Coronavirus (COVID-19): state of the epidemic - 13 May 2022

Covid-19 Related Severe Illness and Death

Please note that patient testing requirements changed on 1 April 2022, which will mean a reduction in asymptomatic cases of Covid detected and a corresponding decrease in ascertained Covid-19 related occupancy and admissions. In addition, from 1 May 2022, testing changed from asymptomatic population-wide testing, to targeted testing for clinical care and surveillance. Therefore, data should be interpreted with caution and over time comparison should be avoided. For more information, please see this resource from the NHS.

Please note that hospital admissions data in Scotland is dynamic and subject to daily revisions. We continue to see a large number of mostly upward revisions which is likely due to infections being identified after patients have been admitted to hospital. As the greatest revisions are likely to impact the latest two weeks of data, we have moved to reporting week-on-week comparisons with a two-week lag. You can still see the latest data in Figure 7 but we advise caution in interpreting the latest trends.

Covid-19 occupancy and admissions figures presented in this section may include patients being admitted and treated in hospital or ICU for reasons other than COVID-19.

Following changes in the Covid-19 Case definition and changing testing policies on 5 January 2022, hospital and ICU occupancy figures include patients with Covid-19 cases confirmed by either PCR or LFD from 9 February and onwards. Prior to this date, it only included cases confirmed by a PCR test. Hospital and ICU occupancy include reinfection cases.

Covid-19 admissions to hospital (including for children and young people) include patients with Covid-19 cases confirmed either by PCR or LFD from 5 January and onwards. Prior to this date, it only included cases confirmed by a PCR test. Hospital admissions include reinfection cases. Admissions to ICU only include PCR confirmed Covid-19 cases.

Hospital and ICU Occupancy

In the week to 8 May, daily Covid-19 hospital occupancy in Scotland appears to be on a decline; however, this is to be interpreted with caution due to recent testing changes. NHS boards reported 1,033 patients in hospital or in short stay ICU on 8 May with recently confirmed Covid-19, compared to 1,285 on 1 May. This follows a period of sharply increasing hospital occupancy numbers which peaked on 2 April with the highest figure seen throughout the pandemic at 2,406 patients (Figure 6)^[30].

NHS boards also reported 13 patients in short-stay or long-stay ICU on 8 May, compared to 20 on 1 May. Due to the changes in testing policy, any interpretations of trends need to be made with caution (Figure 6).

Hospital and ICU Admissions

Covid-19 related admissions to hospital^[33] appear to have decreased, with 917 admissions to hospital for people with confirmed Covid-19 in the week to 19 April compared to 1,128 in the week to 12 April. This is a 19% decrease; however, this is to be interpreted with caution due to recent testing changes. This follows a period of sharply increasing numbers of Covid-19 related hospital admissions, reaching the highest levels seen throughout the pandemic in the week to 18 March 2022 (1,668 admissions)^[34]. As noted above, we are continuing to see a large number of daily revisions, so comparisons for the latest two weeks of data have not been made^[35].

There were 27 new Covid-19 patients admitted to ICU in the week to 24 April, compared to 25 in the week to 17 April. This is an 8% increase; however, this is to be interpreted with caution due to recent testing changes. This compares to 57 weekly ICU admissions during the most recent peak in early January 2022. As noted above we are currently seeing a large number of daily revisions, so the number of admissions to ICU for the latest two weeks are likely to change (Figure 7)^[36].

The highest number of hospital admissions in the week to 26 April were among those aged 80 and over. In the same week, approximately 65% of the hospital admissions related to patients aged 60 or older. This remains similar to 66% of admissions in the week to 12 April. According to the latest data, 67% of the hospital admissions in the week to 3 May related to patients aged 60 or older. However, the latest data does not have a lag applied to account for revisions^[39].

According to data from the PHS Education Dashboard, average hospital admissions related to Covid-19 in children and young adults were at 87 average weekly admissions in the three-week period to 27 April. This compares to 115 average weekly admissions in the previous three-week period to 20 April. This comes after a period of increasing numbers of hospital admissions among children and young people, peaking in the three-week period to 30 March, at 188 weekly average admissions^{[40] [41]}.

In the period 13 April to 26 April 2022, 61% of Covid-19 hospital admissions stayed longer than 48 hours after being admitted. Analysis from Public Health Scotland on the same time period shows that length of stay tends to increase with age, as 66% of hospital stays for those aged 17 or younger had a length of stay of less than 24 hours, while 78% of hospital stays for those aged 80 or older had a length of stay of over 48 hours^[42]. Please note that length of stay can be influenced by a variety of factors, and that the figures above may be subject to future revisions due to the completeness of discharge summary information. For more information, please see the PHS Weekly report.

Not all people hospitalised with a recent Covid-19 diagnosis will be in the hospital setting because of this infection. It is important to be able to differentiate between patients in hospital who are admitted to hospital ‘because of’ their Covid-19 as opposed to patients who are admitted to hospital for other reasons with a Covid-19 diagnosis incidentally identified through testing. For more information, see the PHS Weekly Report published 4 May 2022.

In September 2021, Public Health Scotland developed analysis to calculate the proportion of people in hospital because of Covid-19, based on SMR01 discharge summaries from NHS health boards. A hospital admission ‘because of’ Covid-19 is defined as an admission where acute Covid-19 illness is recorded as the main reason that the patient required treatment (including reinfections). This data provides valuable information, however, there is typically a two-to-three-month lag in receiving the discharge summaries from NHS health boards.

Between August and December 2021, the percentage of hospital admissions where Covid-19 was reported as the main diagnosis ranged between 60% (December 2021) and 74% (September 2021). By January 2022, this decreased to 42% (Figure 8). This decrease was seen despite the actual number of patients admitted with a main diagnosis of Covid-19 remaining similar between November 2021 and January 2022; however, January saw rising Covid-19 prevalence in Scotland, which led to increasing numbers of patients being admitted to hospital with a Covid-19 infection but where Covid-19 was not the main diagnosis. The average length of stay for hospital admissions where Covid-19 was the main diagnosis decreased from 9.9 days in September 2021, to 5.8 days in January 2022^[43].

Please note that patient testing requirements in Scotland and England started changing from 1 April 2022, with further changes implemented in Scotland on 1 May 2022. Changes covering policies for testing general population and patients in Wales were set out to start the transition from the end of March. In Northern Ireland, testing changes in the general population are being phased out from 22 April, with no immediate change to public health advice. For more information see the following links for England, Wales and Northern Ireland.

Due to the testing differences across the four nations mentioned above, we have removed the four nations comparisons on hospital admissions and occupancy. We will continue to monitor the data to see if it will become appropriate to reintroduce this analysis.

Covid-19 Related Deaths and Excess Mortality

There were 85 deaths where Covid-19 was mentioned on the death certificate in the week to 8 May. Out of these, there were 41 deaths where Covid-19 was the underlying cause. The number of deaths where Covid-19 was mentioned on the death certificate decreased by 11%, or 10 deaths, compared to the previous week (95 deaths in the week to 1 May). The 85 deaths where Covid-19 was mentioned on the death certificate in the week to 8 May 2022 is 87% lower than the peak in 2020, when the week ending 27 April 2020 saw a total of 663 deaths where Covid-19 was mentioned on the death certificate^[45]. The number of deaths is higher among those aged 45 and older but is fluctuating on a weekly basis. Covid-19 deaths among younger age groups have remained at low levels throughout the pandemic (Figure 9). National Records of Scotland publish a detailed analysis on deaths involving Covid-19 in Scotland in their weekly data releases and monthly report^[46].

Excess deaths are the total number of deaths registered in a week minus the average number of deaths registered in the same week over the previous five years (excluding 2020). Measuring excess deaths allows us to track seasonal influenza, pandemics and other public health threats. Excess deaths include deaths caused by Covid-19 and those resulting from other causes.

In the week ending 8 May, the total number of deaths registered in Scotland was 1,085. This was 4%, or 38 deaths, above the five-year average for this week (Figure 10)^{[47] [48]}. In the same week, the number of deaths from Dementia and Alzheimer’s disease were 27 below the previous five-year average for this week, the number of deaths from cancer diseases were five below the average, and deaths from circulatory diseases were three below the average. Deaths from respiratory disease (not including Covid-19) were 8 above the average. There were 26 excess deaths from other causes^[49].

Deaths data from England, Northern Ireland, Scotland and Wales use different methodologies, so they cannot be directly compared. Due to recent and upcoming changes to testing policy across the four nations, we have moved from reporting daily number of people who died within 28 days of being identified as a Covid-19 case by a positive test, to reporting on deaths where Covid-19 was mentioned on the death certificate. This type of reporting is based on death registration, and as such it includes a lag of around two weeks to allow for deaths to be registered. For more information see UK Government website.

There was one average daily death per one million where Covid-19 was mentioned on the death certificate in the week leading up to 29 April 2022 in Scotland. This compares to two weekly deaths per one million in the week to 22 April 2022. In the week to 29 April, seven-day average daily Covid-19 deaths for the other UK nations were as follows ^{[51] [52]}:

• England: one per one million. This compares to two average deaths per one million in the week to 22 April 2022,
• Northern Ireland: one per one million. This compares to two average deaths per one million in the week to 22 April 2022,
• Wales: two per one million. This compares to three average deaths per one million in the week to 22 April 2022.