Coronavirus (COVID-19): state of the epidemic - 06 August 2021

State of the Epidemic in Scotland – 6th August 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 5 August 2021 on Covid-19 in Scotland. This updates the previous publication published on 30 July 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 0.7 and 0.9, based on data up until the 2nd August. The lower and upper limits have both decreased since last week.
• An average of 1,139 cases were reported per day in the 7 days to 5 August, which is an 8% decrease in reported cases since 29 July.
• There were 142 weekly cases per 100,000 in the week to 2 August, which is a decrease since last week. This compares to 425 weekly cases per 100,000 on 3 July.
• Case rates have gone down across all age bands over the last week, except for the over 80s. The highest case rates were observed amongst 20-39, followed by 0-19, 40-59, 60-79 and 80+.
• As determined through the latest weekly ONS survey, the estimated proportion of people becoming infected with Covid in the community in Scotland has continued to decrease in the last week (week ending 31 July 2021). Scotland is currently below Northern Ireland and England but above Wales.
• Latest modelled estimates suggest there are currently between 58 and 114 new daily infections per 100,000 people in Scotland.
• There were 46 deaths registered in Scotland where coronavirus was mentioned on the death certificate in the week ending 1 August. Deaths have increased in those aged 45-64 (from 3 to 10 deaths), 65-74 (from 4 to 9 deaths) and 85+ (from 7 to 13 deaths) over the 3 weeks to 1 August. Deaths decreased in those aged 15-44 (from 2 to 0 deaths) and those aged 75-84 (from 15 to 14 deaths) over this period.
• Average daily deaths per 100,000 population in Scotland (0.14) are below Northern Ireland (0.23), but above England (0.12) and Wales (0.08).
• Inverclyde currently has the highest weekly case rate in Scotland reporting 214 cases per 100,000 in the week to 2 August, followed by South Lanarkshire with 207 weekly cases per 100,000, and North Lanarkshire with 202 weekly cases per 100,000. There were 21 other local authorities reporting over a 100 weekly cases per 100,000 population in the last week. Orkney reported 4 weekly cases per 100,000 in the same period.
• Nationwide, relative to last week's reported levels, wastewater SARS-CoV-2 RNA concentrations have fallen by around 20%. Compared to earlier in the year, the current levels of wastewater SARS–CoV-2 are still in a similar range to late January/early February.
• Potential future changes in hospital occupancy and intensive care use are highly uncertain and depend on both current infection levels and the impact of the recent and upcoming relaxations of measures which will take a few weeks to become apparent.
• Over 4.0 million people in Scotland have been given a first vaccine against SARS-CoV-2, and over 3.2 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 5 August and based on data up to 2 August)^[2] was between 0.7 and 0.9 (Figure 1), with a growth rate of between -5% and -2%. Last week the R number was below 1 for the first time since mid-May. R indicator lags by 2 to 3 weeks and does not reflect any behavioural changes that have happened during this time.

An average of 1,139 cases were reported per day in the 7 days to 5 August. This is an 8% decrease from the daily average cases recorded a week earlier to 29 July^[3]. Average daily cases reported are 67% lower than the peak of 3,454 in the week to 4 July. In the 4 week period from 3 July to 30 July 2021, 52.7% of cases (PCR testing only) were in unvaccinated individuals^[4]. Our current position is 142 weekly cases per 100,000 in the week to 2 August^[5]. This compares to 425 weekly cases per 100,000 on 3 July (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, relative to last week's reported levels, wastewater SARS-CoV-2 RNA concentrations have fallen by around 20%. Compared to earlier in the year, the current levels of wastewater SARS-CoV-2 are still in a similar range to late January/early February. All sites, besides Edinburgh, show wastewater SARS-CoV-2 levels continuing to be higher than would be expected given the current rate of new cases. The South Lanarkshire local authority overall wastewater SARS-CoV-2 level is significantly above the national average, in contrast to the low levels of new cases observed.

Case rates have gone down across all age bands this week except for the over 80s. The highest case rates are currently being reported in those aged 20-39 followed by 0-19, 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, or they have mild symptoms and do not come forward. Latest modelled estimates, based on data up to 2 August, suggest there are currently anywhere between 3,200 and 6,200 people infected in Scotland each day^[7]. This means that as of 4 August there were between 58 and 114 new daily infections per 100,000 people.

The number of people in hospital with confirmed Covid 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 5 August there were 381 patients in hospital with Covid-19. This compares to 490 people in hospital on 29 July. Daily hospital admissions for people with Covid have increased from a low of 5 on 15 May to 101 on 13 July, and has since gone down to 34 on 1 August^[9]. This compares to 44 admissions to hospital on 25 July. In the week to 30 July 47.2% of acute Covid-19 hospital admissions were in the unvaccinated individuals^[10].

There were 46 deaths registered where Covid was mentioned on the death certificate in the week to 1 August. This is lower than the 56 deaths the week before (-18%), 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 6% in the week to 1 August, with 2 deaths occurring in care homes. Deaths involving coronavirus have increased in those aged 45-64 (from 3 to 10 deaths), 65-74 (from 4 to 9 deaths) and 85+ (from 7 to 13 deaths) over the 3 weeks to 1 August. Deaths decreased in those aged 15-44 (from 2 to 0 deaths) and those aged 75-84 (from 15 to 14 deaths) in the same period^[11] (Figure 4). From 29 December 2020 to 22 July 2021, 88.2% of Covid deaths were in unvaccinated individuals^[12].

How Scotland compares with the rest of the UK

The latest ONS survey estimates that the proportion of the population infected in the community in Scotland (0.82% of people currently testing positive for Covid-19 from 25 to 31 July) has continued to decrease in the last week. The estimation is below England (1.32%) and Northern Ireland (1.87%), but above Wales (0.43%). In the week to 31 July the estimated rate of community infection was 1 in 120 people in Scotland, compared to 1 in 75 in England, 1 in 55 in Northern Ireland, and 1 in 230 for Wales^[13]. Average daily deaths in Scotland (0.14 per 100,000) in the week to 5 August are below Northern Ireland (0.23), but above England (0.12) and Wales (0.08)^[14]. The Coronavirus Infection Survey estimated that in the week beginning 12 July 2021, 92.5% of the adult population in Scotland would have tested positive for antibodies against Covid-19, as a result of having the infection in the past or being vaccinated. This compares to 93.6% in England, 93.2% in Wales and 90.7% in Northern Ireland^[15].

An estimated 1.46% of the 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 4 July 2021. In Scotland, 75,000 people (1.43% of the respective population) living in private households self-reported long Covid symptoms for this period. This compares to 1.61% in Wales, 1.47% in England and 0.89% in Northern Ireland^[16].

Situation by local authority within Scotland

Inverclyde currently has the highest case rate in Scotland with 214 weekly cases reported per 100,000 in the week to 2 August, which is a 12% increase from the week to 26 July^[17]. It is followed by South Lanarkshire with 207 weekly cases per 100,000 population, and North Lanarkshire with 202 weekly cases per 100,000. In the week to 2 August there were 21 other local authorities reporting over a 100 weekly cases per 100,000 population (Table 1). Case rates have been decreasing, however, there are still mostly high levels of cases across Scotland (Figure 5). Local authorities that recorded an increase in case rates over the last week were Dumfries and Galloway, East Dunbartonshire, Inverclyde, North Ayrshire and South Lanarkshire. Orkney has the lowest case rate in Scotland, reporting 4 weekly cases per 100,000 to 2 August^[18].

Table 1: Total new weekly cases per 100,000 population to 2 August 2021, in order of prevalence

Local Authority	Total new cases in the week, per 100,000 population (2nd August)	Change since previous week (26th July)
Inverclyde	214	+23
South Lanarkshire	207	+19
North Lanarkshire	202	-17
West Dunbartonshire	194	-41
West Lothian	182	-3
North Ayrshire	181	+19
Midlothian	161	-21
Glasgow City	153	-58
Fife	148	-20
Dumfries and Galloway	145	+22
East Lothian	144	-67
Dundee City	142	-26
East Dunbartonshire	141	+14
Clackmannanshire	140	-29
City of Edinburgh	138	-32
Aberdeen City	134	-16
South Ayrshire	134	-3
Renfrewshire	132	-21
Stirling	126	-46
East Renfrewshire	125	-26
East Ayrshire	116	-49
Scottish Borders	109	-36
Falkirk	108	-35
Angus	102	-15
Aberdeenshire	94	-7
Highland	93	-35
Na h-Eileanan Siar	91	-72
Argyll and Bute	90	-42
Perth and Kinross	87	-33
Moray	79	-49
Shetland Islands	61	-79
Orkney Islands	4	-45
Scotland	142	-24

The most recent modelling predicts, based on data up to 2 August, that for the week ending 21 August there are 4 local authorities (Inverclyde, North Lanarkshire, South Lanarkshire and West Dunbartonshire) that have at least a 75% probability of exceeding 50 cases per 100,000 population. There are no local authorities with at least a 75% probability of exceeding 100 cases per 100,000 (Figure 6)^[19].

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^[20]. From this survey we can say that contacts have remained at a similar level in the last two weeks (comparing surveys pertaining to 8th July - 14th July and 22nd July - 28th July) with a current level of 4.2 daily contacts. Mean contacts for those aged between 40-49 and 60-69 have shown an increase in comparison to two weeks prior. For individuals aged between 40-49 this is largely driven by a rise in contacts within the work place in contrast to those aged 60-69 where this increase is driven by a rise in contacts within the home and other setting (contacts had outside of the work, school and home). Interactions between those 18 and over with individuals under 18 have decreased in the last two weeks with the exception of those aged between 40-49 who have increased their interactions with this age group.

Self-reported compliance with the current regulations and guidance has decreased since January but remains at a high level. On 27-28 July, 67% of people reported 'complete' or 'almost complete' compliance^[21].

Potential future changes in hospital occupancy and intensive care use are highly uncertain and depend on both current infection levels and the impact of the recent and upcoming relaxations of measures which will take a few weeks to become apparent (Figure 7)^[22].

Vaccinations are continuing across the priority groups and 89.9% of the adult population in Scotland has now been vaccinated with the first dose^[24]. The first vaccines were administered on Tuesday 8 December and 4,018,503 people had received their first dose by 5 August 2021^[25]. By age group, almost 100% of individuals aged 55+, 97% of those aged 50-54, 91% of those aged 40-49, 81% of those aged 30-39 and 73% of those aged 18-29 have received their first vaccination (Figure 8). 95% of the over 80s, 98% of those aged 75-79, 70-74, 65-69, and 60-64, 96% of those aged 55-59, 92% of those aged 50-54, 82% of those aged 40-49, 52% if those aged 30-39 and 25% of those aged 18-29 have received their second dose. Overall, 3,268,887 people (73.4% of those aged 18 and over) had received their second dose by 5 August^[26]. 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), 14% report they are likely to be vaccinated when a vaccine becomes available to them^[27].

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 ^{[28 29 30]}. It quickly replaced Alpha (VOC-20DEC-01, first identified in the UK, as the dominant strain in Scotland, and 41,501 cases have now been identified as Delta to 4 August 2021.

To date there are five 'variants of concern' (VOCs) and eleven 'variants under investigation' (VUIs)^[31]. 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^{[32 33 34]}. Up to 4 August there have been 61 genomically confirmed cases of the variant Beta/VOC-20DEC-02 (first detected in South Africa), an increase of one since the previous week, and 21 cases of Gamma in Scotland. One case of the new variant, VUI-21JUL-01, has now been detected. 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 9).

Vaccines are effective against Delta, Public Health England preliminary analysis shows that vaccines are highly effective against hospitalisation from Delta variant^[36] with similar vaccine effectiveness against hospitalisation seen with the Alpha and Delta variants^[37]. A recent study from Public Health England shows that after a single vaccine dose there was a 14% absolute reduction in vaccine effectiveness against symptomatic disease with Delta compared to Alpha, and a smaller 10% reduction in effectiveness after 2 doses^[38], which is in line with previous studies^[39]. 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 these effects on infection appeared to be diminished when compared to those with the Alpha VOC^[40].

There remains uncertainty regarding the impact of the Delta variant on severity of illness, treatment or reinfections. There is EAVEII data indicating the Delta variant of SARS-CoV-2 is associated with approximately double the risk of hospitalisation compared with the Alpha variant, but the vaccine continues to protect^[41]. As more data is analysed we shall become more certain of the impact of Delta on hospitalisations and disease severity.

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.