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Publication - Research and analysis

Coronavirus (COVID-19): state of the epidemic - 27 May 2021

Published
27 May 2021
Directorate
Constitution Directorate
Topic
Coronavirus (COVID-19) in Scotland, Health and social care
ISBN
9781802010060

This report brings together the different sources of evidence and data about the coronavirus 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 – 27th May 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 26 May 2021 on Covid-19 in Scotland. This updates the previous publication published on 21 May 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 1.0 and 1.3. This is higher than last week.
  • An average of 396 cases were reported per day in the 7 days to 26 May, which is a 38% increase in reported cases since the 19 May.
  • There were 47 weekly cases per 100,000 in the week to 23 May, which is an increase since last week. This compares to 302 weekly cases per 100,000 on 8 January and is similar to the weekly case rate observed on 23 September.
  • Case rates saw a rise amongst all age bands with the sharpest increase in those aged 80+ followed by 0-19, 40-59, 20-39 and 60-69 this week.
  • The estimated proportion of people becoming infected with Covid in Scotland has continued to decrease in the most recent week and is currently above Wales but below England and Northern Ireland as determined through the latest weekly ONS survey.
  • Latest modelled estimates suggest there are currently between 6 and 14 new daily infections per 100,000 people in Scotland.
  • Deaths involving coronavirus have declined most in those aged 45-64 and 65-74 over the 3 weeks to 23 May, having gone down by 100%. Deaths in those aged 75-84 and 85+ have declined by 78% and 67% respectively over the same period.
  • Average daily deaths per 100,000 population in Scotland (0.01) are below Wales (0.03), in line with England (0.01) and above Northern Ireland (0.00).
  • Clackmannanshire currently has the highest weekly case rate in Scotland reporting 163 cases per 100,000 in the last week, followed by Glasgow with 144 cases per 100,000. Dumfries and Galloway, Highland, Inverclyde, Na h-Eileanan Siar and Scottish Borders reported fewer than 10 weekly cases per 100,000 and Orkney and Shetland reported no weekly cases per 100,000 in the same period.
  • At a national level hospital bed and ICU occupancy are projected to plateau or rise over the next few weeks, as a result of relaxations of non-pharmaceutical interventions.
  • Over 3.1 million people in Scotland have been given a first vaccine against SARS-CoV-2, and over 1.9 million have now received a second dose.
  • The variant of concern VOC-21APR-02 (first identified in India) is spreading rapidly and in some parts of Scotland is fast replacing VOC-20DEC-01 the "UK variant" as 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 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 27 May)[2] was between 1.0 and 1.3 (Figure 1), with a growth rate of between 0% and 4%.

Figure 1. R in Scotland over time.

This column chart shows the estimated range of R over time, from early September 2020. The R number has varied over the pandemic with the estimated range moving above 1 in Autumn 2020 and again in January 2021. The latest R value for Scotland has increased to between 1.0 to 1.3, compared to the previous week’s estimate of between 0.9 and 1.2.

As Scotland continues to move out of national-level stay at home measures, an average of 396 cases were reported per day in the 7 days to 26 May. This is a 38% increase from the daily average cases recorded a week earlier to 19 May[3]. Average daily cases reported are currently a sixth of the peak of 2,323 in the week to 7 January. Our current position is 47 weekly cases per 100,000 in the week to 23 May[4]. This compares to 302 weekly cases per 100,000 on 8 January (see Figure 2) and is similar to the weekly case rate observed on 23 September4.

The number of locations where the levels of Covid in wastewater are monitored has increased to 103 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 Covid-19 has remained at levels similar to last week. This is due to offsetting between large increases and decreases in the Glasgow area, while other locations show smaller increases. Inverclyde and the Falkirk area both show increases in virus levels that are not yet reflected by the case levels. If this follows the patterns seen in Alloa and Lerwick, rises in cases in these areas in the near future is possible.

Figure 2. Seven day case rate for Scotland by specimen date. Refers to PCR testing only.

This line graph shows weekly cases per 100,000 people over time, from mid-September 2020. The case rate rose from a low of 25 in September to 170 in October. It then reduced to 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 during March there was a small increase and then it plateaued for two weeks. It then started to decrease again, with an increase observed in case rates over the last three weeks.

Case rates saw a rise amongst all age bands with the sharpest increase in those aged 80+ followed by 0-19, 40-59, 20-39 and 60-79 this week (Figure 3).

Figure 3. Seven day case rate in Scotland by age group by specimen date [5]. Refers to PCR testing only.

This line graph shows weekly cases per 100,000 people for five different age bands over time, from mid-September 2020. Each age band shows a similar trend with a peak in cases in January, with the 20 to 39 age band having the highest case rate, and the under 20 age band having the lowest case rate. Case rates have reduced in all age groups from this peak. In the week to the 23rd of May, case rates saw a rise amongst all age bands, with the sharpest increase in those aged over 80 followed by under 20, 40 to 59, 20 to 39 and 60 to 79.

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 suggest there are currently anywhere between 300 and 800 people infected in Scotland each day2. This means that as of 26 May there were between 6 and 14 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 26 May there were 98 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 11January to a low of 4 on 28 April, and since increased slightly to 17 on 22 May[6].

There were 4 deaths registered where Covid was mentioned on the death certificate in the week to 23 May. This is a decrease from 6 deaths the week before, and 99% lower than the peak in April 2020 (663 deaths). The proportion of deaths in care homes has decreased from 60% in April 2020 to 25% of Covid deaths in the week to 23 May 2021. Deaths involving coronavirus have declined most in those aged 45-64 and 65-74+ and have gone down by 100% (from 2 to 0) in these age groups over the 3 weeks to 23 May[7] (Figure 4). Deaths in those aged 75-84 and 85+ have declined by 78% and 67% respectively over this period.

Figure 4. Deaths by age group (weekly total by week beginning, NRS) 7.

This line graph shows the weekly number of deaths for seven different age groups over time, from March 2020. In April 2020 the number of deaths in the four age groups over 45 reached a peak, with the highest number of deaths being in the over 85 age group. Deaths then declined steeply and the number of deaths was very low in all age groups from July to September. In October the number of deaths started to increase and then plateaued during November and December for the four age groups over 45. At the end of December deaths rose steeply again to another peak in January, with the highest deaths being in the over 85 age group. The number of deaths has since declined steeply with the largest decrease in the over 85 age group, followed by a sharp decline in the 75 to 84 age group. The number of deaths in all age groups is now very low with 4 deaths registered where Covid was mentioned on the death certificate in the week to the 23rd May. Deaths in the under 44 age groups 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 (0.05% of people currently testing positive for Covid-19 from 9-15 May) has continued to decrease in the most recent week. This is still above Wales (0.02%), but is now below England (0.09%) and Northern Ireland (0.06%). In the week to 15 May the estimated rate of community infection was 1 in 1,960 people in Scotland, compared to 1 in 1,110 for England, 1 in 4,340 for Wales and 1 in 1,550 for Northern Ireland[8]. Average daily deaths in Scotland (0.01 per 100,000 in the week to 26 May) are in line with England (0.01), above Northern Ireland (0.00) and below Wales (0.03). The Coronavirus Infection Survey estimated that in the week to 9 May, 68.6% 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 75.9% in England, 76.6% in Wales and 75.0% in Northern Ireland[9].

Situation by local authority within Scotland

Clackmannanshire currently has the highest case rate in Scotland with 163 weekly cases reported per 100,000 in the week to 23 May, which is a 367% increase from the week to 16 May4. It is followed by Glasgow with 144 weekly cases per 100,000, which is a 31% increase from the previous week. There are mostly low levels of cases across Scotland, with moderate and high levels of cases observed across the central belt (Figure 5). Local authorities that recorded an increase in cases per 100,000 population over the last week include:

  • Angus,
  • Argyll and Bute,
  • City of Edinburgh,
  • Clackmannanshire,
  • Dundee City,
  • East Ayrshire,
  • East Dunbartonshire,
  • East Lothian,
  • East Renfrewshire,
  • Falkirk,
  • Glasgow,
  • Highland,
  • Midlothian,
  • North Ayrshire,
  • Renfrewshire,
  • Scottish Borders,
  • South Ayrshire,
  • South Lanarkshire,
  • Stirling and
  • West Dunbartonshire.

Dumfries and Galloway, Highland, Inverclyde, Na h-Eileanan Siar and Scottish Borders each had fewer than 10 weekly cases per 100,000 in the week to 17 May4. Orkney and Shetland reported no weekly cases per 100,000 in this period.

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 people across Scotland’s Local Authorities. The colours range from light grey for under 1 weekly case, through dark grey for 1 to 20 weekly cases, light orange for 20 to 50 weekly cases, orange for 50 to 150 weekly cases and dark orange for over 150 weekly cases per 100,000 people. Clackmannanshire is shown as red on the map. Dundee, East Dunbartonshire, East Renfrewshire, Glasgow, Midlothian and Renfrewshire are all shown as darker orange on the map. Orkney and Shetland are shown as light grey, with no cases per 100,000 people. All other Local Authorities are showing as dark grey or light orange.

The most recent modelling predicts that for the week ending 12 June East Dunbartonshire, East Renfrewshire, Glasgow City, Midlothian, Renfrewshire and South Lanarkshire have at least a 75% probability of exceeding 50 cases per 100,000 population. Of those, 2 local authorities have at least a 75% probability of exceeding 100 cases (East Renfrewshire and Glasgow City) (Figure 6)2.

Figure 6. Maps of probability of Local Authorities exceeding 50, 100, 300 and 500 cases per 100,000 population in the period 6 June – 12 June 2021.

These four colour coded maps of Scotland show the probability of Local Authorities having more than 50, more than 100, more than 300 and more than 500 cases per 100,000 population. The colours range from light grey for a 0 to 5 percent probability, through dark grey and light orange, to dark orange for a 75 to 100 percent probability. The first map shows that a few local authorities are at least 75% likely to have more than 50 weekly cases per 100,000. The second map shows that 2 local authorities have at least a 75% probability of exceeding 100 cases (East Renfrewshire and Glasgow). The final map shows that no local authorities have more than a 50% chance of having over 500 weekly cases per 100,000.

There were also ten local authorities that exceeded what would be expected at this stage in the epidemic between 20 - 26 May. Health Protection Scotland defines exceedance as a greater than expected rate of infection compared with the usual background rate for the place and time where the incident has occurred[10]. Angus, Argyll & Bute, Dundee City, East Dunbartonshire, East Lothian, Edinburgh City, Glasgow City, Midlothian, Renfrewshire and Stirling were identified as areas at higher risk of increasing transmission in the week to 26 May (Figure 7)2.

Figure 7. Map of cumulative weekly exceedance for Local Authorities in Scotland to 26 May2.

This colour coded map shows cumulative weekly exceedance for local authority areas in Scotland. The colours range from light grey where exceedance is 0, through dark grey and orange, to red where exceedance is 10. Midlothian is coloured dark orange, which corresponds to an exceedance of between 7 and 8. Dundee is red, which corresponds to an exceedance of between 9 and 10. The rest of the map is grey or light orange, corresponding to an exceedance of below 7.

Children and Education

There is no further update to Children and Education from last week's report. An update will be provided next week.

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 Covid2. From this survey we can say that average contacts remained at a similar level in the last two weeks (comparing surveys pertaining to 29 April - 5 May and 13 - 19 May) with a current level of 4.2 daily contacts. Contacts within the home, work and other setting remain at a similar level in comparison to two weeks prior, whereas contacts within the school setting have decreased by 39%. The only age groups to increase their contacts in the last two weeks were those aged between 18-29 and 40-49. These increases were largely driven by contacts within the other setting (contacts outside of the work, home or school settings) for 18-29 year olds, and by a combination of the other and work settings for 40-49 year olds.

Self-reported compliance with the current regulations and guidance has decreased since January but remains at a high level. On 18-19 May, 71% of people reported 'complete' or 'almost complete' compliance[11].

Hospital bed and ICU occupancy are projected to plateau or rise over the next few weeks, as a result of relaxations of non-pharmaceutical interventions (Figure 82).

Figure 8. Medium term projections of modelled ICU bed demand, from Scottish Government modelling [12].

This line graph shows projected demand for ICU beds over time from late March to mid-June 2020, and includes a better and worse case scenario which are related to the success of the vaccine roll out. Markers show the actual number of beds required have decreased from late March to now, and this has been following the better case scenario so far. The number of ICU beds required is projected to rise from 10 to around 15 in mid-July in the better case scenario, or to rise to about 25 in mid-July in the worst case scenario.

Vaccinations are continuing across the priority groups and 70.9% of the adult population in Scotland has now been vaccinated with the first dose6. The first vaccines were administered on Tuesday 8 December and 3,155,733 people had received their first dose by 26 May 2021, a 3% increase from 19 May3. By 26 May over 35,000 residents in care homes had received their first vaccination along with over 53,000 care home staff. In older adult care homes 93% of residents have now received their second dose. By age group, almost 100% of individuals aged 55+ and 93% of those aged 50-54 have received their first vaccination (Figure 9). 94% of the over 80s, 98% of those aged 75-79, 99% of those aged 70-74, and 95% of those aged 65-69 have received their second dose. Overall, 1,913,809 (43.1%) of those aged 18 and over had received their second dose by 26 May6. There remains low levels of hospitalisations and deaths among those groups vaccinated first (Figure 4).

Figure 9. Estimated percentage of adults vaccinated by 26 May 2021.

This bar chart shows the percentage of people that have received their first and second dose of the Covid vaccine so far, for 10 age groups. The six groups aged over 55 have more than 98% of people vaccinated with the first dose. The four groups aged 65 and over have more than 94% of people vaccinated with the second dose. Younger age groups have lower percentages vaccinated, with 22% of 18 to 29 year olds having received the first dose and only 11% having received the second dose.

The proportion of people surveyed who said they would be likely to be vaccinated for Covid-19 remains high. 62% of all respondents have already received at least their first vaccine dose. Of those not vaccinated, 74% report they are likely to be vaccinated when a vaccine becomes available to them[13].

How the virus is changing

The variant of concern VOC-21APR-02 (first identified in India) is spreading rapidly and in some parts of Scotland is fast replacing VOC-20DEC-01, the "UK variant", as the dominant strain. 136 cases have been sequenced as VOC-21APR-02.

To date there are five VOCs and eight variants under investigation[14]. As reported in last week's issue, up to 19 May there have been 49 genomically confirmed cases of the variant VOC-20DEC-02 (first seen in South Africa) in Scotland. There have been 12 confirmed cases of the variant VOC-21JAN-02 (first identified from Brazil). There have also been a number of cases of other variants which are currently under investigation, including 38 cases of VUI-21FEB-03 (first seen in Nigeria) (up one from the week before) and 27 cases of VUI-21APR-01 (first identified in India), an increase of 4 from the week before (Figure 10). 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[15] [16] [17].

Figure 10. Variants detected in Scotland by sequencing (data up to 19 May and reported weekly [18]).

This line graph shows the number of cases of the variants of concern and variants of interest that have been detected by sequencing in Scotland each week, from the 25th of January to the 19th of May 2021. VOC-20DEC-02, first found in South Africa, has been increasing steadily since late January from 3 cases to 49 cases on the 19th of May. VUI-21FEB-03, first identified in Nigeria, has seen a rapid increase since mid-March that started to slow in recent weeks to 38 cases in the week to the 19th May. There are also 27 cases of VUI-21APR-01, first identified in India, an increase of 4 since the week before. VOC-21APR-02, first identified in India, has seen a rapid increase in the past two weeks to 136 cases, an increase of 101 since the week before.

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 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.

Contact

Email: modellingcoronavirus@gov.scot

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