Transparency data

SAGE 22 minutes: Coronavirus (COVID-19) response, 2 April 2020

Published 29 May 2020

Twenty-second SAGE meeting on COVID-19, 2 April 2020.

Held via Video Teleconference.

Addendum

This addendum clarifies the roles of the SAGE attendees listed in the minute. There are 3 categories of attendee. Scientific experts provide evidence and advice as part of the SAGE process. HMG attendees listen to this discussion, to help inform policy work, and are able to provide the scientific experts with context on the work of government where appropriate. The secretariat attends in an organisational capacity. The list of attendees is split into these groups below.

Attendees

Scientific experts:

• Patrick Vallance (GCSA)
• Chris Whitty (CMO)
• Andrew Morris (Scottish COVID-19 Advisory Group)
• Andrew Rambaut (Edinburgh)
• Angela McLean (CSA MOD)
• Brooke Rogers (King’s College London)
• Calum Semple (Liverpool)
• Carole Mundell (CSA FCO)
• Charlotte Watts (CSA DfID)
• Graham Medley (LSHTM)
• Gregor Smith (dCMO Scotland)
• Ian Diamond (ONS)
• James Rubin (King’s College London)
• Jeremy Farrar (Wellcome)
• John Aston (CSA HO)
• John Edmunds (LSHTM)
• Jonathan Van Tam (Deputy CMO)
• Julia Gog (Cambridge)
• Lucy Yardley (Bristol/Southampton)
• Maria Zambon (PHE)
• Neil Ferguson (Imperial)
• Peter Horby (Oxford)
• Rob Orford (Health CSA Wales)
• Sebastian Funk (LSHTM)
• Steve Powis (NHS)
• Therèse Marteau (Cambridge)
• Wendy Barclay (Imperial)

Observers and Government Officials:

• Ben Warner (No. 10)
• Vanessa MacDougall (HMT)

Secretariat: [redacted]

Names of junior officials and the secretariat are redacted.

Participants who were observers and government officials were not consistently recorded therefore this may not be the complete list.

Summary

1. SAGE agreed the importance of consistent recording hospital and community fatalities by date of death.

2. A national testing strategy requires overall target volumes for understanding infection rates among a) hospital patients b) NHS staff c) age-stratified population survey participants and d) communities.

3. SAGE agreed that it is unlikely before week 13 April it can start to advise whether the interventions in place are having enough of an effect. SAGE does not currently recommend that changes be made at that point.

4. There is a danger that lifting measures too early could cause a second wave of exponential epidemic growth — requiring measures to be re-imposed.

Situation update

5. A nosocomial transmission sub-group will be co-chaired by the National Infection Service and the NHS nursing director, with a secretariat from NHS. It will meet twice weekly starting immediately.

6. Adult critical care bed capacity continues to be available, including in London. The lowest English demand is currently in the South-West.

7. CO-CIN data is signalling nosocomial infection more strongly than previously. SAGE will discuss this in detail at its next meeting following output from the specialist sub-group.

8. No update on R or doubling time since SAGE 21.

9. SAGE agreed that the reasonable worst case scenario remains valid.

10. SAGE re-emphasised the importance of consistent recording hospital and community fatalities by date of death. This will be in place by the end of this week.

11. The chief statisticians of the DAs are working to ensure data consistency and reduce time lags in making data available.

12. SAGE agreed that the Nowcast could be a useful resource for HMG once data are fully reconciled.

Actions

• ONS to coordinate agreement with PHE and NHS on a single method of reporting COVID-19 deaths numbers, by the end of the week
• SPI-M to review Nowcast to ensure consistency of data interpretation

Understanding COVID-19

13. There are no current signals that secondary bacterial infection is a major issue. NERVTAG continues to investigate this.

14. CO-CIN data suggests that obesity, lung disease, heart disease and neurological disease are important risk markers for COVID-19. Conventional risk scores do not seem helpful.

15. SAGE can expect an update next week on results from genome sequencing, with a particular focus on nosocomial spread.

Testing

16. PHE is exploring the quality of commercially available tests in measuring both exposure and immunity.

17. The UK is at least 4 to 6 weeks away from implementing reliable antibody testing for healthcare workers.

18. SAGE advised that serology testing should be rolled out to NHS laboratories rapidly once assessed — and noted the importance of PHE guidance to NHS on delivery of this testing. Interpretation of these tests may well not be straightforward and requires further research.

19. SAGE agreed that a feasible and successful, long-term testing strategy:

• is linked to the UK’s overall strategy for managing the epidemic, and will be important for lifting interventions
• needs to match the performance of tests against the prevalence of infection
• requires clear and consistent use of technical terms
• should involve a clear public communications element to address confusions about what different tests can or cannot do (active infection, vs antibody, immunity), and how they will be deployed.

20. Critically, the testing strategy requires target volumes for detecting infections and understanding infection rates among a) hospital patients b) NHS staff c) age-stratified population survey participants (these are already available) and d) wider communities and outbreak detection.

21. Wider community detection will require large volumes of testing and SAGE would like to review the proposal and numbers required.

22. Separately, HMG policy leads should calculate target testing volumes for critical workers in other sectors.

23. The quality of testing and interpretation and communication of results is critical. There is a risk of individuals receiving incorrect test results or misinterpreting them, leading to unsafe behaviours by workers or unsafe demands being made of workers by employers.

Actions

• for the next meeting of SAGE, CMO and NHS clinical director to advise on target volumes for hospital patients and NHS staff; SPI-M to advise on volumes for community testing (following strategic guidance from GCSA and CMO on issues including frequency and levels of control scenarios)
• NIHR to develop a single public communications plan around testing, with input from SPI-B and PHE (Maria Zambon)

Lifting interventions

24. SAGE agreed that, by 13 April (3 weeks following the introduction of interventions), it should able to advise whether interventions in place are having an effect — or whether further interventions might need to be considered.

25. SAGE does not recommend that there will be sufficient scientific data for changes to interventions be made at that point: there is a danger that lifting measures too early could lead to a second wave of exponential growth of the epidemic, requiring measures to be re-imposed.

26. Until and after 13 April, SAGE will consider which measures could be relaxed and in what sequence from an epidemic perspective — for which it will need to understand, with input from SPI-M, which measures are having the greatest impacts on disease progression.

27. SAGE agreed it is not advisable to combine epidemiological and economic or secondary health effect analysis in a single model.

28. SAGE will look further at how shielding of the vulnerable can be incorporated in future modelling.

29. Specific work may be required to understand particular risks, for example around certain occupations, and how evidence can be generated in relation to those risks. SAGE cautioned about the difficulty of interpreting such work

30. Behavioural science suggests that if, as advised, interventions are to be continued, clear communication around how they help in reducing infection rates (for example in hospitals, workplaces) will be important to maintain public compliance. On and Off approaches were discussed and some of the difficulties with such approaches noted.

31. A group led by Ian Diamond and John Aston — and including NHS, HO, Government Actuaries Department — is considering longer-term impacts on overall health from the interventions as part of its work on excess deaths.

Actions

• Ian Diamond and John Aston to consider how best to expand membership of the excess deaths modelling group to cover longer-term health impacts from interventions
• Ian Diamond to explore whether mobile phone data can be used to understand co-location in certain workplaces (for example construction sites) and whether that would help identify specific workplace contact issues

International

32. DfID will discuss modelling in relation to low-income countries with SPI-M and NERVTAG.

33. FCO can, where required, use diplomatic channels to urge sharing of better data from other countries. It was noted that the Royal Society is also setting up a data group to provide information on this to SAGE.

34. A future meeting of SAGE will look at what the UK can learn from actions on other countries.

List of actions

• ONS to coordinate agreement with PHE and NHS on a single method of reporting COVID-19 deaths numbers, by the end of the week
• SPI-M to review Nowcast to ensure consistency of data interpretation
• for the next meeting of SAGE, CMO and NHS clinical director to advise on target volumes for hospital patients and NHS staff; SPI-M to advise on volumes for community testing (following strategic guidance from GCSA and CMO on issues including frequency and levels of control)
• NIHR to develop a single public communications plan around testing, with input from SPI-B and PHE (Maria Zambon)
• Ian Diamond and John Aston to consider how best to expand membership of the excess deaths modelling group to cover longer-term health impacts from interventions
• Ian Diamond to explore whether mobile phone data can be used to understand co-location in certain workplaces (for example construction sites)

Attendees

SAGE participants:

• Patrick Valiance
• Chris Whitty
• Andrew Morris
• Andrew Rambaut
• Angela Mclean
• Ben Warner
• Brooke Rogers
• Calum Semple
• Carole Mundell
• Charlotte Watts
• Graham Medley
• Gregor Smith
• Ian Diamond
• James Rubin
• Jeremy Farrar
• John Aston
• John Edmunds
• Jonathan Van Tam
• Julia Gog
• Lucy Yardley
• Maria Zambon
• Neil Ferguson
• Peter Horby
• Rob Orford
• Sebastian Funk
• Steve Powis
• Therese Marteau
• Vanessa MacDougall
• Wendy Barclay

4 Secretariat members redacted.