- 29 Mar 2021
Attendees and apologies
Advisory Group Members
- Andrew Morris
- Dave Caesar
- David Crossman
- Tom Evans
- Nick Hopkins
- Jim McMenamin
- Jill Pell, Stephen Reicher
- Chris Robertson
- Sheila Rowan
- Gregor Smith
- Aziz Sheikh
- Devi Sridhar
- Carol Tannahill
- Cat Carver
- Gabe Docherty
- Andrew Millar
- Alan Deuchars
- Daniel Kleinberg
- Elizabeth Morrison
- Arlene Reynolds
Items and actions
The chair welcomed group members, guests and SG observers
2. Minutes & papers
Comments on the draft minutes of the previous meeting to be provided to the Secretariat by 9 am Monday.
Cat Carver introduced the Long Covid update paper, highlighting differences since the last discussion. The discussion noted that early data from Scottish studies were showing similar results. Primary care physicians are seeing cases and impact on the workforce may be significant in the longer term, with questions about inequalities, but data is key. It was noted that the US terminology is post-acute Covid syndrome (PACS) and sharing international experience will be important. WHO is expected to update its guidance on clinical management to include long Covid and that this might lead to a global consensus on a case definition, which would be helpful. The Chief Scientist’s office had funded a number of projects on long Covid and research had also been commissioned south of the border – all of this will improve our knowledge base.
Action: next meeting to hear a report on Scottish study data on long Covid.
3. State of the pandemic
a. SAGE Update
SAGE is now expected to meet fortnightly [REDACTED]
b. Scottish Government Update
CMO noted that cases had seemed to plateau at 800 for around 10 days, but were now down to lower rates. There is a need to bottom out if there has been any different impact of Kent on different age groups and look at the convergence of evolution of the virus around particular mutations, probably due to selection pressure and what that means for future testing strategy and next version of PCR. Need to look forward over next two years and think about what’s needed to prepare our infrastructure. Keen as a country to pursue suppression to the lowest level and be part of global move towards elimination but we need info on vaccination effect and effect on children. Latest analysis from USA reinforced concerns about mutations is available.
c. Modelling Update
d. Vaccine Impact on Hospitalisation
R is 0.7-0.9 for UK & Scotland and test positivity much lower than previously, particularly in NHS labs – Lighthouse labs do less tests but have a higher positivity. Asked about any difference in age distribution of the new variants, it was confirmed that age distributions are similar but we are starting to see a decline in older age group hospitalisations – majority of admissions are now under 65.
This may be the impact of the vaccines, though more data was needed. Further work will be needed to look at any waning impacts and the impact of second doses. It was noted that the Edinburgh University data on vaccine effects had global impact, which was a credit to the team for their work on this. Further detail could be provided to the next meeting.
4. Waste Water Testing
Andrew Millar gave a presentation on developments in waste water testing. The group commended the work, from a standing start in April to developing sampling, correcting for dilution and construction of the dashboard, as a public health legacy of the pandemic which will be powerful to combine with specific PCR in the testing programme and link to genomic sequencing. Andrew Millar noted that credit was due to SEPA & Scottish Water.
It was confirmed that sensitivity of the tests depends on sampling size and healthcare can distort where patients are drawn from a much wider area – Fort William for example. Test sites can be moved, but there are practical limitations. England has done more sub-regional sampling, with food processing piloted and 65 US universities are using the technology; Colorado at dormitory level. This had been successful, but was a lot of work. Prisons were a possibility. Work in Scotland was part of the community testing approach and could be applied to levels system, though may need development. Local Public Health departments are utilising as part of surveillance, linked to community mobile testing, and finding it a very useful tool.
The Testing subgroup would be discussing the potential of new waste water technology at their next meeting.
5. Education Subgroup Update
The chair expressed thanks to the subgroup for all the work they had undertaken to provide detailed reasoning in their advice to Ministers. The subgroup chair noted that they had been asked for advice on stage 2 on 15 March, but didn’t yet have full data on the impact of stage 1 and their advice had to take account of this. The subgroup would meet again to examine data from Scotland and international experience. The proportion of cases in under 19s is increasing, as is the proportion of cases who are education staff. This may be an impact of vaccinations and we know from ONS that education staff are not at higher risk.
Around half of staff have taken LFT tests. There has been a very low rate of positivity (0.04%) and any LFT positives have to be confirmed by PCR. The real issue is not that children can become infected but typically introduced into schools by adults. There is little evidence of children transmitting infection. There is significant uncertainty about observations made so far as there are limited numbers. Key is to reduce transmission and prevalence in communities, which will impact on schools. Thus far, the number of incidents we’re observing are not too worrying, but need to keep under observation. Timely feedback is important and the natural break of the Easter holidays will be a good opportunity to re-examine.
The subgroup was looking to proposed return after Easter and had advised on physical distancing and face coverings, though noting there was no international consistency on these issues. Looking forward, the exam systems need to make allowances for the detrimental impacts of pandemic on learning and this needs to feed into Universities’ admissions policies.
6. International experience – vaccine passports
Devi Sridhar introduced a paper on international experience of Covid-19 Vaccine Passports. Two of the biggest issues over the next 12 months will be the use of vaccine passports internationally (airlines, the EU and the African Union are looking at this) and domestically (the US is already giving different advice to those vaccinated). Tied to this is the position on variants, which are probably the biggest risk, though there are also ethical issues. The African Union is considering setting up app where you can upload vaccination status and Australia & New Zealand are also examining.
It was noted that there was already work underway in Scottish Government to consider the issues and this would be informed by the Advisory Group’s discussions. Some of the issues had also been discussed at meetings of the testing sub group, as there is a question as to whether testing and vaccination are rolled up together. Issues around privacy need resolved and we will need to be consistent with international moves but there are critical ethical and inequality issues. The group’s role would be to stick to the science and drill down into the issues.