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

State of the Epidemic in Scotland – 27th 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 19 August 2021 on Covid-19 in Scotland. This updates the previous publication published on 20 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 1.0 and 1.3, based on data up until 23 August. This is an increase in the lower and upper limits from last week.
• An average of 3,961 cases were reported per day in the 7 days to 26 August, which is a 102% increase in reported cases since 19 August.
• There were 480 weekly cases per 100,000 in the week to 23 August, which is an increase since last week and the highest since the epidemic began. 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. 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 increased in the last week (week ending 20 August 2021). Scotland is currently below England, Northern Ireland and Wales.
• Latest modelled estimates suggest there are currently between 45 and 125 new daily infections per 100,000 people in Scotland.
• There were 41 deaths registered in Scotland where coronavirus was mentioned on the death certificate in the week ending 22 August.
• West Dunbartonshire currently has the highest weekly case rate in Scotland reporting 866 cases per 100,000 in the week to 23 August, followed by East Dunbartonshire with 794 weekly cases per 100,000, East Renfrewshire with 684 weekly cases per 100,000, Clackmannanshire with 675 weekly cases per 100,000 and North Lanarkshire with 665 weekly cases per 100,000. All local authorities apart from the Orkney Islands reported over 100 weekly cases per 100,000 population in the last week. Orkney Islands reported 67 weekly cases per 100,000 in the same period.
• Nationwide, the latest levels of wastewater SARS-CoV-2 RNA have approximately doubled since the previous week.
• Hospitalisations are now rising. Future hospital occupancy and intensive care use are likely to continue rising as infections rise.
• Over 4 million people in Scotland have been given a first vaccine against SARS-CoV-2, and over 3.6 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 26 August and based on data up to 23 August)^[2] was between 1.0 and 1.3 (Figure 1), with a growth rate of between -1% and 6%. R is now clearly above 1, and is the highest upper limit of R since 12 July.

An average of 3,961 cases were reported per day in the 7 days to 26 August. This is a 102% increase from the daily average cases recorded a week earlier to 19 August^[3]. In the 4 week period from 24 July to 20 August 2021, 40.3% of cases (PCR testing only) were in unvaccinated individuals^[4]. Our current position is 480 weekly cases per 100,000 in the week to 23 August^[5]. This compares to 425 weekly cases per 100,000 on 3 July and is the highest since the epidemic began (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, the latest levels of wastewater SARS-CoV-2 RNA have approximately doubled since the previous week.

Wastewater SARS-CoV-2 RNA concentrations are now approaching the maximum level reached during the peak in July 2021. The rise in wastewater SARS-CoV-2 RNA concentrations has been greatest in the central belt and the south.

Case rates have gone up across all age bands this week. 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 23 August, suggest there are currently between 2,500 and 6,800 people becoming infected in Scotland each day^[7]. This means that as of 23 August there were between 45 and 125 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 26 August there were 426 patients in hospital with Covid-19. This compares to 317 people in hospital on 19 August. Daily hospital admissions for people with Covid-19 have increased from a low of 5 on 15 May and now sit at 57 on 20 August^[9]. In the 4 weeks to 20 August 44.0% of acute Covid-19 hospital admissions were in unvaccinated individuals^[10].

There were 41 deaths registered where Covid-19 was mentioned on the death certificate in the week to 22 August. This is the same number of deaths as the previous week, and 94% lower than the peak in April 2020 (663 deaths). The proportion of deaths in care homes decreased from 60% in April 2020 to 10% in the week to 22 August, with 4 deaths occurring in care homes. Deaths involving coronavirus have increased in those aged 15-44 (from 0 to 1 death) and 45-64 (from 10 to 11 deaths) compared to three weeks previous. Deaths decreased in those aged 65-74 (9 to 6 deaths) and 75-84 (14 to 10 deaths) in the same period^[11] (Figure 4). From 29 December 2020 to 12 August 2021, 85.8% of Covid-19 deaths were in 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 (0.70% of people currently testing positive for SARS-CoV-2 from 14 to 20 August) has increased in the last week. The estimation is below England (1.39%), Northern Ireland (2.36%) and Wales (0.83%). In the week to 21 August the estimated rate of community infection was 1 in 140 people in Scotland, compared to 1 in 70 in England, 1 in 40 in Northern Ireland, and 1 in 120 for Wales^[13]. Average daily deaths in Scotland (0.11 per 100,000) in the week to 26 August are below Northern Ireland (0.41) and England (0.17) but above Wales (0.07)^[14]. Average daily cases in Scotland (72.5 per 100,000) in the week to 26 August are below Northern Ireland (88.8), but above England (47.2) and Wales (54.5).

The Coronavirus Infection Survey estimated that in the week beginning 26 July 2021, 93.5% of the adult population in Scotland would have tested positive for antibodies against SARS-CoV-2, as a result of having the infection in the past or being vaccinated. This compares to 94.2% in England, 93.2% in Wales and 89.1% 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

West Dunbartonshire currently has the highest weekly case rate in Scotland reporting 866 cases per 100,000 in the week to 23 August, followed by East Dunbartonshire with 794 weekly cases per 100,000, East Renfrewshire with 684 weekly cases per 100,000, Clackmannanshire with 675 weekly cases per 100,000 and North Lanarkshire with 665 weekly cases per 100,000. All local authorities apart from the Orkney Islands reported over 100 weekly cases per 100,000 population in the last week (Table 1). Case rates have increased across all local authorities over the last week and there are mostly high or very high levels of case rates across Scotland (Figure 5). The Orkney Islands have the lowest case rate in Scotland, reporting 67 weekly cases per 100,000 in the week to 23 August^[17].

Table 1. Total new weekly cases per 100,000 population to 23 August 2021, in order of prevalence

Local authority	Total new cases in the week, per 100,000 population	Change since previous week
West Dunbartonshire	866	568
East Dunbartonshire	794	525
East Renfrewshire	684	418
Clackmannanshire	675	419
North Lanarkshire	665	376
Argyll and Bute	659	398
South Lanarkshire	646	378
Renfrewshire	646	385
Glasgow City	623	390
Dumfries and Galloway	622	239
Inverclyde	554	280
City of Edinburgh	536	314
North Ayrshire	448	159
West Lothian	437	215
Stirling	437	284
Dundee City	418	252
East Lothian	412	155
South Ayrshire	397	217
Midlothian	396	216
Falkirk	394	201
Scottish Borders	389	200
Fife	371	155
East Ayrshire	340	119
Highland	319	164
Angus	265	123
Perth and Kinross	245	86
Aberdeen City	243	122
Aberdeenshire	225	106
Na h-Eileanan Siar	132	11
Shetland Islands	127	101
Moray	125	38
Orkney Islands	67	18
Scotland	480	263

The most recent modelling predicts, based on data up to 23 August, that for the week commencing 5 September 2021, there are 28 local authorities which are expected to exceed 100 cases per 100k with at least 75% probability. Of these, twelve local authorities are expected to exceed 300 cases per 100k with at least 75% probability. These are Argyll & Bute, Edinburgh, Dumfries & Galloway, East Dunbartonshire, East Renfrewshire, Glasgow, North Ayrshire, North Lanarkshire, Renfrewshire, South Lanarkshire, West Dunbartonshire and West Lothian. (Figure 6)^[18].

Children and Education

Schools have resumed in Scotland. Angus went back on 11^th August. East Dunbartonshire and Na h-Eileanan Siar went back on 12^th August, and the rest of the local authorities returned in the week beginning 16^th August.

Over the last week there was a further increase in the total number of Covid-19 cases in young people aged under 20, which has gone up from 3,094 cases in the week to 15 August to 7,181 cases in the week ending 22 August. 7 day cases per 100,000 have also increased in all age groups in the week ending 22 August (Figure 7). The percentage of cases made up of children under 12 was just under 30% (2,142 cases) compared to just over 38% (1,192 cases) in the previous week^[19].

The rate of testing increased amongst all age groups in the week ending 22 August. Test positivity rates have decreased in the 5-11 year old age group. Age groups 0-1, 2-4 year olds, 12-15, 16-17 year olds and 18-19 year olds have increased. The proportion of positive cases who report having been in an education setting in the 7 day period prior to the onset of symptoms has increased to 11.6% in week ending 22 August, from 2.9% of positive cases in the previous week. Hospital admissions amongst children are decreasing, with a 3-week rolling average of 10.7 for 0-1 year olds, 1.3 admissions for 2-4 year olds, 5.3 for 5-11 year olds, and 9.7 for 12-17 year olds up to 18 August. This compares to 10.7 among 0-1 year olds, 1.7 among 2-4 year olds, 6.0 among 5-11 year olds and 11.0 among 12-17 year olds in the period ending 11 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. Average contacts have increased by 15% in the last two weeks (comparing surveys pertaining to 5 August - 11 August and 19 August - 25 August) with a current level of 4.7 daily contacts.

Contacts within the work have increased by approximately 64% compared to two weeks prior. Contacts within the home and other settings (contacts outside of the home, school and work) have remained at similar levels over the same period. All age groups with the exception of those aged 18-29 have had a rise in contacts within the last two weeks, with those aged 30-39 approximately doubling. Increases across the age groups are largely driven by a rise in contacts within the work setting.

Visits to a work place have increased from approximately 14% to 19% with individuals visiting a pub or restaurant increasing from 46% to 49% in the last two weeks.

Self-reported compliance with the current regulations and guidance has decreased since January but remains at a high level. On 24-25 August, 68% of people reported ‘complete’ or ‘almost complete’ compliance^[20].

Hospitalisations are now rising. Future hospital occupancy and intensive care use are likely to continue rising as infections rise (Figures 8 and 9)^[21].

Vaccinations are continuing across the priority groups and 91.0% of the adult population in Scotland has now been vaccinated with the first dose^[23]. The first vaccines were administered on Tuesday 8 December and 4,092,295 people had received their first dose by 26 August 2021^[24]. By age group, almost 100% of individuals aged 55+, 96% of those aged 50-54, 91% of those aged 40-49, 82% of those aged 30-39 and 74% of those aged 18-29 have received their first vaccination (Figure 10). 100% of the over 80s, 100% of those aged 75-79, 99% of those aged 70-74, 100% of those aged 60-69, 96% of those aged 55-59, 93% of those aged 50-54, 84% of those aged 40-49, 69% of those aged 30-39 and 45% of those aged 18-29 have received their second dose. Overall, 3,617,687 people (81.3% of those aged 18 and over) had received their second dose by 26 August^[25]. 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. 92% of all respondents have already received at least their first vaccine dose. Of those not vaccinated (and small base must be noted), 6% report they are likely to be vaccinated when a vaccine becomes available to them^[26].

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 ^[27,28,29]. It quickly replaced Alpha (VOC-20DEC-01), first identified in the UK, as the dominant strain in Scotland, and 49,855 cases have now been identified as Delta to 25 August 2021.

To date there are five ‘variants of concern’ (VOCs) and eleven ‘variants under investigation’ (VUIs)^[30]. 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^[31,32,33]. Up to 25 August there have been 62 genomically confirmed cases of the variant Beta/VOC-20DEC-02 (first detected in South Africa), and 23 cases of Gamma, an increase of one from the previous week, in Scotland. There has also been one new case of VUI-21JUL-01 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 11).

A large study from the University of Oxford and Office of National Statistics shows that with Delta, Pfizer-BioNTech and Oxford-AstraZeneca vaccines still offer good protection against new infections, but effectiveness is reduced compared with Alpha^[35]. 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. Vaccine effectiveness against symptomatic disease is high for both Alpha (89%) and Delta after two doses (79%)^[36]. 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 effectiveness against infection appeared to be diminished when compared to those with Alpha^[37].

There remains uncertainty regarding the impact of the Delta variant on severity of illness, treatment or reinfections. 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.