- 1 Feb 2021
Attendees and apologies
Advisory Group Members
- Andrew Morris
- Dave Caesar
- David Crossman
- Tom Evans
- Nick Hopkins
- Angela Leitch
- Jim McMenamin
- Jill Pell
- Stephen Reicher
- Jacqui Reilly
- Chris Robertson
- Sheila Rowan
- Aziz Sheikh
- Gregor Smith
- Devi Sridhar
- Nicola Steedman
- Carol Tannahill
- Mark Woolhouse
- Mary Black
- Cat Carver
- Gabe Docherty
- Daniel Kleinberg
- Audrey MacDougall
- Marion McCormack
- Alisdair McIntosh
- John Nicholson
- Elizabeth Sadler
Items and actions
The chair welcomed group members and SG observers attending.
The minutes of the previous meeting have been shared with group members for comments by 9 a.m. on 08 January.
3. Long Covid
The Chair introduced the discussion, noting the work of the CSO office in commissioning research into Long Covid.
CSO (Health) provided an overview of this research call and the projects selected, noting that the issue of direct viral attack remains complex and studies are limited by a lack of knowledge on the pathophysiology in different tissues and organs. Post viral syndromes are complex and mechanistically challenging. In some syndromes, there is clear presentation such as Epstein-Barr in others it is more heterogeneous. It was noted that many cases reported of long covid arise from those who had only mild symptoms of the disease.
Group members shared details of their ongoing research projects on Long Covid with the group. Some of the challenges with research in this area are the absence of widespread testing during the first lockdown, the limited understanding of long covid and the wide breadth of symptoms in patients presenting with this condition. While there is not yet an agreed definition of long covid, the group recognised the work done by NICE, SIGN and the RCGP on guidelines for managing long covid. The Group also recognised the important work of CSO in driving research into long covid, noting that another challenge is the limited data on the actual prevalence of long covid. Current research will be central to understand what treatments may help those affected by long covid.
[REDACTED] and Daniel Kleinberg noted that understanding what existing research and data is available on long covid is important to support the government’s ability to support those affected by long covid. The burden of long term morbidity will be important to consider as part of the ongoing government response and vaccine policy.
The Chair suggested the group would build on research being done by CSO and contributions from the group to provide a review of the existing evidence base on ongoing research across the UK into long-covid.
Action– Prepare a synthesis of current evidence and research gaps in long covid.
4. Preparation for Scenario Planning
The Chair introduced the discussion, noting the importance of highlighting the latest scientific evidence around the central pillars of the existing covid response. We are at an inflection point. Looking ahead to August 2021 there is a need to define what needs to be put in place between now and then and enable the optimisation of a package of interventions that will comprise the 2021 pandemic response. For example, to consider how isolation has been deployed and how to increase the effectiveness of this. The Chair asked group members to consider the key interventions that will form the spine of the 2021 response, where these may have reduced in effectiveness and where new science has emerged which could improve the impact of these measures.
Daniel Kleinberg provided a brief overview of the work in government to adapt or amend existing frameworks for the new variant. This is tied to work to articulate how to build a maximally effective system to guide our response in 2021. Alisdair McIntosh added that there is work to review current restrictions and how they fit with vaccination and testing policy to inform the strategy for the period between now and the end of the summer 2021. The input of the advisory group to help define what we can expect from vaccination and testing is key to help inform the use of NPIs going forward.
The group noted the importance of planning to avoid a situation similar to the current one by next winter. An important consideration is whether to accept that covid-19 will remain as an endemic condition. The current number of cases requires a focus on protecting the NHS. Group members agreed that consideration must be given now to reviewing existing tools to ensure that once prevalence decreases any future resurgence is prevented. Suppression is also important to help prevent the arrival of new variants. While vaccines are an important new tool in our response, it is important to continue to continue to draw on existing pillars, such as testing, isolation and NPIs. As part of this, it is also important to recognise the possible impact of ‘fatigue’ on adherence in the long term, as well as ensure mitigations are put in place for groups such as secondary students whose education has been heavily disrupted.
It was suggested that there are two broad questions the group can help with. First, what do we need to do differently from before to prevent large swings in the impact on the community. This includes testing, border control measures, NPIs etc. Second, how can vaccination alter the situation to allow normal life to return and reduce the risk of another significant variant appearing. Stopping infection will reduce the likelihood of new variants emerging.
Group members noted the importance of being clear that normal life may still mean the use of NPIs for a prolonged time period. The possibility that the new variant cannot be fully suppressed with existing measures cannot be discounted at this stage.
The group briefly considered the increase in cases over the autumn and winter. International travel and student migration without testing had contributed to rising cases. It was noted that no country in Western Europe has successfully eliminated the virus and therefore it might not be realistic to aim to eliminate the virus. However, countries like Finland and Norway which prevented international travel did not have a similar sharp rise in cases, though the only Western European countries currently seeing decreases in case numbers are Belgium and Sweden.
Marion McCormack echoed earlier comments about the need to reframe what the ‘new normal’ will be. On vaccinations, people may need to get revaccinated on a regular basis. There is a need to ensure the wider population is aware that the vaccine will be rolled out across the population, not just to the priority groups.
It was noted that alongside the existing use of vaccination, testing and NPIs, testing may need to become less centrally controlled. Issues of passporting and certification must be refined, as well as open testing.
The group commented on the burden of disease across the four nations and noted that there will be long term changes likely needed as part of the ‘new normal’. Work should be done to think about how this is communicated with the public to raise awareness of what the future will look like. There is also an opportunity to boost resilience; involving people and getting them to be part of the solution can help to boost mental wellbeing while building up a sense of community. Community resilience is key to continued adherence to measures. The group noted that adherence levels are high, with a significant majority of the population shown to be favourable to current restrictions being implemented. Barriers to adherence should be considered to refine how support can be improved, with the emphasis on enabling adherence.
It was noted that work is ongoing in SAGE and the EMG to look at the built environment and how this can be made increasingly safe.
On vaccines and immunity, the group noted that we do not yet know the impact of the current lockdown on the new variant. The new vaccines have the potential to make a significant contribution to reducing mortality in the short term and easing the burden on the NHS. What won’t be possible in the short term is to get close to the herd immunity threshold and it is very realistic possibility that we may not reach the herd immunity threshold. Schools could still return in this scenario but elimination would not be feasible.
Experience from London and the South East of England does not show us yet how effective suppression of the new variant will be. Vaccination should however, dramatically improve the situation in acute healthcare settings. The group noted observations on the morbidity and mortality of the new variant from analysis of EAVE-II data, based on clinical data from the lighthouse laboratory. There are some signs of increased S gene dropout in high deprivation groups, there are also minor differences in age. Regression modelling so far shows that there is no particular increase in hospitalisation for S gene dropout cases compared to wild type cases. It was noted that this highlights the power of data linkage and the importance of real time information to build resilient and frictionless systems to enable this type of analysis.
CMO thanked the group, noting that we are currently in an extremely high risk period. It is important to reflect and learn on our current experience to see how this can be optimised and improved going forward. The Covid Analysis Team and wider Scottish Government policy teams will draw on today’s discussion to feed into ongoing modelling and scenario planning work.
5. Subgroup Updates
for the Chair noted the highly valuable work of the Education and Children’s Issues subgroup over the past two weeks. The group heard a brief overview of recent work of the education and children’s issues subgroup, including advice around school closure. Current issues under consideration include the numbers of key worker children attending schools, as demand is currently much higher than during the first lockdown. The subgroup is considering what needs to be in place for schools to reopen safely and well as how to prevent and mitigate the harm from children not attending schools.
The group were provided with an update from the nosocomial subgroup. A review of IPC measures has concluded that current IPC measures are sufficient for the new variant. Admission testing and staff testing are being shown to have significant impact in NHS England Trusts that have implemented these measures.
The group also heard about the upcoming testing subgroup, one focus of which will be widespread access to testing and integrating genomics into the testing system.
6. SAGE Update
The group heard a brief overview of topics discussed at SAGE.