also asked about consideration of behavioural psychology and communication and the role of this in behaviours and decision making. If restrictions are lifted, it will be a challenge to get individuals to identify risks and carry-out their own ‘risk-assessment’ of situations, rather than the return to pre-pandemic behaviours. The report will include psychological, social and economic factors that affect the response and individual behaviours in response to the pandemic.
Group members noted that from an epidemiological perspective there continues to be regional heterogeneity in the course of the epidemic. In addition in Scotland, poor population health in parts of the country could a significant impact on the case fatality rate in Scotland. Behavioural and clinical uncertainties mean that projections will need to be communicated carefully, taking into consideration the wider consequences of COVID-19 and policy decisions in this area. The burden of longer term health conditions linked to COVID-19 are important to consider as part of future research agendas, given the significant burden these could place on the NHS in the long term.
A patient and carer reference group has been established which links in to the AMS Expert Advisory Group, along with public engagement workshops which will include a diverse audience including BAME communities, younger adults, and those who have received shielding letters. The social and behavioural aspects of the response will be a particular focus of the report.
The Chair thanked Stephen Holgate and Claire Cope and noted his appreciation of their work and the involvement of the four nations at an early stage.
Action: Officials to link in to the Stephen Holgate offline to discuss how engagement can reflect Scottish specificities.
Action: AMS noted they are keen for input from Scotland and suggested the nomination of a member of the C-19 AG to act as a conduit between the two committees.
State of the pandemic
The group received an update on variants of concern and in particular B.1.617.2. S-gene dropout is used as a surrogacy for the emergence of dominant strain types.
Data is showing a rapid spread of this variant in England as S-gene positive strains establish an increase in England. The available information from WGS shows the B.1.617.2 variant represents a significant proportion of this increase, mainly in working age group (those under 50) with little extension into older age groups. Geographically, this is more present in Glasgow and Lothian based on recent days analysis. The cases appear to be predominantly in south Asian ethnic groups, though not exclusively.
The group received an update from SAGE. The SPI-M paper 2a and its conclusions were updated. For B.1.617.2 there appears to be geographic differences in the doubling time of this variant, but B.1.1.7 is diminishing across regions. There is evidence that B.1.617.2 could have an increased degree of transmissibility compared to B.1.1.7. It is too early to make a conclusion on antigenicity. The group asked whether there is evidence of increase severity of disease or hospitalisation with B.1.617.2. From very early reports there are a small number of individuals who have died who had tested positive for B.1.617.2. Of those looked at so far these appeared to be unvaccinated. We are seeing hospitalisation though it is again too early for this to be conclusive. Data suggests that the majority of those who have tested positive for B.1.617.2 have been unvaccinated. The effect of the vaccine on the reduction of the transmission risk is not yet known. Case numbers of B.1.617.2 in Scotland are still low compared to the rest of the UK.
The group considered the emergence in Scotland and geographically in the rest of the UK. It remains too early in Scotland to be able to make conclusions from data given low case numbers. In England clusters of cases are apparent in some London Borough and parts of the North West such as Bolton. The rapidity of spread of B.1.617.2 is reminiscent of B.1.1.7 though we are not seeing any indication yet on potential additional pressure of hospitals from B.1.617.2.
The group recognised the challenges in public communication from rising variants while lockdown easings are planned and recognised the difficult decisions facing government.
Investigation of First Dose Waning Effects of Pfizer or AstraZeneca Vaccines
The group was shown data from the EAVE-II study. The data shows that there is no evidence of waning up to 10 weeks (end of study) for either vaccines and there were similar vaccine effects for both.
The situation in India, Asia and South America should continue to be monitored. Ring fencing and models in each Asia on outbreak management should be considered, to draw on lessons learned that could be applied in Scotland. Additional considerations may be needed for children and learnings from the US should be considered.
The return of in person teaching has gone well. The subgroup has been considering the situation in schools regarding music, drama and PE to ensure guidance for these remains in line with what is permitted in wider society. Work will take place next week to consider what the implications of changing levels in Scotland will be for mitigations in schools. Guidance will be prepared to draw on learnings to inform the return of schools following the summer holidays. A new subgroup focussing on Universities and Advanced learning will meet for the first time next week.
Work is underway to add L452R to the E484K amplification to identify the Indian variants more rapidly. More primers will need to be made and discussions are underway concerning this. Secondary PCR testing of positive is to confirm whether they are B.1.617.2 variants is likely to be available from next week in the Central Belt.
Nosocomial Review Group
The nosocomial covid risk is currently low. No clusters or outbreaks have been reported over the past few weeks. In light of news regarding the B.1.617.2 a review of measures is being considered. A subgroup to consider preparedness of IPC for next winter has been established.
Future of the group
SAGE has signalled a return to business as usual arrangements. The SNP Manifesto included a commitment to create a Standing Committee on Pandemic Preparedness. Work is underway to consider the future of this group and the role of future arrangements for COVID-19 advice in government.
Action: The C-19 Advisory Group to meet again in 2 weeks.