 Welcome to the first meeting of the Covert. This morning we will take evidence from the Scottish Government on the latest ministerial statements on coven 19. I'd like to welcome to the meeting John Sweeney, Deputy First Minister and Cabinet Secretary for Covert Recovery, Professor Jason Leitch, national clinical director, Penelope Cooper, director of coven coordination and Nev O'K konta sceneswilas, deputy director for testing and contact tracing I wish you all a happy new year, and I hope that you managed to have some sort of break over the festive period. Deputy First Minister, would you like to make any remarks before we move on to questions? Thank you, convener, and good morning. I'm grateful to the committee for the opportunity to discuss a number of matters, including updates to Parliament on Covid-19, and to make some opening remarks before taking questions. I set out by the First Minister on Tuesday, while Omicron is continuing to cause extremely high levels of new cases, we must remain careful. There are grounds for cautious optimism that our current additional measures and the efforts being made by people across Scotland are having an impact. Last month, our central projection was that new infections could reach 50,000 a day by early January. So far, this has not materialised, and we estimate that the total number of daily infections may be around 30,000. We have also seen the number of cases that are confirmed by PCR tests have fallen in all age groups except the over 85s. That is encouraging and gives us some hope that cases might be at or close to the peak. Further, although the number of people in hospital with Covid has continued to increase over the past week, there are signs that the rate of increase may be starting to slow. In line with our guidance set out last week, people with symptoms should test positive with a lateral flow test. No longer need to secure a confirmatory PCR test. That means that the current daily numbers are capturing fewer positive cases than before. To address this, Public Health Scotland will, from today, augment its daily reports to include the combined figure for the number of people who have recorded a first positive PCR or lateral flow test. That additional data will allow us to assess the trend in cases more accurately. I encourage members of the public to continue to record in their lateral flow results whether they are positive or negative. That can be done very easily through the UK Government website under the report a lateral flow test search approach. Although we must remain careful and cautious, Cabinet agreed in Tuesday to begin lifting the additional protective measures that were introduced before Christmas. We will do so in a phased manner and further dates will be announced in due course. From Monday 17 January, the attendance limits on large-scale outdoor events will be removed. Certification will remain in place for events and venues previously covered by the scheme, and we are asking event organisers to check the certification status of more people attending events. From Monday, for the purposes of certification, the requirement to be fully vaccinated will include having a booster if the second dose was more than four months ago. By the time being, baseline measures that were in place before the emergence of Omicron, such as wearing face coverings in indoor places, and working from home where possible, will remain in place. For the immediate period ahead, our advice remains that people should limit their contact with other households and, in particular, not meet indoors with more than three households. We are not asking people to cut all social interaction, but reducing contacts and prioritising who we meet will help to reduce the risk. Our advice remains to take a lateral flow test and report the result when meeting others. When the First Minister confirmed that the Scottish Government intends to publish a revised strategic framework in the next few weeks, I will update the committee further once that has been published, and I am happy to be there to answer any questions that the committee may have. Thank you, Deputy First Minister. I will turn to questions. If I may begin by asking the first question, I think that we are all very cautiously thankful that Omicron is not as severe as we first expected when it emerged in early December. With the schools going back in the last week, I really wanted to ask about the effect of Omicron on children, on my school children, and especially as most of them have not been vaccinated and maybe an update on vaccinations for the five to 12-year-olds. Just in the school settings, is ventilation adequate at the moment as the schools have gone back? Obviously, we will be monitoring very carefully, convener, the impact of schools returning, and that is central to the approach that the Government is taking, because we recognise that the schools returning marks a gathering of individuals within our society at a fairly high level. As we know with Covid, the meeting of individuals from multiple households leads to spread of the virus. We will be monitoring that data very closely. That is why we are taking a phased approach to the relaxation of restrictions, because although the data at the present moment is encouraging, that could be influenced by the effect of schools returning. We will only now just be beginning to see the effects of that in the numbers to the extent that that will have an effect. In relation to the questions on vaccination of our younger citizens, we do not have the authorisation for widespread vaccination of children in the five to 12-year-olds group from the JCVI. The case has not been made for that by the JCVI. As the committee will be familiar, we look to and take forward the advice of the JCVI. Obviously, in relation to some children, the JCVI has indicated that it is appropriate for vaccination to take place, simply where a child may be of themselves clinically vulnerable or living in a household with individuals who are clinically vulnerable. We are obviously taking steps to implement those recommendations, as has been confirmed in the Parliament. In relation to the last part of your question, convener, on ventilation, this is ostensibly a local authority priority. We have been engaging with local authorities over the course of the past 20 months on the issues of ventilation and have made requirements of local authorities to enhance the monitoring of air quality in schools. First, we will ensure that we have a good understanding of where some of the ventilation requirements may need to be in place. On Tuesday, the First Minister announced some further expansion of the funding that is available to local authorities to enhance ventilation schemes should that be a requirement. I would also point out that local authorities have undertaken extensive audits on a classroom-by-classroom basis about the ventilation requirements. We would expect local authorities to act accordingly to address any ventilation weakness that emerges out of those surfaces. Thank you, Deputy First Minister. If I could just ask one more question. Just given that we do know that our NHS at the moment is under a lot of pressure—and we always knew it would be—in light of some of the NHS boards calling in military help and declaring major incidents, can the cabinet secretary provide the committee with the rundown of the position of the other NHS boards? There is a huge amount of pressure on NHS boards around the country. I think that it would be fair to say that all boards are under intense pressure. They are having to manage high demand for services along with some of the difficulties of staff absence, which is caused by Omicron of itself. The changes to testing arrangements and isolation periods that the Government has implemented will be beginning to have a welcome effect on easing some of those staffing pressures. We are confident about the sustainability of NHS services at this moment, but I have to say that that is a constantly dynamic position. The individual hospitals will come under greater pressure as a consequence of incidents that take place and demand that presents itself. Across the national health service, we are circulating and issuing advice, encouraging people to use the appropriate health services for the circumstances that they face. At this stage, I would say that the national health service in all parts of the country is coping, but it is coping under enormous pressure and the headroom that is available to deal with increased demand is very limited. For that reason, I have been leading along with the health secretary and the social justice secretary dialogue with the local government about expanding the capacity of social care services around the country. The more we can have in place effective social care services in the community, the more we can support individuals to have their needs met at home and, on other care settings, avoid them presenting in NHS facilities. That is one of the crucial interventions that we are making to try to stem demand and pressure on the national health service. Thank you, Deputy First Minister. Your update is appreciated. I move on to other members now and, if I could bring in Murdo Fraser, please. Thank you, convener, and good morning to the cabinet secretary and to colleagues. I would like to ask a couple of different issues this morning if there is time, and I would like to start off by raising again an issue that I have raised previously, which is the question of data. We have been trying to pursue this question of understanding in terms of hospital admissions. How many of those admitted to hospital are there because Covid is the primary cause of their admission, as opposed to it being secondary or incidental? We saw some limited data being published on Friday from Public Health Scotland based on two health boards, but I wonder when we might have a fuller picture, because I think that that is actually really important in terms of understanding the true impact of Omicron on the health service. The second issue is around the question of vaccinations. How many of those in hospital because of Covid, and in particular in intensive care units, are vaccinated as opposed to unvaccinated? Thirdly, has there been anyone as yet who has died that we are aware of as a result of the Omicron variant? I do not know if the Scottish Government has this information, but it has not been shared with us or with the public. I would be interested to know if that data is being collected. I will draw on some contributions from Professor Jason Leitch in relation to some of the material, but let me work my way through the different points that Mr Fraser raised. First of all, on the issue of the reasons for hospitalisation for individuals, whether it is because of Covid or people admitted with Covid or people who are in hospital with Covid, the data has been developed by Public Health Scotland working on datasets from Greater Glasgow and Clyde health board and NHS Grampian. Those are two very significant boards at NHS Greater Glasgow and Clyde, the largest board in the country, which covers a substantial share of the population. We have to get into a proper perspective the scale of the country that is covered by the data from. There was the subject of release last week, if my recollection is correct, yes, it will be. That gives us a fairly substantial picture around the country. It demonstrates a pattern that is about 60 per cent of people who are being admitted to hospital in connection with Covid are being admitted because of Covid. That is a relatively similar number to the number in the studies that have been produced in other nations in the United Kingdom. It is also not that dissimilar to the position with the earlier strains of the virus. My recollection is correct that the previous data in the exercise that was published by Public Health Scotland was 68 per cent in the previous survey that was undertaken by being admitted to hospital because of Covid. In the context of the volume of data that we publish on these questions, the data that has been published on this issue gives us a pretty good understanding of the balance and breakdown of that information. Obviously, Public Health Scotland will be working on further iterations of that data in due course. On the second point, in relation to the position on vaccinated and unvaccinated individuals in hospital, the latest data that I have seen showed that the unvaccinated hospitalisation rate was 59 out of 100,000, while the boosted hospitalisation rate was 15 out of 100,000, meaning that the unvaccinated hospitalisation rate is four times more likely to be hospitalised than people who have had their booster or third dose. I hope that that data helps, but I will draw on the input from Professor Leitch in the further detail that he will provide on that. Can I bring in Professor Leitch, please? Good morning, everybody. Good morning, convener, and a happy new year to everybody. Your questions are good, Mr Fraser. Let me deal with them in simplicity order. I will come to the harder one last. The vaccination status of hospitalisations and deaths are published every week. I do not know why there is too much fuss in finding them from individuals that were most recently published yesterday by Public Health Scotland, Mr Swinney. As read out, one of the elements of it is 59 versus 15. There are also mortality rates in that same publication that was published a week before, and each of those publications shows the previous four weeks, but they divide them into seven days. The mortality rate—and forgive the callous way of talking about mortality rates—I understand absolutely that those are real people with families who have had to grieve even over the Christmas and New Year period because of this horrible disease, but the unvaccinated mortality rate was £4.79 per 100 k and the boosted mortality rate was £0.21 per 100 k. If we needed it confirmed again that the best protection you can have is your booster dose, will those data be replicated globally? Bear in mind that, if you just look at the raw numbers of deaths, you may come to a different conclusion, but that is because the vast majority of the country is boosted. You have to age adjust and make it rates in order to understand the difference that the booster rate is having. Those numbers vary a little bit from week to week because the numbers are quite low. Your key question about whether those people die of Omicron or not, I am afraid, is not straightforward to answer. Over 92 per cent now of every positive case in Scotland is Omicron, so we have no reason to believe that there is a continuing big delta wave, but we probably still have some stragglers coming through the system who will have delta. It is not absolutely certain that those deaths are Omicron, but I am anticipating, as is the rest of the research community, that Omicron does lead to some deaths, particularly in the unvaccinated. We are learning more and more about risk, and I think that I have said to this committee before that we now know that the principal risk is immunity. Whether your immunity is hampered by disease—a transplant, HIV, something else going on with your leukemia or something—those are the big risk factors now and age, because, as you age, your immunity diminishes. That is why vaccination is such a big solution. The intensive care data is harder to get than the hospitalisation data, and the death data just because of the nature of data collection and the small numbers of people who end up in intensive care. We rely on a slightly different mechanism called the Scottish intensive care audit group. They are about to publish their most recent data in the next two weeks, but the last one that they did was that they were six times less likely to be in intensive care if you were vaccinated. That is the headline. They are six times less likely to be in intensive care if you are vaccinated. They will redo that data now for boosters and for Omicron, and I look forward to seeing their conclusion. However, the global data is around six times less likely. Let me come to your slightly harder point that we have covered here before, and Mr Swinney covered it. That is in with Covid or because of Covid. I do not know what the fascination with this data is. You have all the data that we have. We have published everything that I have around this question, but it speaks to a, if you will forgive me, a slight misunderstanding of how healthcare works. Healthcare is not a single disease. The people in hospital with Covid, who are in trouble, do not just have Covid. They have diabetes, they have leukemia, they are 87, they are all kinds of things going on. The death certificates often have five reasons for death, not one. Principal diagnosis, just a secondary diagnosis, is a matter of judgment at a time of death by the junior doctor who perhaps is filling in the death certificate. By all means, you can get all the data that we have and you have it, I promise, but I am not as convinced that this data is as important as perhaps some think, because healthcare is not linear. There are very few people in who are having their leg fixed because they fell over in the ice who get a positive Covid test. There will be some, of course, but the vast majority getting care in our hospitals with a Covid test and getting it because they have Covid and they have other things going on as well. I will bring you back in for a brief supplementary, but can I ask for the answers to be brief? I really have to. Thank you, convener, and thanks to Professor Leitch for a very detailed comprehensive response. I will make a point very briefly. When the reason I am asking those questions is that I have been asking those questions for some weeks now and it has been really hard to get as clear an explanation as we have just had as to the numbers. Specifically, on the question of the difference in hospitalisation between vaccinated and unvaccinated, I just asked whether the Scottish Government should be doing more to put that message out to the public because we are all wanting to encourage people more and more to get vaccinated and get boosted. I think that if it was as clear as you have just stated about the statistics, and that was more widely known amongst the public, that would be a really helpful message to you. That is fair, and I agree. I think that Mr Swinney will say the same. To me, those messages are communicated by Government. Our clinical advisers have been to the forefront of arguing for the rationale for vaccination and the booster programme and ministers likewise. I think that, at the heart of many of the interventions that we have made, whether it is about the public communication or whether it has been about policy interventions such as vaccine certification, the purpose has been to increase the level of vaccination within the population because it is a compelling protection against the virus. I can assure Mr Fraser that those messages will be communicated—what has been communicated by ministers—and will be communicated by ministers. However, if I can give my reflections on this, some of the endless speculation about these matters muddies the waters. It has been pretty crystal clear for a long time that vaccination was a critical issue as an obstacle to the circulation of the virus. When we go through all those different issues about extra bits of data, it is almost trying to leave the public thinking that there is something that they are missing about this data or that the Government is missing about this data. However, it is crystal clear that, if you get vaccinated, you have more protection against Covid. Alex Rowley, can we please move to you? I would re-emphasise the point that Murdo makes. I think that it is important that if we have information that demonstrates that you are much better protected and those ending up in hospital are those not vaccinated, then it is important that we share that information. The latest figures that we have on vaccination focus on two areas. One is that our advisers have pointed out to us that, in terms of the uptake of the booster, there is a tendency that it goes up with age. However, when you reach the eight to plus, there is a dip. There seems to be a dip in the over-80s getting the booster. One of the reasons for that may well be that many of those people are housebound. However, one, what do you think of that? Two, what are you going to do about it? Likewise, in the SPICE document that we have, it shows that the uptake of the booster is good across the country generally, but particularly poorer in the cities. We Glasgow at 52.6 per cent, Edinburgh at 59 per cent, you have the islands up in the 80s, you have Fife in the 70s, so there seems to be an issue with take-up. Do you acknowledge that? What are you doing about it? Obviously, there is a huge amount of effort that is put into securing the take-up of vaccination and boosters. I am just checking. I do not have in front of me the breakdown in the over-70s category, but over-70s? The group over the over-70s has 95 per cent got boosters, so it is a very, very... Over-80s, Deputy First Minister, there is that. I will look at those figures specifically, but we have got to have a sense of context here that there is a very, very high level of vaccination undertaken at that level. We obviously take a range of steps, whether it is about the prioritisation of care homes for the delivery of the vaccination programme. Again, at the outset of the approach to this, there was a bit of criticism of the Scottish Government that we were not moving as fast as there were now, but we were doing the painstaking work of doing the care homes to make sure that people were well vaccinated within our care homes. I think that that level has been very high. Equally, we have got to make sure that people who are housebound are vaccinated. From my constituency experience, I think that I certainly dealt with a number of cases where it was perhaps slower than people would have liked for housebound vaccinations to be undertaken, but my recent case law would indicate that that is a substantially enhanced position. I agree with Mr Rowley on the importance of vaccination, but we have got to keep a sense of perspective about that. We have very, very high levels of vaccination in those age groups. I might ask Neave O'Connor if she wants to add anything to what I have said or Professor Leitch for that matter. Not on vaccinations, Professor Leitch has the request to speak in the chat box, Deputy First Minister. Only to give the data, Deputy First Minister. Mr Rowley, your premise is correct. I would give some reasons for that. The 70 to 74 is 96 per cent, the 74 to 79 is 98 per cent and the over 80s is 92 per cent. Those numbers are astonishing when you compare them globally and across the UK. The over 80s group is slightly more complex than thinking that it is one homogenous group. Forgive the short hand again, there is quite a lot of end-of-life care in that over 80s group who you would not vaccinate. Quite a lot of people in that group proportionately who you would not vaccinate for a number of healthcare reasons, but you are right. If some of that group is because we have not reached them, then we should do everything we can to do so. I have colleagues all over the country working to do precisely that. My inbox has not got almost any cases of over 80-year-olds waiting to be vaccinated. I am relatively confident that the health boards have found all those people and have boosted all those people. Care homes are done, most home visits are done, but if you have individual cases, of course, we will be happy to do it. Do not rely entirely on the percentages, because there is good reason, particularly as you get very old near the end of your life, when you perhaps would not have your booster vaccine. What about the cities? No one is picked up on that point. As I say, last go, 52 per cent have had their vaccination. Edinburgh is a bit higher, around 59 per cent. There seems to be a problem in the cities compared to Fife, which is well over 70 per cent. As I say, the islands are over 80 per cent. Is there a problem with the cities and people not getting the booster? Obviously, the data will vary from area to area. What I am absolutely satisfied about is that the Government and health boards have put in place adequate opportunities for individuals to secure the booster jag. The level of performance has been very high. We have had a surplus capacity, so there has been absolutely no difficulty about people getting appointments. There will obviously be, in some circumstances, a time lag that if individuals were slower in coming forward for their first and second doses, they would be delayed in getting their booster dose because of the time limits that have to be applied. We are not at the end of the booster programme by any stretch of the imagination. That is continuing on an on-going basis to vaccinate people with the appropriate gap—the 12-week gap—from the second dose to the booster dose. The best way to explain that is that we are still in a work-in-progress on the booster vaccination programme, and I would expect that the rates of coverage to increase. We have to continue to intensify the message. One of the points that concerns me a little bit is that, if there is a sense that Omicron is a less acute variant, that might suggest to people that I do not need to go forward to get my vaccination, but, as Professor Leitch has just explained, there is an absolute necessity for individuals to have the booster vaccination because that will give them a level of protection that is absolutely critical in dealing with the virus. The Government's messages will remain resolute about the importance of rolling out that booster vaccination programme in all circumstances and in all geographies. Finally, on that point, given that the vaccination in the cities is so low, is that, given the Government's concern and the specific actions that you are proposing or are you just letting it run and seeing if the update comes? Obviously, we are tackling it because we have the capacity available within cities to enable people to be vaccinated. We have got headline messaging and marketing, which is encouraging people to undertake the vaccination. There have been very focused communications issued to individuals around where they have not had a booster vaccination, where we have been communicating with them directly to encourage them to do so, and the capacity will be maintained to ensure that we have opportunities for vaccination available for individuals. Given the point that I just made about the fact that there may be time gaps between the moments at which people have been vaccinated, I assume, Mr Rowley, that the Government intends to maintain the messaging, the communications and the approaches to individuals, and we will maintain the capacity to ensure that we can deliver the vaccination programme. Thank you, convener, and welcome to the committee and to the panel. I am very happy that you are here today. I hope that you all are in a nice break. I would like to go back to both Murdo Fraser's and Alec Rowley's point about emphasising the point about the numbers of people who have not been vaccinated who have landed up in hospital with real illness. That is a message that we have to continually get out of. One of the things that I am confused about is why there is, and I think that Jason Leitch touched on it, emphasis on whether people are in hospital because of Covid or with Covid. I struggle to see where the differentiation is. We have just had a clinician give us some private advice that she is having the position where people will go in, particularly when the patient will go in, with a condition, to discover that they have Covid, but it is not until she gets to know them better and studies them that she realises that Covid is hampering their recovery. We also have the position where people who are in hospital with Covid, whether it is affecting them or not, will still go through the process of being isolated and everything else. I really like the messaging to get away from whether people are in hospital with Covid or because of Covid, because it really does muddy the message and it muddies the waters for us. Could you answer how we get over that position? I think that I am in a slightly difficult position to do that, because I am not the one making the big song and dance about that particular data. The Government has to respond to demands for information. Mr Fraser set out to the committee this morning that he has been demanding this information for some considerable time. The Government has an obligation to address issues raised by members of Parliament. Ministers have made it pretty clear that we rather take the view that you have expressed that we do not think that there is particularly a particular significance in the difference between the cause of or with. We have a massive Covid challenge in our healthcare system and the more we can do to tackle the prevalence of Covid, the more we will relieve that pressure on our healthcare system. The Government's messages have been absolutely crystal clear about the dangers of Covid. We have been ensuring that there has been understanding of the severity of Covid, whether it is Omicron or not, because we cannot have a relaxed attitude prevailing that somehow Omicron is not a big threat. Omicron is a massive threat to our healthcare system and to public health. We have to get that across to people, which is why the Government has been taking the strong action that it has taken to protect the public. We are not in control of all the questions that we get asked, but we certainly are in control of the key messages about the importance of tackling Covid and ensuring that people in whatever circumstance they find themselves. In Mr Bailey's points about the advice from your clinician that is absolutely correct, if somebody has an underlying condition and they also have Covid, their ability to deal with their underlying condition will be severely compromised by the presence of Covid, and we know that very clearly from the clinical advice that we have had. Will Jason Leitch confirm that later point? Yes, I am going to argue against myself slightly here in defence of the data. There are two categories of people who are slightly different from that group, but they still require infection prevention control and it will still complicate their recovery. That is very straightforward admissions, so let's say a 24-year-old with no underlying condition breaks their ankle on the ice and comes in three days in tests positive for Covid. That will still affect their recovery, could severely affect their recovery and the hospital will still need to behave differently, and those who unfortunately still get nosocomial spread of Covid, so those in hospital who perhaps catch Covid in hospital or in an institution, which is still possible, much, much lower than it's ever been but still possible. Those two groups, you could argue if you kind of squint that you would want to know those two groups separately, but in reality you're still going to treat them for the disease and you're going to be complicating their recovery because of Covid. Okay, I'm very conscious of the fact that we're out of time, but my concern is that messaging is absolutely vital and I really cannot see why we're worrying about whether people are in because of or with Covid. Given the fact that we've only got a 50 per cent uptake in cities of the booster, we need to keep the messaging strong that we've got to get the boosters out there. Siobhan, thank you very much. Thank you, Mr Fairlie. Can I bring in Brian Whittle? Thank you. Good morning and colleagues there. I want to return to the question of data, really. A couple of points. One is around data collection of non-Covid-related issues. I've had a constituent or friend of mine who has unfortunately been diagnosed with stage 3 pancreatic cancer with complications but waited six months to get that test. In terms of data, are we collecting the right data here with regards to the stage at which people are now being diagnosed with the likes of cancer compared to pre-Covid and are we collecting data on how many people are being diagnosed with those kinds of conditions? I presume that Professor Leitch would be the best person to answer that question. If you were just before I come to Professor Leitch, it is absolutely critical that our healthcare system is able to meet the needs of all individuals, regardless of the health condition that they are facing, and recognise the necessity of interventions where they are appropriate. That is one of the arguments why we have to manage and suppress the prevalence of Covid, because the more Covid cases that are in our hospitals, the less space there is for other conditions to be addressed. That has been a central argument that ministers have set out to the committee and to the Parliament and to the public in the steps that we have taken to take what I think is appropriate and proportionate action to tackle Covid, so that our health service is able to meet the needs of all constituents, such as the individual that Mr Whittle has raised in his question, and to do that timuously, although we also deal with the pressures that come from Covid. Those are fundamental questions about the capacity of the health service. I invite Professor Leitch to give some more detail. I agree wholeheartedly with the Deputy First Minister that whatever the answer to your question is, the answer to the problem is to reduce Covid infections, which consequently will reduce pressure on hospitals and allow us to treat more cancer bluntly. Globally, cancer is presenting later. There is no doubt about that for two principal reasons. One is that people were staying away because they were either told to stay away or worried about coming to hospitals everywhere in the world, so Scotland is not immune to that. Secondly, because of capacity issues, most cancer patients do not have cancer on their referral letter. Most cancer patients are found because of some other symptom with which they are sent to a hospital. Subsequently, after tests and a number of visits, they are discovered to have cancer. Some of those people are on waiting lists, waiting lists in Cardiff and waiting lists in Edinburgh. We have to get to them. The way to get to them is to relieve the pressure on the health service. Most of the data that I have seen around the world suggests that the late presentation of cancer is becoming more common. I do not know exactly what that looks like in Scotland, and we will not know until we audit it over time. However, I would not be remotely surprised if that is the case. The way to fix that is to reduce Covid care and therefore increase cancer care. I think that my point here is totally understandable that we have a capacity issue, and we have only so many people who can work within our health service at the moment, and that Covid has such a significant impact on that. I think that my point is around the collection of that data and the potential issues that might be coming down the line. In our last private session, we had a sort of expert condition suggesting that we are going to do an investigation into non-Covid-related conditions. The adequate data is not being collected to make the decisions that need to be made. I think that that is really the point that I wanted to make here, is that the collection of that data is so crucial and pointing to the potential future issues that we have. Who would like to speak to that? Those are absolutely legitimate points that Mr Pyttle raises. It does come back to some of the points that I made in my earlier answer, but we must ensure that the needs of the population are met by the national health service. That is the fundamental founding commitment of the national health service, free at the point of need when individuals are in that need. Covid poses a threat to that, because it takes up capacity within our hospitals. There are over 1,500 patients in hospital with Covid at this present moment. That is 1,500 beds that could be used for other purposes if Covid was not a problem for us. The more we can get on top of Covid, the more we can reduce the circulation of the virus for the better, because it creates the space for patients such as the people on whose behalf Mr Pyttle argues today and for that matter, is argued consistently for some considerable time. The Government has tried to take all the necessary steps to sustain the engagement of critical services that have a life-threatening impact on individuals. We have worked very hard, clinicians have worked hard, health services have worked hard to sustain cancer services. Obviously, on acute presentations of life-threatening conditions, the health service is there to meet the needs. That is why we look carefully at the numbers in ICU with Covid, because we have to have space in ICU for the people who are coming in because of heart attacks or brain hemorrhages or whatever it happens to be. Mr Pyttle is right to raise those issues. I want to assure him and the public that the Government, in its management of Covid, very much has the patient group that Mr Pyttle raised with me this morning very much a link to ensure that their interests are protected. I want to give one final point. I know a lot of our data, especially initially pointed to the fact that the morbidity from Covid came in tandem with high levels of obesity, high levels of diabetes and other comorbidity issues, even some of the cancers. If we want to treat Covid, it highlights to me that we have to look at the health in a much more holistic way. Does it not point to the fact that we need to look at our healthcare service in a more preventative manner that, in long term, we need to do more to tackle the poor health of the nation? Yes. In whatever circumstance we look at, the Government accepts the argument. We have accepted it for many years and we have taken a number of steps to try to address it. I noticed some of the data and detail that is available on the challenges that individuals will face as a consequence of Covid will be made worse by other weaknesses in their health and fitness. Mr Whittle makes a strong argument that the Government accepts for people to pursue a healthy living approach. Many of our public messages are supportive of that approach, to encourage people to exercise, to look after their health, to take preventative action, to make sure that they are in the strongest possible position to be able to withstand the effects of conditions such as Covid, or, for that matter, some other challenging health conditions that they will face in our society. The emphasis on preventative interventions is a core part of the Government's health strategy and will remain so in the future. I thank you, convener. Thank you, Mr Whittle. Can I bring in John Mason, please? Thank you very much, convener. A few weeks ago, the numbers in hospital were under 500, and on Tuesday I think there were 14.79 and then yesterday there were 15.37. So they are still rising, and for me that is the key figure that I have been watching day by day. When they are still rising, is it not too early to be relaxing some of the restrictions, such as those huge crowds at football and rugby? It is a very careful judgment, convener, that has to be established here. I think that Mr Mason puts a fair and challenging point to me. The situation that we have to consider is a balance of considerations around a number of factors, around the prevalence of the virus, the presence of hospital cases, the pressures on intensive care and a variety of other social and economic indicators, not least of which the wider wellbeing of the population and the ability to sustain restrictions and the impact that that may have on the mental and economic wellbeing of individuals. There is a careful balance to be struck here. I hope that Mr Mason would accept from the explanation that the First Minister gave on Tuesday and the explanation that I have given today that the Government, although hopeful, continues to take a cautious course in the relaxation of restrictions. We are taking a phased approach. I have dealt with a range of broadcast media in the course of this week where I have been dealing with criticism of the Government that we did not go further in the relaxation of measures that we went on Tuesday. Those criticisms have been strongly expressed by a number of sectors, but I would essentially say that Mr Mason puts the counterpoint to me that he is going as fast as he is going. It is a not unreasonable point. There is a careful balance to be struck. We judge that the larger events such as in outdoor football stadiums, where vaccine certification and lateral flow device testing is required, at least 50 per cent of the crowds, is a reasonable first step in the relaxation of the restrictions to enable some of those events to take their course. Whilst we consider whether, with the benefit of another week of data, we can see a wider improvement in the situation that allows us to relax measures further. However, I acknowledge that it is a careful balance, and it is one of the Government's wrestlers with a great deal of consideration. I take the point about balance, and I suspect that you might be going to give me a similar answer to my next question, which would be about isolation. We were at 10 days, we are now at seven, and the United States is at five. How are we getting the balance and what is the thinking about exactly how long that should be? That is the balance question again. I am going to invite Professor Leitch in a moment to give some detail about the clinical justification, because we need to hear that. Ministers have heard that, and we have come to conclusions about that. However, I think that there is an important perspective here that has to be borne in mind. It really goes back to, I suppose, many of the questions that we have wrestled with as ministers, which I shared with the committee on a number of occasions around the Four Harms framework, that there are multiple harms created as a consequence of Covid. Loss of economic wellbeing is one of them. Loss of social interaction is another. Ministers have to be conscious of those factors when we take decisions around questions such as self-isolation. We have been criticised for taking so long to relax the self-isolation rules. I think that we took an appropriate amount of time to make those judgments within the context of the arrangements and the policy approach that we have taken to managing the pandemic. That will be an important point in the judgments that we have to apply in the future. I invite Professor Leitch to add some remarks to what I have said in relation to the clinical explanation on the relaxation of self-isolation requirements. It is a balance, Mr Mason. We did go from 14 to 10, if you remember. That is as we learn more about the virus, and it is as we learn more about the risk of the virus in your position that you have, not only in the state of your pandemic, so the number of cases that you have, but also the science that you have available to you. We would not have gone from 10 to 7 without testing, for example. The UK HSA, who is the real boffent here who does the risk adjustment for us, roughly said that 10 days with no testing is about the same risk as 7 days with two tests. That was a relatively straightforward piece of clinical advice to politicians to say that it is not exact, of course, because there are confidence intervals in the statistics, but, roughly speaking, moving from 10 days with no tests to 7 days with two tests was about the same risk that you were taking. What we now need to know is that France and the US have gone to five days with testing, so we need to know what is the risk percentage that you would be taking of release of infected cases on day five. In reality, what the US and France have done has been a little bit misunderstood. What they are doing is actually five days of isolation release on day six, which is only one day less than us. Actually, the headline is not quite right, so in France or America you would test and get released on day six. We test now and release on day seven if both your tests are negative. We do not yet know what that percentage risk would be, and that clearly changes if you have 15,000 cases or 150 cases. If you have 150 cases in your community, your risk can be higher. You can take more risk, because you are less likely to meet positive cases. If you have 15,000 cases, your risk is higher, so it is not only a matter of the percentage risk that you will be taking by release, but it is also the number of people that you have in your community who are positive. We will take that UK HSA advice, as will the other three UK countries. We will adapt it for our date of our pandemic and we will give appropriate advice. My instinct right now is that we have only just moved from 10 to 7. We need to let that work through in the real world, because the theory is one thing. People actually doing lateral flow tests in houses with kids running around their legs and pets and everything else does not really work like it works in the laboratory, so we need to see what happens with 10 to 7 before we would give advice about 7 to what would effectively be 6. Thanks very much for that. My next point would be concerning vaccine passports. We heard a lot about them in September, especially, and there was a lot of discussion around them, but we might not have heard so much about them recently. However, the suggestion is that we might have greater use of them in the next few weeks. If there is a vaccine passport, a negative test will be accepted. I say that a vaccine passport, I realise that the correct term is certificate. Will there also be a negative test that will be accepted? The cabinet will consider the steps that we take on any future expansion of the vaccine certification scheme. The vaccination certification scheme works well. I failed to understand what the fuss is about it. I think that it is a completely reasonable request for us to make. The arrangements are in place, and it functions well. As I indicated in my response to oral questions in Parliament yesterday, where you have a system involving over 10 million individual vaccinations, there is bound to be teeding issues on certain vaccine certificates. I have made it clear that ministers will help to resolve any issues. Indeed, I had an email last night from a gentleman who is not a constituent of mine looking for my help to solve a vaccination certification issue, and that is under way this morning. We will resolve those minor issues when they arise, but the vaccination certification scheme works perfectly well. The cabinet will consider any future expansion in our discussions on Tuesday. We have put in place steps that enable negative lateral flow device tests to be an alternative to vaccination certification. That would remain an option for us to take forward in any future expansion, and the Government will consider that. The committee's next meeting will be on 20 January, when we will take evidence from the Deputy First Minister and Cabinet Secretary for Covid Recovery again. That concludes the public part of our meeting this morning. I suspend the meeting to allow the witnesses to leave and members to move on to MS Teams, and I move the meeting into private.