Coronavirus (COVID-19): state of the epidemic - 9 July 2021

State of the Epidemic in Scotland – 9^th July 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 8 July 2021 on Covid-19 in Scotland. This updates the previous publication published on 2 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 1.2 and 1.5, based on data up until the 5^th July. This is unchanged from last week. The R and growth rate indicators lag by two to three weeks, as a result the estimates cannot fully reflect the significant increase in daily cases seen over the past few weeks.
• An average of 2,999 cases were reported per day in the 7 days to 8 July, which is a 3% decrease in reported cases since the 1 July.
• There were 414 weekly cases per 100,000 in the week to 5 July, which is an increase since last week. This compares to 302 weekly cases per 100,000 on 8 January.
• Case rates have gone down across all age bands over the last week. The highest case rates were observed amongst 20-39, followed by 0-19, 40-59, 60-79 and 80+ this week.
• 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 increase in the most recent week. Scotland is currently above England, Wales and Northern Ireland.
• Latest modelled estimates suggest there are currently between 89 and 124 new daily infections per 100,000 people in Scotland.
• There were 21 deaths registered in Scotland where coronavirus was mentioned on the death certificate in the week ending 4 July. Deaths have increased in those aged 15-44 (from 0 to 1 death), 45-64 (from 0 to 3 deaths), 65-74 (from 2 to 6 deaths), 75-84 (from 1 to 6 deaths) and 85+ (from 4 to 5 deaths) over the 3 weeks to 4 July.
• Average daily deaths per 100,000 population in Scotland (0.06) are above England (0.03), Wales (0.01) and Northern Ireland (0.01).
• Dundee currently has the highest weekly case rate in Scotland reporting 875 cases per 100,000 in the week to 5 July, followed by Midlothian with 720 weekly cases per 100,000 and East Lothian with 580 weekly cases per 100,000. There were 25 other local authorities reporting over a 100 weekly cases per 100,000 population in the last week. Shetland reported 35 weekly cases per 100,000 in the same period.
• Modelled rates of positive tests per 100,000 population using data to 5 July indicate that for the week commencing 18th July 2021, there are 26 local authorities with at least a 75% probability of exceeding 150 cases. Of these, 9 local authorities have at least a 75% probability of exceeding 500 cases per 100,000. These are Fife, Dundee, Glasgow, Perth & Kinross, Renfrewshire, East Dunbartonshire, North Lanarkshire, West Lothian and Aberdeen. Fife is the only local authority with at least a 75% probability of exceeding 1,000 cases per 100,000.
• The overall level of wastewater (WW) Covid-19 rose rapidly in the last week, reaching the highest level observed.
• Following a recent upsurge, case numbers have started to fall back and there may be a plateau occurring. However there is considerable uncertainty about what this means for future weeks.
• Over 3.9 million people in Scotland have been given a first vaccine against SARS-CoV-2, and over 2.8 million have now received a second dose.
• The Delta variant of concern, (VOC-21APR-02, first identified in India), is now 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 8 July and based on data up to 5 July)^[2] was between 1.2 and 1.5 (Figure 1), with a growth rate of between 3% and 7%. The R and growth rate indicators lag by two to three weeks, as a result the estimates cannot fully reflect the significant increase in daily cases seen over the past few weeks.

An average of 2,999 cases were reported per day in the 7 days to 8 July. This is a 3% decrease from the daily average cases recorded a week earlier to 1 July^[3]. Average daily cases reported are 29% higher than the peak of 2,323 in the week to 7 January. Our current position is 414 weekly cases per 100,000 in the week to 5 June^[4]. This compares to 302 weekly cases per 100,000 on 8 January (see Figure 2).

Following PHS analysis, 1,991 people resident in Scotland with a laboratory-confirmed COVID-19 diagnosis were identified as having attended one or more Euro 2020 events during their infectious period (a time in which they may have unknowingly transmitted their infection to others) between 11-28 June 2021^[5]. Almost 74% (1,470 cases) of these were of 20-39 year olds^[5].

The number of locations where the levels of Covid 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. The level of wastewater (WW) Covid-19 levels continued to rise rapidly, reaching the highest levels observed. Increases are seen in a broad range of local authorities. The highest WW Covid-19 values were seen at the Seafield site, which covers Edinburgh. The reading on 2nd July is almost twice as high as the previous peak in the area. Of the sites that gave WW Covid-19 measurements in the last week, only Stornoway gave negative viral test results.

Case rates have gone down across all age bands this week, with the highest case rates similarly to last week 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 5 July, suggest there are currently anywhere between 4,900 and 6,800 people infected in Scotland each day^[2]. This means that as of 7 July there were between 89 and 124 new daily infections per 100,000 people.

The number of people in hospital with confirmed Covid for less than 28 days has started to increase. After peaking at 2,053 on 22 January, this figure decreased to a low of 58 on 6 May. This has since increased and as of 8 July there were 401 patients in hospital with Covid-19. Daily hospital admissions for people with Covid follow a similar pattern, having decreased from a peak of 241 on 11 January to a low of 4 on 28 April, and have since increased to 59 on 4 July^[7].

There were 21 deaths registered where Covid was mentioned on the death certificate in the week to 4 July. This is slightly higher than the 17 deaths the week before (+24%), and 97% lower than the peak in April 2020 (663 deaths). The proportion of deaths in care homes decreased from 60% in April 2020 to 19% in the week to 4 July. In the most recent week ending 4 July, 4 deaths occurred in care homes. Deaths involving coronavirus have increased in all age groups over the 3 weeks to 4 July^[8] (Figure 4), except for the under 15 age groups. However, this variation in age and location is expected when death numbers are low.

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 (1.01% of people currently testing positive for Covid-19 from 27 to 3 July) has continued to increase in the most recent week. The estimation is above England (0.61%), Northern Ireland (0.33%) and Wales (0.30%). In the week to 26 June the estimated rate of community infection was 1 in 100 people in Scotland, compared to 1 in 160 for England, 1 in 300 for Northern Ireland and 1 in 340 for Wales^[9]. Average daily deaths in Scotland (0.06 per 100,000 in the week to 7 July) are above England (0.03), Wales (0.01) and Northern Ireland (0.01). The Coronavirus Infection Survey estimated that in the week beginning 14 June 2021, 84.7% 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 89.8% in England, 91.8% in Wales and 87.2% in Northern Ireland^[10].

81,000 people in Scotland (1.53% of the respective population) living in private households were experiencing self-reported long COVID symptoms for any duration as of 6 June 2021. This compares to 1.51% in England, 1.41% in Wales and 0.97% in Northern Ireland^[11].

Following the ONS analysis of new positive infection after COVID-19 vaccination at the UK level, 0.5% of those who had been vaccinated had a new infection after vaccination to 31 May 2021. A lower proportion (0.1%) tested positive after two vaccinations^[12].

Situation by local authority within Scotland

Dundee currently has the highest case rate in Scotland with 875 weekly cases reported per 100,000 in the week to 5 July, which is an 11% increase from the week to 28 June^[4]. It is followed by Midlothian with 720 weekly cases per 100,000 and East Lothian with 580 cases per 100,000 population. In the week to 5 July there were 25 other local authorities reporting over a 100 weekly cases per 100,000 population (Table 1). There are mostly very high levels of cases across Scotland (Figure 5). Shetland has the lowest case rate in Scotland, reporting 35 weekly cases to 5 July^[4].

Table 1: Total new weekly cases per 100,000 population to 5 July 2021, in order of prevalence.

Local Authority	Total new cases in the week, per 100,000 population (5th July)	Change since previous week (28th June)
Dundee City	875	86
Midlothian	720	44
East Lothian	580	-45
City of Edinburgh	564	-22
Perth and Kinross	530	168
Angus	509	85
Inverclyde	496	220
West Dunbartonshire	496	40
Renfrewshire	492	6
Glasgow City	491	80
East Renfrewshire	483	52
East Dunbartonshire	481	50
Fife	456	81
Aberdeen City	433	77
West Lothian	388	29
North Lanarkshire	385	34
East Ayrshire	366	-89
Falkirk	334	2
South Lanarkshire	323	44
North Ayrshire	298	47
Scottish Borders	280	15
Highland	261	42
South Ayrshire	253	6
Stirling	247	-22
Aberdeenshire	232	47
Clackmannanshire	208	-70
Argyll and Bute	201	-34
Dumfries and Galloway	138	-6
Moray	91	21
Orkney Islands	54	13
Na h-Eileanan Siar	37	30
Shetland Islands	35	-22
Scotland	414	39

The most recent modelling predicts, based on data up to 5^th July, that for the week ending 24 July there are 26 local authorities that have at least a 75% probability of exceeding 150 cases per 100,000 population. Of those, 9 local authorities have at least a 75% probability of exceeding 500 cases (Fife, Dundee, Glasgow, Perth & Kinross, Renfrewshire, East Dunbartonshire, North Lanarkshire, West Lothian and Aberdeen) Fife is the only local authority with at least a 75% probability of exceeding 1,000 cases per 100,000 (Figure 6)^[2].

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^[2]. From this survey we can say that average contacts have remained at a similar level in the last two weeks (comparing surveys pertaining to 10th June - 16th June and 24th June - 30th June) with a current level of 4.2 daily contacts. Contacts within the work setting have decreased by 15% compared to two weeks prior and contacts within the other setting (contacts outside of the school, home and work) have increased by 7%. Average contacts within the home setting have remained at similar levels over the same period. Mean contacts across all age groups remain around similar level in comparison to two weeks prior with the exception of those aged between 18-29 who have decreased their contacts by 29% which is largely driven by reductions in contacts within the work setting. The biggest increase in interactions is seen with those aged between 30-49 with those aged under 18 whereas the biggest decrease is with those aged between 18-29 with those 5-12.

Self-reported compliance with the current regulations and guidance has decreased since January but remains at a high level. On 29-30 June, 66% of people reported 'complete' or 'almost complete' compliance^[13].

Based on the recent increase in cases, infections, hospital beds and ICU are projected to rise – how long this continues for is uncertain. (Figure 7^[2]). Following the recent increase in cases, projections of a continued growth in the epidemic in Scotland, are with considerable uncertainty as to what this means for future weeks.

Vaccinations are continuing across the priority groups and 87.5% of the adult population in Scotland has now been vaccinated with the first dose^[6]. The first vaccines were administered on Tuesday 8 December and 3,900,864 people had received their first dose by 8 July 2021, a 2% increase from 1 July^[3]. By age group, almost 100% of individuals aged 55+, 94% of those aged 50-54, 89% of those aged 40-49, 79% of those aged 30-39 have received their first vaccination (Figure 8). 95% of the over 80s, 99% of those aged 75-79, 100% of those aged 70-74, 98% of those aged 65-69, 100% of those aged 60-64, 96% of those aged 55-59 and 88% of those aged 50-54 have received their second dose. Overall, 2,825,886 people (63.5% of those aged 18 and over) had received their second dose by 8 July^[6]. There remains low levels of hospitalisations and deaths among those groups vaccinated first (Figure 4).

The proportion of people surveyed who said they would be likely to be vaccinated for Covid-19 remains relatively high. 88% of all respondents have already received at least their first vaccine dose. Of those not vaccinated, 30% report they are likely to be vaccinated when a vaccine becomes available to them^[15].

How the virus is changing

The variant of concern Delta, also referred to as VOC-21APR-02 (first identified in India) is spreading rapidly and has fast replaced Alpha

(VOC-20DEC-01, first identified in the UK) as the dominant strain in Scotland, and 28,559 cases have now been sequenced as Delta to 7 July 2021.

To date there are five 'variants of concern' (VOCs) and ten 'variants under investigation' (VUIs)^[16]. 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 ^{[17, 18, 19]}. Up to 7 July there have been 60 genomically confirmed cases of the variant Beta/VOC-20DEC-02 (first seen in South Africa) and 21 cases of Gamma in Scotland, an increase of 5 and 5, respectively, since last 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 9).

The Delta/VOC-21APR-02 variant is more transmissible than Alpha/VOC-20DEC-01^{[21, 22]} and R is currently estimated to be 40–80% higher for delta than for alpha (B.1.1.7), although this is highly uncertain^[23]. The secondary attack rates for contacts of cases with Delta/VOC-21APR-02 and no travel history are higher than those for contacts of non-travel cases with Alpha/VOC-20DEC-01^[24]. Public Health England recent study shows that after a single 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^[25], which is in line with previous studies^[26]. Public Health England preliminary analysis also shows that vaccines highly effective against hospitalisation from Delta variant^[27] with similar vaccine effectiveness against hospitalisation seen with the Alpha and Delta variants^[28]. EAVEII 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^[29].

There remains uncertainty regarding the impact of the Delta variant on severity of illness, treatment or reinfections. Updated Risk Assessment for Delta variant suggests that vaccine effectiveness against hospitalisation is maintained^[22]. Current data from the EAVEII project shows that compared to the Alpha variant, the Delta variant is associated with an increase in the risk of Covid-19 hospitalisation in Scotland by 85% (95% CI 39-147)^[30]. 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.