- 22 Nov 2021
Attendees and apologies
- Andrew Morris
- Linda Bauld
- David Crossman
- Tom Evans
- Julie Fitzpatrick
- Jill Pell
- Jacqui Reilly
- Chris Robertson
- Aziz Sheikh
- Nicola Steedman
- Mark Woolhouse
- Dave Caesar
- Daniel Kleinberg
- Cat Carver
Items and actions
The Chair welcomed group members and noted apologies received.
State of the pandemic
The chair noted the current state of the pandemic, with ONS data indicating a prevalence of 1 in 60 in Scotland and the challenges of winter approaching. There was cause to be optimistic but not complacent.
The group heard a report from the SAGE meeting earlier that day, together with a presentation on the current state of the pandemic.
This phase of the pandemic is hard to predict – a high equilibrium leaves us little room for manoeuvre and makes it more difficult to predict the future. We seem to have hit a balance, but not a settled one - changes in behaviour are offset by a build-up of population immunity. There is reasonable optimism about the run up to Christmas, with hope for a slight improvement but much more uncertainty afterwards - predictions range from a substantial surge to minimal change. Projections are however based on the same family of models used in spring, which did not perform well - predicting a substantial summer surge that didn’t really arise.
While there was some reason to be optimistic, it was noted that there is room for evolution of the virus and we must not be complacent. Delta is currently outcompeting other variants with immune escape, but the virus had demonstrated significant evolutionary tendencies and new variants could change that. There is genuine scientific credibility about the possibilities for greater transmission – some existing variants are more transmissible than Delta. There was an acknowledgement that the UK was at a high equilibrium compared to the EU and there is the possibility of a ‘delta plus’ variant arising from high case rates, with the potential for vaccine escape.
There is a need to keep the vaccination programme at very high level. It is the main tool we have to mitigate the pandemic. The big issues on vaccination are for JCVI, including advice on extending the booster beyond age 50. While there are some limitations to vaccination – efficacy, waning immunity– there is a real risk of underplaying the importance and significance of vaccination.
A discussion of prospects for the next few months noted that vaccine waning would be a key issue. Clear that immunity is waning and it will be key not to leave it too late taking action in response. A decline in immunity should be gradual and EAVE data should give advance warning of problems – so there should be warning signs, giving an opportunity to react. Clear that the timing of mitigations is important.
Boosters will have a role in addressing problems caused by waning, but catch-up vaccinations also important - improving from 96% vaccinated to 98% halves the proportion of the population who remain unvaccinated. There is also scope to increase take up in certain groups e.g. work being done on analysis of vaccine uptake in NI by those with mental health problems.
Scotland and England have been in tandem for most of the pandemic but not since around the time of the Euros. Infections in Scotland peaked, then declined without intervention and are now plateauing. There is an unresolved question as to why England did not peak to the same extent. It may be because things are so delicate that small movements have produced big changes. High levels of infectiousness and high levels of vaccination is new territory but the infectiousness of delta means that we cannot attain population immunity.
Coinfections with flu/RSV was discussed – duration was an important consideration as well as severity of infection. Very good flu data is available from PHS – no flu at the moment so coinfection is not currently impacting on hospitalisation or other indicators.
A further main driver going forward will be behaviour – activity levels in England are back to near pre-pandemic behaviour. Caution is needed though when referring to previous behaviour as statistics only measures activity and not the intensity of contacts. The modelling on behaviour and contact rates for transmissions outside the household tends to be more accurate than modelling of household transmission rates e.g. around Christmas.
Vaccination rates for pregnant women are low, with pregnant women sadly making up a significant proportion of those admitted to hospital with COVID-19. But there is little published evidence on vaccination during pregnancy. More data is being collected on uptake and outcomes and there is an ONS study on pregnancy. DHSC are to pull together experts across UK on this. Royal College of Obstetricians and Gynaecologists information is helpful but it would be useful to provide Scottish data to supplement this. The COVID-19 in Pregnancy in Scotland (COPS) is a major Scottish study within EAVE studying the pregnancy and covid outcomes of all women pregnant in Scotland from March 2020 onwards.
It was noted that international vaccination rates in the EU are high – e.g. Portugal, France & Spain ahead of the UK due to making an earlier start on vaccinating children – while African rates are still very low. There is heterogeneity of experience in the US, with high rates in the eastern and western coastal states and much lower rates in the southern states.
It was noted that the recently announced membership of WHO’s Scientific Advisory Group for the Origins of Novel Pathogens (SAGO) included Dr Stuart Blacksell, University of Oxford and Dr John Watson, London School of Hygiene & Tropical Medicine.
Aziz Sheikh and Chris Robertson to engage with SAGE participants regarding data on pregnancy and COVID-19.
The group heard that university return has gone well and PHS would be releasing an analysis soon showing the difference from last year. The student population have a higher vaccine uptake than the average for equivalent ages. There was a low uptake of asymptomatic testing and efforts were needed to encourage take-up around the Christmas break.
Education and Children
The group heard that there had been challenging discussions in last few meetings on appropriate reductions in mitigations such as face coverings at desks, restrictions on assemblies and parental engagement. The timing of reducing measures needed to consider the 4 harms and take account of prevalence for school age children and other factors. Advice was awaited from JCVI on a second dose for children.
The group heard that the current nosocomial risk is relatively low. There are ongoing clusters and outbreaks though less of them and lower numbers than previously. Lessons had been learned about the reliability of processes and on dealing with unvaccinated patients. Scottish respiratory pathways advice for winter is out for consultation, with arrangements in hand for supporting implementation. There were behavioural lessons arising on HCW perception of different risk for patients and HCW. Presenteeism was identified as an issue for some mildly symptomatic staff.
The group head that a number of key tasks had been completed and future priorities discussed, with meetings now monthly. There would be discussion of the future of the testing infrastructure established for Covid, (which would link with the Standing Committee on Pandemics) the interaction between PCR & Lateral flow testing as well as dual testing for RSV & flu as well as Covid. The importance of free lateral flow tests at this stage in the pandemic was noted.
Any other business
Future meeting will be arranged, where possible, to coincide with meetings of SAGE, so group discussions can be informed by any developments arising. The group’s next meeting will consider what advice might be provided to the Standing Committee on Pandemics to inform their consideration of preparedness for future pandemics.