Transparency data

SAGE 20 minutes: Coronavirus (COVID-19) response, 29 March 2020

Published 29 May 2020

Twentieth SAGE meeting on COVID-19, 29 March 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)
• Andrew Morris (Scottish COVID-19 Advisory Group)
• Angela McLean (CSA MOD)
• Calum Semple (Liverpool)
• Charlotte Watts (CSA DfID)
• Graham Medley (LSHTM)
• Gregor Smith (dCMO Scotland)
• Ian Young (CMO Northern Ireland)
• James Rubin (King’s College London)
• Jenny Harries (Deputy CMO)
• John Aston (CSA HO)
• Jonathan Van Tam (Deputy CMO)
• Neil Ferguson (Imperial)
• Peter Horby (Oxford)
• Rob Orford (Health CSA Wales)
• Steve Powis (NHS)

Observers and government officials:

• Simon Whitfield (GoS).

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 endorsed the reasonable worst case and optimistic scenarios, incorporating changes discussed in the meeting.

2. Further work is required to understand how best to release measures and the scale of any resultant epidemic peaks.

3. Further work is required on age distribution of ICU cases.

Situation update

4. The average length of stay in ICU was taken as 9.5 days on NHS advice.

5. Vast majority of admissions to ICU and high dependency units are aged between mid-40s and 70. There are fewer admissions among the over 70s.

6. ICU care may not reflect the full burden of disease, as now many patients are being cared for in other settings.

7. NHS reported that critical care bed occupancy is not yet reaching saturation levels, London included.

8. There is evidence that severity varies by sex (men are affected more severely), but there is no evidence that transmission varies by sex.

9. NHS models use numbers approved by SAGE, but they are run more frequently and need to provide regional and other detail — leading to quantitative, but not qualitative differences in projected scenarios.

Reasonable worst case (RWC) and optimistic scenario

10. SAGE noted that the underlying epidemiology is unchanged, but cases within the NHS have grown rapidly, affecting bed requirements.

11. Some numbers contained in the scenarios derive from data; others are assumptions —for example, around compliance.

12. Age profile of ICU patients is not critical to modelling the trajectory of the epidemic — but modelling will need to evolve to reflect emerging practice in referrals to ICU.

13. The modelling draws on both admission and death data.

14. SAGE endorsed the document under review, subject to the following changes:

• there needs to be a clearer narrative, clarifying areas subject to uncertainty and sensitivities
• it makes clear that these are scenarios, not absolute predictions, and that timings are only indicative
• it makes clear that R assumptions are different for each scenario, and highly dependent on levels of contact among the population (such as on compliance)
• it clarifies that assumptions about compliance are based on survey and other data, but these do not measure contacts, which must be inferred: the reality could be better or worse
• it explains that the scenarios are modelled for 6 months, both predicting a second epidemic peak when measures are released
• the wording around workplace contacts needs to be clearer
• it makes clear the modelling does not consider sex, and this does not affect outputs
• it makes clear the modelling makes no judgements about who is admitted to ICUs

15. Further work is required to understand how best to release measures and the scale of the second epidemic peak. This is a priority for SAGE in the coming week.

16. Further work is required on age distribution of ICU cases.

Actions

SPI-M and SAGE secretariat to revise reasonable worst case and optimistic case scenarios to:

• make clear that these are scenarios, not predictions
• explain how assumptions on compliance have been made
• make clear these have been modelled over 6 months, assuming continued social distancing measures, but there will be a second peak when measures are released and that further work is needed to model release of measures
• include R values in the different scenarios
• not include age profiling within this iteration

For future discussion at SAGE

17. It would be useful to understand regional variation in compliance with measures, and whether compliance correlates with social deprivation levels.

Attendees

SAGE participants:

• Patrick Vallance
• Andrew Morris
• Angela Mclean
• Calum Semple
• Charlotte Watts
• Graham Medley
• Gregor Smith
• James Rubin
• Jenny Harries
• John Aston
• Jonathan Van Tam
• lan Young
• Neil Ferguson
• Peter Horby
• Rob Orford
• Steve Powis

SAGE secretariat

• Simon Whitfield

4 Secretariat members redacted.