Coronavirus (COVID-19) state of the epidemic 25 March 2022

Severe Illness: Hospitalisation, ICU and Deaths

Hospital and ICU Occupancy and Admissions

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

In the week to 23 March, daily Covid-19 hospital occupancy continued to increase to the highest level of Covid-19 related hospital occupancy reported throughout the pandemic. NHS boards reported 2,257 patients in hospital or in short stay ICU on 23 March with recently confirmed Covid-19, compared to 1,999 on 16 March. This is an increase of 258 patients, or 13%, from a week previously, and an increase of 748 patients, or 50%, compared to two weeks previously (9 March). This is 10% higher than the peak of 2,053 patients in hospital in January 2021 (Figure 9).

Combined ICU occupancy (including short and long stay) has decreased to 32 patients on 23 March, a decrease of 9 patients, or 22%, compared to a week previously on 16 March. Low numbers in ICU occupancy means that the data is sensitive to minimal changes, which had led to the trend fluctuating in recent weeks. Combined ICU occupancy remains lower than the peak of 172 ICU patients recorded in January 2021.

This decrease in ICU occupancy was seen among both short and long stay ICU patients. There were 25 patients in short stay ICU on 23 March, compared to 32 a week previously (16 March). This is a decrease of 7 patients. There were 7 patients in long stay ICU on 23 March, compared to 9 a week previously (16 March). This is a decrease of 2 patients (Figure 9)^[40].

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. Please note that admissions to ICU only include PCR confirmed Covid-19 cases. Covid-19 occupancy figures presented in this section may include patients being admitted and treated in hospital or ICU for reasons other than COVID-19.

Please note that hospital admissions data in Scotland is dynamic and subject to daily revisions. We are currently seeing a large number of daily revisions, which is likely due to infections being identified after patients have been admitted to hospital. This means that week-on-week comparisons are likely to rely on incomplete data. As a result we have moved to reporting comparisons over a longer period of time. Greatest revisions are likely to impact the latest two weeks of data; however, longer time periods could be subject to revision.

According to data from Public Health Scotland, there has been an increasing trend in Covid-19 admissions to hospital over the past month. There were 1,341 admissions to hospital for people with confirmed Covid-19 in the week to 19 March which is a 41% increase from four weeks prior (week to 19 February)^[43]. As noted above, we are currently seeing a large number of daily revisions, so the number of admissions for the latest week is likely to change^[44].

There has been a fluctuating trend in Covid-19 admissions to ICU over the past month. There have been 23 admissions to ICU for people with confirmed Covid-19 in the week to 22 March which compares to 22 in the week to 22 February^[45]. As noted above we are currently seeing a large number of daily revisions, so the number of admissions to ICU for the latest week is likely to change (Figure 10)^[46].

According to data from the PHS Education Dashboard, average hospital admissions related to Covid-19 in children and young adults have continued to increase in the three-week period to 16 March, and have reached the highest levels seen in the pandemic, at 163 average weekly admissions. This is a 17% increase compared to the previous three-week period to 9 March (138 average weekly admissions), and compares to 155 average weekly admissions at the previous peak in three-week period to 19 January. These figures refer both to young patients in hospital because of Covid-19 and with Covid-19, and link to both PCR and LFD test results^[50].

The highest number of hospital admissions in the week to 15 March were among those aged 80 and over. In the same week, approximately 58% of the hospital admissions related to patients aged 60 or older. This is a decrease from 63% in the week to 22 February^[51].

While it may be helpful to compare hospital occupancy and admissions between the UK nations, any comparisons must be made with caution. Definitions are not consistent across the nations and data are not reported daily by each nation. Data from Scotland, Wales and Northern Ireland is updated retrospectively if errors come to light, while data from England is not revised retrospectively, but instead is corrected in the following day's data update. This means Covid-19 hospital occupancy and admissions figures are not directly comparable across the four nations. For more information see UK Government dashboard.

The seven-day average hospital occupancy in Scotland per one million people was 381 patients in the week to 22 March 2022. This is an increase of 21% from one week prior (week to 15 March 2022). The seven-day average hospital occupancies per one million in the same period for other UK nations were as follows^{[52] [53]}:

• England: 211 per one million (an increase of 21% from one week prior),
• Northern Ireland: 299 per one million (a decrease of 8% from one week prior),
• Wales: 259 per one million (an increase of 29% from one week prior).

Due to revisions to the hospital admissions data mentioned above (page 16), we have removed the four nations comparisons in this week's publication. We will continue to monitor the data to see when it is appropriate to reintroduce this analysis.

Deaths

After a period of decreasing numbers of Covid-19 deaths throughout the last two months of 2021, the week to 23 January 2022 saw a peak of 146 deaths where Covid-19 was mentioned on the death certificate. This came after three weeks of increasing numbers of deaths, largely consisting of fatalities among those aged 45 or above. Covid-19 deaths among younger age groups have remained at similar low levels throughout the pandemic. While the weekly total number of deaths has decreased since January, the number of deaths are at higher levels among those aged 45 and older but are fluctuating on a weekly basis (Figure 11).

The overall number of Covid-19 deaths has remained unchanged at a total of 118 deaths in the week leading up to 20 March, compared to the week leading up to 13 March. This figure is 82% lower than the peak in 2020, when the week ending 27 April saw a total of 663 deaths where Covid-19 was mentioned on the death certificate^[54]. National Records of Scotland publish a weekly detailed analysis on deaths involving Covid-19 in Scotland in their weekly report^[55].

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 20 March, the total number of deaths registered in Scotland was 1,245. This was 8% higher than the five year average for this week^[56].

There were 4 average daily deaths per one million population in the week leading up to 23 March 2022 in Scotland. This compares to 3 weekly deaths per one million in the week to 16 March. In the same time period, average daily deaths for the other UK nations were as follows^{[57] [58]}:

• England: 2 per one million. This compares to 1 weekly death per one million in the week to 16 March.
• Northern Ireland: 2 per one million. This compares to 2 weekly deaths per one million in the week to 16 March.
• Wales: 2 per one million. This compares to 1 weekly death per one million in the week to 16 March.