Coronavirus (COVID-19): state of the epidemic - 13 August 2021

State of the Epidemic in Scotland – 13th 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 12 August 2021 on Covid-19 in Scotland. This updates the previous publication published on 6 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 0.7 and 0.9, based on data up until the 9 August. This is unchanged since last week.
• An average of 1,255 cases were reported per day in the 7 days to 12 August, which is a 10% increase in reported cases since 5 August.
• There were 159 weekly cases per 100,000 in the week to 9 August, which is an increase since last week. This compares to 425 weekly cases per 100,000 on 3 July.
• Case rates have gone up 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 SARS-CoV-2 in the community in Scotland has continued to decrease in the last week (week ending 7 August 2021). Scotland is currently below Northern Ireland and England but above Wales.
• Latest modelled estimates suggest there are currently between 49 and 85 new daily infections per 100,000 people in Scotland.
• There were 51 deaths registered in Scotland where coronavirus was mentioned on the death certificate in the week ending 8 August. Deaths have increased in those aged 15-44 (from 2 to 5 deaths), 45-64 (from 9 to 10 deaths) and 65-74 (from 7 to 13 deaths) over the 3 weeks to 8 August. Deaths decreased in those aged 75-84 (from 14 to 8 deaths) over this period.
• Average daily deaths per 100,000 population in Scotland (0.12) are below Northern Ireland (0.20) and England (0.13) but above Wales (0.04). Average daily cases per 100,000 in Scotland (23.0) are below Northern Ireland (70.3), England (44.4) and Wales (24.4).
• East Lothian currently has the highest weekly case rate in Scotland reporting 264 cases per 100,000 in the week to 9 August, followed by South Lanarkshire with 226 weekly cases per 100,000, North Ayrshire with 221 weekly cases per 100,000, West Dunbartonshire with 218 weekly cases per 100,000 and North Lanarkshire with 214 weekly cases per 100,000. There were 21 other local authorities reporting over 100 weekly cases per 100,000 population in the last week. Orkney and Na h-Eileanan Siar each reported 49 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%. However regional variations exist.
• 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 relaxations of measures which will take a few weeks to become apparent.
• Over 4 million people in Scotland have been given a first vaccine against SARS-CoV-2, and over 3.3 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 13 August and based on data up to 9 August)^[2] was between 0.7 and 0.9 (Figure 1), with a growth rate of between -4% and -1%. R is an indicator that lags by 2 to 3 weeks and therefore should not be expected to reflect recent fluctuations, such as the small increase in reported cases that has been seen in the last week.

An average of 1,255 cases were reported per day in the 7 days to 12 August. This is a 10% increase from the daily average cases recorded a week earlier to 5 August^[3]. Average daily cases reported are 64% lower than the peak of 3,454 in the week to 4 July. In the 4 week period from 10 July to 6 August 2021, 48.1% of cases (PCR testing only) were in unvaccinated individuals^[4]. Our current position is 159 weekly cases per 100,000 in the week to 9 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%. However regional variations exist. In both North and South Lanarkshire, wastewater SARS-CoV-2 levels remain higher than would be expected given the number of cases.

Case rates have gone up 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-19, or they have mild symptoms and do not come forward. Latest modelled estimates, based on data up to 9 August, suggest there are currently between 2,700 and 4,600 people becoming infected in Scotland each day^[7]. This means that as of 11 August there were between 49 and 85 new daily infections per 100,000 people.

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 12 August there were 356 patients in hospital with Covid-19. This compares to 381 people in hospital on 5 August. Daily hospital admissions for people with Covid-19 have increased from a low of 5 on 15 May to 102 on 13 July, and has since gone down to 31 on 8 August^[9]. This compares to 34 admissions to hospital on 1 August. In the 4 weeks to 6 August 46.8% of acute Covid-19 hospital admissions were in the unvaccinated individuals^[10].

There were 51 deaths registered where Covid-19 was mentioned on the death certificate in the week to 8 August. This is higher than the 46 deaths the week before (+11%), and 92% 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 8 August, with 3 deaths occurring in care homes. Deaths involving coronavirus have increased in those aged 15-44 (from 2 to 5 deaths), 45-64 (from 9 to 10 deaths) and 65-74 (from 7 to 13 deaths) over the 3 weeks to 8 August. Deaths decreased in those aged 75-84 (from 14 to 8 deaths) in the same period^[11] (Figure 4). From 29 December 2020 to 29 July 2021, 87.4% of Covid-19 deaths were in the 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 (0.53% of people currently testing positive for SARS-CoV-2 from 1 to 7 August) has continued to decrease in the last week. The estimation is below England (1.33%) and Northern Ireland (1.88%), but above Wales (0.46%). In the week to 7 August the estimated rate of community infection was 1 in 190 people in Scotland, compared to 1 in 75 in England, 1 in 55 in Northern Ireland, and 1 in 220 for Wales^[13]. Average daily deaths in Scotland (0.12 per 100,000) in the week to 12 August are below Northern Ireland (0.20) and England (0.13) but above Wales (0.04)^[14]. Average daily cases in Scotland (23.0 per 100,000) in the week to 12 August are below Northern Ireland (70.3), England (44.4) and Wales (24.4).

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

East Lothian currently has the highest case rate in Scotland with 264 weekly cases reported per 100,000 in the week to 9 August, which is an 84% increase from the week to 2 August^[17]. It is followed by South Lanarkshire with 226 weekly cases per 100,000 population, North Ayrshire with 221 weekly cases per 100,000, West Dunbartonshire with 218 weekly cases per 100,000 and North Lanarkshire with 214 weekly cases per 100,000. In the week to 9 August there were 21 other local authorities reporting over 100 weekly cases per 100,000 population (Table 1). Case rates have increased across most local authorities over the last week and there are mostly high or very high levels of case rates across Scotland (Figure 5). Orkney and Na h-Eileanan Siar have the lowest case rate in Scotland, reporting 49 weekly cases each per 100,000 to 9 August^[18].

Table 1. Total new weekly cases per 100,000 population to 9 August 2021, in order of prevalence

Local Authority	Total new cases in the week, per 100,000 population (9th August)	Change since previous week (2nd August)
East Lothian	264	+120
South Lanarkshire	226	+18
North Ayrshire	221	+39
West Dunbartonshire	218	+24
North Lanarkshire	214	+12
Fife	195	+47
Dumfries and Galloway	181	+36
East Renfrewshire	168	+42
Midlothian	163	+2
City of Edinburgh	157	+19
Inverclyde	157	-57
Glasgow City	155	+2
Renfrewshire	154	+22
Highland	150	+56
East Ayrshire	149	+32
Scottish Borders	146	+36
Stirling	145	+18
South Ayrshire	144	+11
West Lothian	141	-41
Aberdeenshire	130	+35
East Dunbartonshire	127	-15
Clackmannanshire	127	-16
Argyll and Bute	125	+35
Falkirk	123	+15
Dundee City	118	-24
Aberdeen City	110	-25
Perth and Kinross	99	+12
Angus	89	-13
Moray	80	0
Shetland Islands	66	+4
Orkney Islands	49	+45
Na h-Eileanan Siar	49	-68
Scotland	159	+16

The most recent modelling predicts, based on data up to 9 August, that for the week ending 28 August there are 27 local authorities that have at least a 75% probability of exceeding 50 cases per 100,000 population. Of these, there are eight local authorities (Dumfries & Galloway, Fife, Glasgow, Midlothian, North Ayrshire, North Lanarkshire, South Lanarkshire and West Lothian) with at least a 75% probability of exceeding 100 cases per 100,000 (Figure 6)^[19]. No local authorities are expected to exceed 300 cases per 100,000 with at least 75% probability in the week ending 28 August.

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^[20]. From this survey we can say that contacts have decreased by approximately 7% in the last two weeks (comparing surveys pertaining to 15 July - 21 July and 29 July - 4 August) with a current level of 3.7 daily contacts. Contacts within the work setting have increased by approximately 11% whereas contacts within the other setting (contacts outside of the work, school and home) have decreased by 16% compared to two weeks prior. Mean contacts across all age groups have shown a decrease in comparison to two weeks prior with the exception of those aged between 60-69 who have reported an increase of 12%. The proportion of contacts reported to have been indoors only has decreased within the last two weeks, whereas the proportion of contacts occurring outside only has shown an increase over the same period.

Self-reported compliance with the current regulations and guidance has decreased since January but remains at a high level. On 10-11 August, 66% 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 relaxations of measures which will take a few weeks to become apparent (Figure 7)^[22].

Vaccinations are continuing across the priority groups and 90.1% 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 4,039,226 people had received their first dose by 12 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 74% 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, 99% of those aged 60-64, 96% of those aged 55-59, 93% of those aged 50-54, 83% of those aged 40-49, 62% of those aged 30-39 and 30% of those aged 18-29 have received their second dose. Overall, 3,393,900 people (76.2% of those aged 18 and over) had received their second dose by 12 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. 89% of all respondents have already received at least their first vaccine dose. Of those not vaccinated (and small base must be noted), 13% 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 44,254 cases have now been identified as Delta to 11 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 11 August there have been 62 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. Three new cases of Theta/VUI-21MAR-02 have also been detected 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 9).

Vaccines are effective against the Delta variant. 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 ^[36], which is in line with previous studies ^{[37] [38]}. Vaccine effectiveness against symptomatic disease is high for both Alpha (89%) and Delta after two doses (79%). 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^[39].

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^[40]. 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.