Coronavirus (COVID-19): state of the epidemic - 3 September 2021

State of the Epidemic in Scotland – 3rd September 2021

Background

This report summarises the current situation on the Covid-19 epidemic in Scotland. It brings together the different sources of evidence and data about the epidemic in Scotland at this point in time, why we are at that place, and what is likely to happen next. This summarises the data up to and including 2 September 2021 on Covid-19 in Scotland. This updates the previous publication published on 27 August 2021^[1]. The information in this document helps the Scottish Government, the health service and the wider public sector respond to the epidemic and put in place what is needed to keep us safe and treat people who have the virus.

This edition of the State of the Epidemic summarises current data on Covid-19 at a national and local level, and how Scotland currently compares to the rest of the UK. It looks at the vaccination program in Scotland and the effects that are beginning to be seen from this. Information is provided about variants of concern and what impact these may have. Bringing this information together in one place gives the opportunity to better understand the current state of the epidemic in Scotland.

Key Points

• The reproduction rate R in Scotland is currently estimated as being between 1.3 and 1.6. This is an increase in the lower and upper limits from last week, and is the highest upper limit of R since October 2020.
• An average of 6,043 cases were reported per day in the 7 days to 2 September, which is a 53% increase in reported cases since 26 August.
• There were 749 weekly cases per 100,000 in the week to 30 August, which is an increase since last week and the highest since the epidemic began. The previous peak was recorded on 3 July with 425 weekly cases per 100,000.
• Case rates have gone up across all age bands over the last week. The highest case rates were observed amongst under 20s, followed by 20-39, 40-59, 60-79 and 80+.
• As determined through the latest weekly ONS survey, the estimated proportion of people becoming infected with SARS-CoV-2 in the community in Scotland increased in the last week (week ending 28 August 2021).
• Latest modelled estimates suggest there are currently between 73 and 138 new daily infections per 100,000 people in Scotland.
• There were 48 deaths registered in Scotland where coronavirus was mentioned on the death certificate in the week ending 29 August.
• North Lanarkshire currently has the highest weekly case rate in Scotland reporting 1,262 cases per 100,000 in the week to 30 August, followed by Inverclyde with 1,238 weekly cases per 100,000, and East Dunbartonshire with 1,160 weekly cases per 100,000. All local authorities apart from the Orkney Islands reported over 100 weekly cases per 100,000 population in the last week. Orkney Islands reported 54 weekly cases per 100,000 in the same period.
• Nationwide, levels of Covid-19 in wastewater have risen by around 30% since the previous week. In the week prior to this, levels approximately doubled.
• Covid-19 levels in wastewater are currently at the highest reported since the start of the pandemic.
• Hospitalisations are now rising. Future hospital occupancy and intensive care use are likely to continue rising as infections rise.
• Over 4.1 million people in Scotland have been given a first vaccine against SARS-CoV-2, and almost 3.7 million have now received a second dose.
• The Delta variant of concern (VOC-21APR-02, first identified in India), remains the dominant strain in Scotland.

Method

This report brings together a wide range of publically available figures from a range of data sources. These include publications by Scottish Government, Public Heath Scotland, National Records of Scotland and Office for National Statistics along with scientific publications and SAGE summaries where appropriate to summarise the state of the epidemic in Scotland in a given week. We also provide information on public attitudes to the virus from weekly YouGov polling surveys.

The national picture

The latest R value for Scotland (published on 2 September)^[2] was between 1.3 and 1.6 (Figure 1), with a growth rate of between 5% and 10%. This is an increase in the lower and upper limits from last week, and is the highest upper limit of R since October 2020.

An average of 6,043 cases were reported per day in the 7 days to 2 September. This is a 53% increase from the daily average cases recorded a week earlier to 26 August^[3]. In the 4 week period from 31 July to 27 August 2021, 40.2% of cases (PCR testing only) were in unvaccinated individuals^[4]. Our current position is 749 weekly cases per 100,000 in the week to 30 August^[5]. This compares to the previous peak of 425 weekly cases per 100,000 on 3 July and is the highest since the epidemic began (see Figure 2).

The number of locations where the levels of SARS-CoV-2 in wastewater are monitored has increased to 110 sites around Scotland. In contrast to Covid-19 case records, virus shedding into wastewater is a biological process. This means that wastewater data is unaffected by factors that impact whether testing is done. Nationwide, levels of Covid-19 in wastewater have risen by around 30% since the previous week. In the week prior to this, levels approximately doubled.

Covid-19 levels in wastewater are currently at the highest reported since the start of the pandemic.

Case rates have gone up across all age bands this week. The highest case rates are currently being reported in those aged under 20 followed by 20-39, 40-59, 60-79 and 80+ (Figure 3).

Not everyone who has the virus will be tested, as many people do not realise they have Covid-19, or they have mild symptoms and do not come forward. Latest modelled estimates suggest that, as at 17th August, the incidence of new daily infections in Scotland was between 73 and 138 new infections per 100,000. This equates to between 4,000 and 7,500 people becoming infected each day in Scotland^[7].

The number of people in hospital with confirmed Covid-19 for less than 28 days peaked at 2,053 on 22 January and decreased to a low of 58 on 6 May^[8]. This has since increased and as of 2 September there were 624 patients in hospital with Covid-19. This compares to 426 people in hospital on 26 August. Daily hospital admissions for people with Covid-19 have increased from a low of 5 on 15 May and are now at 86 on 29 August^[9]. In the 4 weeks to 27 August 40.1% of acute Covid-19 hospital admissions were in unvaccinated individuals^[10].

There were 48 deaths registered where Covid-19 was mentioned on the death certificate in the week to 29 August. This is an increase of 7 in the number of deaths from the previous week, and 93% lower than the peak in April 2020 (663 deaths). The proportion of deaths in care homes decreased from 60% in April 2020 to 15% in the week to 29 August, with 7 deaths occurring in care homes. In the week ending 29 August, deaths involving coronavirus have increased in those aged 75-84 (from 9 to 16 deaths) compared to week ending 8 August. Deaths decreased in those aged 15-44 (from 5 to 1 death), 45-64 (from 10 to 8 deaths), 65-74 (13 to 11 deaths) and 85+ (16 to 12 deaths) in the same period^[11] (Figure 4). From 29 December 2020 to 19 August 2021, 85.1% of Covid-19 deaths were in unvaccinated individuals^[12].

How Scotland compares with the rest of the UK

The ONS COVID-19 Infection Survey estimates that the percentage of the community population testing positive for COVID-19 in Scotland increased in the week 22 to 28 August to 1.32% (95% CI: 1.06% to 1.61%). Estimates for the same week in the other UK nations are as follows: 1.41% for England (95% CI: 1.31% to 1.51%), 1.56% for Northern Ireland (95% CI: 1.10% to 2.09%) and 0.92% for Wales (95% CI: 0.66% to 1.26%). This equates to around 1 in 75 people in Scotland, 1 in 70 in England, 1 in 65 in Northern Ireland and 1 in 110 in Wales. Estimates for England relate to 21 to 27 August^[13].

The ONS COVID-19 Infection Survey estimated that in the week beginning 9 August 2021, 93.6% (95% CI: 92.3% to 94.7%) of the adult community population in Scotland would have tested positive for antibodies against SARS-CoV-2, as a result of having the infection in the past or being vaccinated. This compares to 94.1% in England (95% CI: 93.1% to 95.0%), 92.0% in Wales (95% CI: 90.3% to 93.4%) and 90.4% in Northern Ireland (95% CI: 86.7% to 92.9%)^[14].

An estimated 1.5% of the community population in the UK were experiencing self-reported long Covid symptoms (symptoms persisting for more than four weeks after the first suspected coronavirus (Covid-19) infection that were not explained by something else) in the 4 weeks ending 1 August 2021. In Scotland, 74,000 people (1.41% of the respective population) living in private households self-reported long Covid symptoms for this period. This compares to 1.43% in Wales, 1.53% in England and 1.03% in Northern Ireland^[15].

Average daily deaths in Scotland (0.12 per 100,000) in the week to 2 September are below Northern Ireland (0.40) and England (0.17) but above Wales (0.09)^[16]. Average daily cases in Scotland (110.5 per 100,000) in the week to 2 September are above Northern Ireland (70.6),Wales (61.4) and England (43.2).

Situation by local authority within Scotland

North Lanarkshire currently has the highest weekly case rate in Scotland reporting 1,262 cases per 100,000 in the week to 30 August, followed by Inverclyde with 1,238 weekly cases per 100,000, East Dunbartonshire with 1,160 weekly cases per 100,000, West Dunbartonshire with 1,105 weekly cases per 100,000, East Renfrewshire with 1,084 weekly cases per 100,000, Renfrewshire with 1,054 weekly cases and South Lanarkshire with 1,011 weekly cases per 100,000 population. All local authorities apart from the Orkney Islands reported over 100 weekly cases per 100,000 population in the last week (Table 1). Case rates have increased across most local authorities over the last week and there are very high levels of case rates across Scotland (Figure 5). The Orkney Islands have the lowest case rate in Scotland, reporting 54 weekly cases per 100,000 in the week to 30 August^[17].

Table 1: Total new weekly cases per 100,000 population to 30 August 2021, in order of prevalence

Local authority	Total new cases in the week, per 100,000 population	Change since previous week
North Lanarkshire	1,262	+594
Inverclyde	1,238	+675
East Dunbartonshire	1,160	+363
West Dunbartonshire	1,105	+235
East Renfrewshire	1,084	+400
Renfrewshire	1,054	+407
South Lanarkshire	1,011	+362
Glasgow City	996	+370
North Ayrshire	783	+334
Midlothian	751	+353
City of Edinburgh	730	+189
Argyll and Bute	723	+61
Clackmannanshire	702	+27
Dundee City	699	+278
Falkirk	683	+286
West Lothian	681	+240
South Ayrshire	668	+268
East Ayrshire	634	+294
Stirling	618	+180
East Lothian	614	+201
Dumfries and Galloway	606	-22
Fife	601	+227
Highland	515	+189
Scottish Borders	434	+40
Angus	433	+168
Aberdeenshire	421	+196
Aberdeen City	413	+170
Perth and Kinross	298	+47
Shetland Islands	232	+105
Na h-Eileanan Siar	181	+49
Moray	177	+51
Orkney Islands	54	-13
Scotland	749	+266

The most recent modelling predicts, based on data up to 27 August, that for the week commencing 12 September 2021, there are 29 local authorities which are expected to exceed 50 cases per 100,000 population with at least 75% probability. Of these, 12 local authorities are expected to exceed 500 cases per 100,000 with at least 75% probability. These are Dumfries & Galloway, East Dunbartonshire, East Renfrewshire, Falkirk, Glasgow, North Ayrshire, North Lanarkshire, Renfrewshire, South Ayrshire, South Lanarkshire, West Dunbartonshire and West Lothian. North Lanarkshire and South Lanarkshire are expected to exceed 1,000 cases per 100,000 population with at least 75% probability (Figure 6)^[18].

Children and Education

Schools have resumed in Scotland and the majority of children and young people had returned to full time education by the week ending 20^th August.

Over the last week there was a further increase in the total number of Covid-19 cases in young people aged under 20, which has almost doubled from 7,209 cases in the week to 22 August to 13,848 cases in the week ending 29 August. 7 day cases per 100,000 have also increased in all age groups in the week ending 29 August (Figure 7). The percentage of cases made up of children under 12 was just over 38% (5,306 cases) compared to just over 29% (2,149 cases) in the previous week^[19].

The rate of testing increased amongst all age groups in the week ending 29 August. Test positivity rates have increased in all age groups except 2-4 year olds and 18-19 year olds. The proportion of positive cases who report having been in an education setting in the 7 day period prior to the onset of symptoms has increased to 15.0% in week ending 29 August, from 12.3% of positive cases in the previous week. Hospital admissions in children increased overall in the period 5 to 25 August compared to the previous three-week period (29 July to 18 August). There were increases amongst 0-1 year olds, 5-11 year olds and 18-19 year olds and decreases amongst 2-4 year olds and 12-17 year olds.

Looking ahead

Changes in patterns of mixing and adherence to restrictions will impact on future case numbers. The Scottish Contact Survey measures times and settings that people mix where they could potentially spread Covid-19. Average contacts have increased by approximately 33% in the last two weeks (comparing surveys pertaining to 12th August - 18th August and 26th August - 1st September) with a current level of 5.1 daily contacts.

Contacts within the work setting have at least doubled in the last two weeks. There has also been a rise in mean contacts within the home and other setting (contacts outside of the home, school and work), increasing by 6% and 11% respectively. All age groups with the exception of those aged 30-39 have had an rise in contacts within the last two weeks. Increases across the age groups are largely driven by a rise in contacts within the work setting.

The proportion of individuals using public transport increased from approximately 21% to 25% with individuals visiting a work place increasing from 15% to 18% in the last two weeks.

Self-reported compliance with the current regulations and guidance has decreased since January but remains at a high level. On 24-25 August, 68% of people reported 'complete' or 'almost complete' compliance^[20].

Hospitalisations are now rising. Future hospital occupancy and intensive care use are likely to continue rising as infections rise (Figures 8 and 9)^[21].

Vaccinations are continuing across the priority groups and 91.2% of the adult population in Scotland has now been vaccinated with the first dose^[23]. The first vaccines were administered on Tuesday 8 December and 4,111,513 people had received their first dose by 2 September 2021^[24]. By age group, almost 100% of individuals aged 55+, 96% of those aged 50-54, 91% of those aged 40-49, 82% of those aged 30-39, 74% of those aged 18-29 and 51% of those aged 16-17 have received their first vaccination (Figure 10). 100% of the over 80s, 100% of those aged 75-79, 99% of those aged 70-74, 100% of those aged 60-69, 96% of those aged 55-59, 93% of those aged 50-54, 85% of those aged 40-49, 71% of those aged 30-39, 52% of those aged 18-29 and only 9% of those aged 16-17 have received their second dose. Overall, 3,699,250 people (83.1% of those aged 18 and over) had received their second dose by 2 September^[25]. There remains a low level of hospitalisations and deaths among those groups vaccinated first (Figure 4).

The proportion of people surveyed who said they have been vaccinated for Covid-19 is high. 92% of all respondents have already received at least their first vaccine dose. Of those not vaccinated (and small base must be noted), 6% report they are likely to be vaccinated when a vaccine becomes available to them^[26].

How the virus is changing

The variant of concern Delta, also referred to as VOC-21APR-02 (first identified in India) is more transmissible than Alpha variant ^{[27] [28] [29]}. It quickly replaced Alpha (VOC-20DEC-01), first identified in the UK, as the dominant strain in Scotland, and 53,043 cases have now been identified as Delta to 1 September 2021.

To date there are five 'variants of concern' (VOCs) and eleven 'variants under investigation' (VUIs)^[30]. There is a concern that some of these new variants may partially escape immunity, from both natural infection and from vaccines currently being deployed and we are monitoring the evidence on this^{[31] [32] [33]}. Up to 1 September there have been 62 genomically confirmed cases of the variant Beta/VOC-20DEC-02 (first detected in South Africa), and 23 cases of Gamma in Scotland. There has also been one new case of VUI-21JUL-01 in the past week. Genomically confirmed cases of other VOCs and VUIs remain low, there have been no new cases of other VOCs or VUIs in the last week (Figure 11).

A large study from the University of Oxford and Office of National Statistics shows that with Delta, Pfizer-BioNTech and Oxford-AstraZeneca vaccines still offer good protection against new infections, but effectiveness is reduced compared with Alpha^[35]. Public Health England analysis shows that vaccines are highly effective against hospitalisation from Delta variant with similar vaccine effectiveness against hospitalisation seen with the Alpha and Delta variants at 93% and 96% respectively after two doses of vaccine. There was a 14% absolute reduction in vaccine effectiveness against symptomatic disease after a single vaccine dose with Delta compared to Alpha, and a smaller 10% reduction in effectiveness after 2 doses. Vaccine effectiveness against symptomatic disease is high for both Alpha (89%) and Delta after two doses (79%)^[36]. EAVE II data from Scotland also shows that both the Oxford–AstraZeneca and Pfizer–BioNTech Covid-19 vaccines are effective in reducing the risk of SARS-CoV-2 infection and Covid-19 hospitalisation in people with the Delta variant, but effectiveness against infection appeared to be diminished when compared to those with Alpha^[37].

There remains uncertainty regarding the impact of the Delta variant on severity of illness, treatment or reinfections. As more data is analysed we shall become more certain of the impact of Delta on infections, hospitalisations and disease severity and long term vaccine protection effects.

Next steps

The Scottish Government continues to work closely with Public Health Scotland and modelling groups to monitor what happens following the high number of cases in Scotland this week and how this effects the course of the epidemic.

Each week this report will provide an overview of the current Covid-19 situation in Scotland. This will include real time data on case rates, hospitalisations and deaths and how Scotland's figures compare to those from the rest of the UK.

Modelling can tell us where the epidemic is likely to be heading. Local data and data by age group can highlight where problems arise, which can help in addressing some of these issues. In the coming weeks the roll out of the vaccine will continue to be monitored along with the impact of this on case rates and deaths among different age cohorts. Investigations are ongoing by NERVTAG, SPI-M, SAGE, Public Health England and Public Health Scotland regarding the impact of new variants and of vaccination; this will be reflected here as work is undertaken.