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Publication - Research and analysis

Coronavirus (COVID-19): state of the epidemic - 1 April 2021

Published
1 April 2021
From
Director-General Health and Social Care
Directorate
Constitution Directorate
Topic
Coronavirus (COVID-19) in Scotland, Health and social care, Public safety and emergencies
ISBN
9781800049277

This report brings together the different sources of evidence and data about the covid epidemic to summarise the current situation, why we are at that place, and what is likely to happen next.

View supporting documents Supporting documents

State of the Epidemic in Scotland (1st April 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 the 31 March 2021 on COVID-19 in Scotland. This updates the previous publication published on 26 March 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 level, at a local level and how Scotland currently compares to the rest of the UK. It looks at the vaccination program in Scotland and the effects which 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 0.8 and 1.0.
  • An average of 505 cases were reported per day in the 7 days to 31 March, which is a 7% decrease in reported cases since the 24 March.
  • There were 66 weekly cases per 100,000 in the week to 28 March, which is a slight decrease since last week. This compares to 302 weekly cases per 100,000 on 8 January and is similar to the weekly case rate observed at the end of September.
  • Case rates in most age groups have slightly decreased, with the sharpest decline in cases in those aged 80+ this week.
  • The estimated proportion of people becoming infected with Covid in Scotland has decreased slightly in the most recent week and is currently above England, and Wales but below Northern Ireland as determined through the latest weekly ONS survey.
  • Latest modelled estimates suggest there are currently between 13 and 31 new daily infections per 100,000 people in Scotland.
  • Average daily deaths per 100,000 population in Scotland (0.10) are above England, Northern Ireland and Wales (0.07 each).
  • Clackmannanshire currently has the highest weekly case rate in Scotland reporting 165 cases per 100,000 in the last week, while Shetland, Argyll and Bute, Na h-Eileanan Siar and Orkney each reported 10 or fewer cases per 100,000 in the same time.
  • At a national level hospital bed and ICU occupancy are projected to fall over the next few weeks, but these both may plateau or increase as a result of schools reopening and other relaxations of non-pharmaceutical interventions.
  • Over 2.4 million people in Scotland have been given a first vaccine against SARS-CoV-2, and over 350,000 have now received a second dose.
  • The current UK variant of concern is now the dominant strain.

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, 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 You Gov polling surveys.

The national picture

The latest R value for Scotland (published on 1 April)[2] has remained the same this week and was between 0.8 and 1.0 (Figure 1), with a growth rate of between -4% and -1%.

Figure 1: R in Scotland over time
The R number has varied over the pandemic with the estimated range moving above 1 in Autumn 2020 and January 2021. For the number of infectious people to fall we need to keep the R number consistently below 1.The latest R value for Scotland (published on 1 April) has remained between 0.8 to 1.0 compared to the previous weeks estimate of between 0.8 and 1.0 (Figure 1), with a growth rate of between -4% and -1% implying that the number of infectious people is still falling.

Since they were introduced in early January at a national level we have seen the impact of stay at home measures in reducing the level of SARS-CoV-2 in Scotland. An average of 505 cases were reported per day in the 7 days to 31 March, this is a 7% decrease from the daily average cases recorded a week earlier to 24 March[3]. Average daily cases reported are now around a fifth of the peak of 2,323 in the week to 7 January. Our current position is 66 weekly cases per 100,000 in the week to 28 March[4]. This compares to 302 weekly cases per 100,000 on 8 January and is similar to the weekly case rate observed at the end of September (see Figure 2)[4].

Levels of Covid in wastewater are monitored at 28 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 overall level of wastewater RNA this week was similar to the last three weeks, consistent with the continued levelling off in the rate of new cases.

Figure 2: Seven day case rate for Scotland by specimen date. Refers to PCR testing only.
The weekly case rate of diagnosed infection is defined as the number of newly reported, laboratory confirmed cases of SAR-CoV-2 per 100,000 population. This case rate rose from a low of 24.7 in September to 170.1 in October. It then reduced and levelled off at just over 100 by the beginning of December. At the end of December it rose sharply to just over 300 at the start of January. It has been decreasing since then but three weeks ago there was a small increase and then it plateaued for two weeks with a slight decrease in the last week. The weekly case rate is 66 as at 28 March and is now similar to the weekly case rate observed at the end of September.

Case rates in most age groups have slightly decreased, with a sharpest decline in cases in those aged 80+ this week (Figure 3).

Figure 3: Seven day case rate in Scotland by age group by specimen date [5]. Refers to PCR testing only.
Figure 3 shows the seven day case rates per 100,000 for five different age bands over time. Each age band shows a similar trend with a peak in cases in January, with the 00-19 age band having the highest case rate and the over 80s age band having the lowest case rate. The case rates in most age groups have slightly decreased with the sharpest decrease in cases in the 40-59 and 80+ age groups this week.

Not everyone who has the virus will be tested, as many people do not realise they have COVID, or have mild symptoms and do not come forward. Latest modelled estimates suggest there are currently anywhere between 700 and 1,700 people infected in Scotland each day[2]. This means that as of 31 March there were between 13 and 31 new daily infections per 100,000 people.

The number of people in hospital with confirmed Covid for less than 28 days is declining. After peaking at 2,053 on 22 January, this figure has decreased and as of 31 March there were 237 patients in hospital with COVID-19. In addition, there was a fall in daily hospital admissions for people with Covid from a peak of 242 on 11 January to 16 on 27 March[6].

There were 61 deaths registered where Covid was mentioned on the death certificate in the week to 28 March. This is an 8% decrease on the week before (66 deaths), and 91% lower than the peak in April 2020 (663 deaths). The proportion of deaths in care homes has decreased from 36% in mid-December to 8% of total deaths in the week to 28 March. Deaths involving coronavirus have declined most in those aged 45-64 and 75-84 and have gone down by 67% and 66% respectively over the 3 weeks to 28 March[7] (Figure 4). Deaths in those aged 65-74 have declined by 47%, and in the 85+ deaths decreased by 51% over the same period.

Figure 4: Deaths by age group (weekly total by week beginning, NRS) [7]
This figure shows the number of deaths over time for seven different age groups. In April 2020 the number of deaths in the four age groups for 45+ reached a peak with the highest number of deaths being in the 85+ group. Deaths then declined steeply and the number of deaths were very low in all age groups during July to September. In October the number of deaths started to increase and then plateaued during November and December for the four age groups 45+. At the end of December deaths rose steeply again to another peak in January with the highest deaths being in the 85+ group. The number of deaths has since declined steeply with the largest decrease in the 85+ age group observed first followed by a sharp decline in the 75-84 age group. Over the last three weeks to 28 March, deaths have declined similarly in those aged 45-64, 75-84 and 85+ and have gone down by 67%, 66% and 51% respectively. Deaths in the under 44s have remained very low throughout the whole period.

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 (0.32% people currently testing positive for Covid-19 on 21-27 March) has decreased slightly since last week and is now above England (0.27%), and Wales (0.18%), but below Northern Ireland (0.45%). In the week to the 27 March the estimated rate of community infection was 1 in 320 people in Scotland, compared to 1 in 370 for England, 1 in 570 for Wales and 1 in 220 for Northern Ireland[8]. Average daily deaths in Scotland (0.10 per 100,000 in the week to 31 March) are above Northern Ireland, England and Wales (0.07 per 100,000 each).

Situation by local authority within Scotland

Clackmannanshire currently has the highest case rates in Scotland with 165 weekly cases being reported per 100,000 in the week to 28 March. This is an increase of 175% from the week to 21 March[4]. There remains high or moderate levels of cases across large areas of Scotland (Figure 5). Local Authorities with increases greater than 20 cases per 100,000 include Angus, East Dunbartonshire, Moray and North Lanarkshire. Local Authorities with the biggest fall in cases in the last week include Dundee, East Renfrewshire, Glasgow, Perth and Kinross, Shetland, South Ayrshire and West Lothian. Shetland, Argyll and Bute, Na h-Eileanan Siar and Orkney currently have the lowest case rates at 10 or less per 100,000 each[4].

Figure 5: Map of weekly new positive cases per 100,000 people in Scotland
This colour coded map of Scotland shows the different rates of weekly positive cases per 100,000 across Scotland’s Local Authorities. The colours range from green with under 1 weekly case, through light blue with 1 – 20 weekly cases, dark blue 20-50 weekly cases, purple 50-150 weekly cases and red with over 150 weekly cases per 100,000. Clackmannanshire is currently the only area in Scotland showing as red, with the highest case rate in Scotland with 165 weekly cases being reported per 100,000 in the week to 28 March. Na h-Eileanan Siar and Orkney are showing as green with no cases per 100,000 population. All other Local Authorities areas are showing as light blue or dark blue or purple.

Children and Education

Children in early learning and childcare and those in primaries 1-3 went back to school or nursery on 22 February, and all children in primaries 4-7 went back on the 15 March. There has also been a phased return to secondary schools, with some Senior Phase (S4-S6) pupils returning to school on a part-time basis to attend practical lessons from the 22 February and all secondary school pupils (S1-S6) returning on a part-time basis from the 15 March. Subject to continued suppression of the virus, all pupils are expected to return to full time education after the Easter break.

Over the last week there was a slight decrease in the total number of COVID-19 infections in children (Figure 6)[9], with the highest proportion of cases still observed in those aged 5 to 11. Alongside this there has been a substantial increase in testing for this age group, and an increasing proportion which are asymptomatic.

Figure 6: Seven day case rate in Scotland by age group by specimen date for children. Refers to PCR testing only.
This figure shows the 7-day case rate of school pupils who tested positive for COVID-19, grouped in four age groups, during the period 1 November 2020 to 28 March 2021. The rates for all age groups have varied over time with a sharp increase in rates for all groups at the start of January, with the 16/17 age group or S4-S6 school year group with the highest rate. The rates reduced back down to their lowest levels at the beginning of February. The rates for most age groups have decreased in the last week, with only a slight increase observed in 14-15 year olds.

Overall, the proportion of primary school (P1-3) and early learning and childcare settings with incidents remains low. Where outbreaks have occurred these have been predominantly in areas with higher case rates in the local community.

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 contacts increased by 15% in comparison to two weeks prior (currently 3.7 average daily contacts). Contacts within the work, school and other setting have all shown an increase in the last two weeks, with school contacts increasing by 50% and work and other contacts increasing by 33% and 23% respectively. Since the start of the phased school return, the biggest increase in interactions has been for those aged 30-49 with individuals under 18, with interactions doubling as a minimum. Those aged under 70 have shown an increase in contacts in the most recent survey, largely driven by contacts in the work and school setting.

There is a high level of self-reported compliance with the Stay at Home regulations that came into effect on 5 January. On 23-24 March, 77% of people reported 'complete' or 'almost complete' compliance[10].

Hospital bed and ICU occupancy are projected to fall over the next few weeks, but these both may plateau or increase as a result of schools reopening and other relaxations of non-pharmaceutical interventions (Figure 7)[2].

Figure 7: Medium term projections of modelled hospital bed demand, from Scottish Government modelling [11].
Figure 7 shows the projections of modelled demand for hospital beds required over time and displays a better and worst case scenario which are related to the success of the vaccine roll out. The actual number of beds required has been following the better case scenario so far with the projected demand to continue to fall in the next few weeks but may plateau or increase as a result of schools reopening and other relaxations of non-pharmaceutical interventions.

Vaccinations are continuing across the priority groups and just over 54% of the adult population in Scotland has now been vaccinated with the first dose[4]. The first vaccines were administered on Tuesday 8 of December and 2,463,069 had received their first dose by 31 March 2021, a 9% increase from the 24 March[3]. By the 31 of March over 34,000 residents in care homes had received their first vaccination along with over 51,000 care home staff, in older adult care homes almost 87% of residents have now received their second dose. By age group, 98% and over of individuals aged 60+, and 83% of those aged 55-59 had received their first vaccination (Figure 8). 354,756 (7.8%) of those aged 16 and over have also received their second dose by 31 March[6]. There are indications of decreasing hospitalisations and deaths among those groups vaccinated first (Figure 4).

Figure 8: Estimated percentage of people vaccinated by 31 March 2021
The first vaccines were administered on Tuesday 8 of December and 2,463,069 had received their first dose by 31 March 2021, a 8% increase from the 25 March. For the ten age groups identified, five groups have more than 98% vaccinated (everyone over age 60) and for the age group between 70-79, 100%, and for age group 55-59, 83%, have been vaccinated. 31% of over 80s have received their second dose by 31 March.

The proportion of people surveyed who said they would be likely to be vaccinated for COVID-19 remains high. 52% of all respondents have already received at least their first vaccine dose. Of those not vaccinated, 78% report they are likely to be vaccinated when a vaccine becomes available to them[12].

How the virus is changing

The variant of the virus commonly known as the UK variant (VOC-20DEC-01) has been increasing its share of confirmed cases since it was first detected in Scotland in mid-December and is now the dominant strain[13]. This new variant of Covid is more transmissible[14]. It is likely that infection with this variant is associated with an increased risk of hospitalisation and death compared to infection with non-VOC viruses[15].

Other variants of concern (VOCs) are being monitored by sequencing of SARS-CoV-2 samples. To date there are four VOCs and six variants under investigation[16]. Up to 24 March, there have been 22 genomically confirmed cases and 5 probable cases of the variant VOC-20DEC-02 (first seen in South Africa) detected in Scotland. There have been 3 confirmed and 1 probable case of the variant VOC-21JAN-02 (first identified from Brazil). There is some 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].

Next steps

The Scottish Government continues to work closely with Public Health Scotland to monitor the course of the epidemic using several data sources. Each week this report will provide an overview of 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 problem 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.

Contact

Email: modellingcoronavirus@gov.scot

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