Coronavirus (COVID-19): state of the epidemic - 30 July 2021

State of the Epidemic in Scotland – 30th July 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 29 July 2021 on Covid-19 in Scotland. This updates the previous publication published on 23 July 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 0.8 and 1.0, based on data up until the 26^th July. The lower and upper limits have both decreased since last week.
• An average of 1,238 cases were reported per day in the 7 days to 29 July, which is a 32% decrease in reported cases since 22 July.
• There were 166 weekly cases per 100,000 in the week to 26 July, which is a decrease since last week. This compares to 425 weekly cases per 100,000 on 3 July.
• Case rates have gone down 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 Covid in the community in Scotland has decreased in the last week (week ending 24 July 2021). Scotland is currently below England and Northern Ireland but above Wales.
• Latest modelled estimates suggest there are currently between 89 and 165 new daily infections per 100,000 people in Scotland.
• There were 56 deaths registered in Scotland where coronavirus was mentioned on the death certificate in the week ending 25 July. Deaths have increased in those aged 45-64 (from 3 to 15 deaths), 65-74 (from 6 to 14 deaths), 75-84 (from 7 to 14 deaths) and 85+ (from 5 to 13 deaths) over the 3 weeks to 25 July.
• Average daily deaths per 100,000 population in Scotland (0.12) are above England (0.11), Northern Ireland (0.09) and Wales (0.05).
• West Dunbartonshire currently has the highest weekly case rate in Scotland reporting 234 cases per 100,000 in the week to 26 July, followed by North Lanarkshire with 217 weekly cases per 100,000, Glasgow with 210 weekly cases per 100,000 and East Lothian with 209 weekly cases per 100,000. There were 26 other local authorities reporting over a 100 weekly cases per 100,000 population in the last week. Orkney reported 49 weekly cases per 100,000 in the same period.
• Overall, wastewater Covid-19 levels have dropped since the peak of several weeks ago, but still remain slightly higher than cases.

However at a number of locations, wastewater Covid-19 levels remain high. This includes Nigg (covering Aberdeen), Kirkcaldy and Levenmouth in Fife, Daldowie, Carbarns and Hamilton in Lanarkshire, and Paisley in Renfrewshire. In the case of Paisley, as cases decline, wastewater Covid-19 levels appear to be increasing. These sites need to be monitored closely to see if the situation persists.

• Following the upsurge in cases at the end of June, case numbers have started to decrease. There is considerable uncertainty about what this means to projections for future weeks, and depends on both current infection levels and the impact of the move to level 0 nationally.
• Over 4.0 million people in Scotland have been given a first vaccine against SARS-CoV-2, and over 3.1 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 30 July and based on data up to 26 July)^[2] was between 0.8 and 1.0 (Figure 1), with a growth rate of between -3% and 1%. The epidemic in Scotland appears to be at a turning point. Cases have been decreasing over the past few weeks. There remains uncertainty about the epidemic in future weeks.

An average of 1,238 cases were reported per day in the 7 days to 29 July. This is a 32% decrease from the daily average cases recorded a week earlier to 22 July^[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 26 June to 23 July 2021, 57.0% of cases were in unvaccinated individuals^[4]. Our current position is 166 weekly cases per 100,000 in the week to 26 July^[5]. This compares to 425 weekly cases per 100,000 on 3 July (see Figure 2).

The number of locations where the levels of Covid 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. Overall, wastewater Covid-19 levels have dropped since the peak of several weeks ago, but still remain slightly higher than cases. However at a number of locations, wastewater Covid-19 levels remain high. This includes Nigg (covering Aberdeen), Kirkcaldy and Levenmouth in Fife, Daldowie, Carbarns and Hamilton in Lanarkshire, and Paisley in Renfrewshire. In the case of Paisley, as cases decline, wastewater Covid-19 levels appear to be increasing. These sites need to be monitored closely to see if the situation persists.

Case rates have gone down 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).

Figure 3. Seven day case rate in Scotland by age group by specimen date ^[6]. Refers to PCR testing only.

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, based on data up to 26 July, suggest there are currently anywhere between 4,900 and 9,000 people infected in Scotland each day^[7]. This means that as of 28 July there were between 89 and 165 new daily infections per 100,000 people.

The number of people in hospital with confirmed Covid 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 29 July there were 490 patients in hospital with Covid-19. This compares to 488 people in hospital on 22 July. Daily hospital admissions for people with Covid have increased from a low of 5 on 15 May to 101 on 13 July, and has since gone down to 44 on 25 July^[9]. This compares to 64 admissions to hospital on 18 July. In the four weeks to 23 July 48.1% of acute COVID-19 hospital admissions were in the unvaccinated individuals^[10].

There were 56 deaths registered where Covid was mentioned on the death certificate in the week to 25 July. This is higher than the 47 deaths the week before (+19%), 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 9% in the week to 25 July, with 5 deaths occurring in care homes. Deaths involving coronavirus have increased in those aged 45-64 (from 3 to 15 deaths), 65-74 (from 6 to 14 deaths), 75-84 (from 7 to 14 deaths) and 85+ (from 5 to 13 deaths) over the 3 weeks to 25 July. Deaths decreased in those aged 15-44 (from 1 to 0 deaths) in the same period^[11] (Figure 4). From 29 December 2020 to 15 July 2021, 89.3% of Covid 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 (0.94% of people currently testing positive for Covid-19 from 18 to 24 July) has decreased in the last week. The estimation is below England (1.57%) and Northern Ireland (1.48%), but above Wales (0.62%). In the week to 24 July the estimated rate of community infection was 1 in 110 people in Scotland, compared to 1 in 65 for England and Northern Ireland, and 1 in 160 for Wales^[13]. Average daily deaths in Scotland (0.12 per 100,000) in the week to 29 July are above England (0.11), Northern Ireland (0.09) and Wales (0.05)^[14]. The Coronavirus Infection Survey estimated that in the week beginning 28 June 2021, 88.6% 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 91.9% in England, 92.6% in Wales and 90.0% in Northern Ireland^[15].

An estimated 1.5% 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) as of 6 June 2021. 81,000 people in Scotland (1.53% of the respective population) living in private households self-reported long COVID symptoms for this period. This compares to 1.51% in England, 1.41% in Wales and 0.97% in Northern Ireland^[16].

Situation by local authority within Scotland

West Dunbartonshire currently has the highest case rate in Scotland with 234 weekly cases reported per 100,000 in the week to 26 July, which is a 3% increase from the week to 19 July^[17]. It is followed by North Lanarkshire with 217 weekly cases per 100,000 population, Glasgow with 210 weekly cases per 100,000, and East Lothian with 209 weekly cases per 100,000 population. In the week to 26 July there were 26 other local authorities reporting over a 100 weekly cases per 100,000 population (Table 1). Case rates have started to decrease however there are still mostly very high or high levels of cases across Scotland (Figure 5). Local authorities that recorded an increase in case rates over the last week were Na h-Eileanan Siar, North Ayrshire, Orkney and West Dunbartonshire. Orkney has the lowest case rate in Scotland, reporting 49 weekly cases per 100,000 to 26 July^[18].

Table 1. Total new weekly cases per 100,000 population to 26 July 2021, in order of prevalence

Local Authority	Total new cases in the week, per 100,000 population (26th July)	Change since previous week (19th July)
West Dunbartonshire	234	+8
North Lanarkshire	217	-74
Glasgow City	210	-65
East Lothian	209	-87
Inverclyde	189	-61
South Lanarkshire	188	-39
West Lothian	185	-71
Midlothian	183	-199
Stirling	170	-1
Clackmannanshire	170	-53
City of Edinburgh	169	-127
Dundee City	169	-150
Fife	167	-100
East Ayrshire	164	-12
Na h-Eileanan Siar	162	+72
North Ayrshire	160	+28
Renfrewshire	151	-117
East Renfrewshire	151	-119
Aberdeen City	150	-60
Scottish Borders	145	-29
Falkirk	143	-86
Shetland Islands	140	-26
South Ayrshire	136	-60
Argyll and Bute	132	-35
Moray	127	-22
Highland	127	-57
East Dunbartonshire	124	-111
Dumfries and Galloway	123	-34
Perth and Kinross	119	-122
Angus	117	-121
Aberdeenshire	100	-48
Orkney Islands	49	+31
Scotland	166	-73

The most recent modelling^[19] predicts, based on data up to 26^th July, that for the week ending 14 August there are 10 local authorities (Clackmannanshire, Dumfries & Galloway, East Ayrshire, Glasgow, Moray, North Lanarkshire, South Lanarkshire, Stirling, West Dunbartonshire and West Lothian) that have at least a 75% probability of exceeding 50 cases per 100,000 population. There are no local authorities with at least a 75% probability of exceeding 100 cases per 100,000 (Figure 6)^[20].

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^[21]. From this survey we can say that average contacts have increased slightly in the last two weeks by 5% (comparing surveys pertaining to 1st July - 7th July and 15th July - 21st July) with a current level of 4 daily contacts. Contacts within the work, home and other setting (contacts outside of the work, school and home) have all increased compared to two weeks prior. With work contacts increasing by approximately 7% and contacts within the home and other setting increasing by approximately 6%. Mean contacts across all age groups have shown a rise in comparison to two weeks prior with the exception of those aged between 60-69 who have reported a decrease. Those aged 30-39 have shown the biggest increase, by 22%, which is largely driven by a rise in contacts within the work place. Contacts within the work place make up the majority of overall contacts for those who do not work at home, therefore changes in work contacts has proportionate impact on overall contacts.

Self-reported compliance with the current regulations and guidance has decreased since January but remains at a high level. On 27-28 July, 67% of people reported ‘complete’ or ‘almost complete’ compliance^[22].

Following the upsurge in cases at the end of June, case numbers have started to decrease. There is considerable uncertainty about what this means to projections for future weeks and depends on both current infection levels and the impact of the move to level 0 nationally (Figure 7)^[23].

Vaccinations are continuing across the priority groups and 89.6% of the adult population in Scotland has now been vaccinated with the first dose^[25]. The first vaccines were administered on Tuesday 8 December and 4,005,421 people had received their first dose by 29 July 2021^[26]. By age group, almost 100% of individuals aged 55+, 96% of those aged 50-54, 91% of those aged 40-49, 81% of those aged 30-39 and 72% 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, and 60-64, 95% of those aged 55-59, 92% of those aged 50-54 and 79% of those aged 40-49 have received their second dose. Overall, 3,145,017 people (70.6% of those aged 18 and over) had received their second dose by 29 July^[27]. 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), 14% report they are likely to be vaccinated when a vaccine becomes available to them^[28].

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 ^{[29] [30] [31]}, and has fast replaced Alpha (VOC-20DEC-01, first identified in the UK) as the dominant strain in Scotland, and 38,484 cases have now been identified as Delta to 28 July 2021.

To date there are five ‘variants of concern’ (VOCs) and eleven ‘variants under investigation’ (VUIs)^[32]. 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^{[33] [34] [35]}. Up to 28 July there have been 60 genomically confirmed cases of the variant Beta/VOC-20DEC-02 (first detected in South Africa) and 21 cases of Gamma in Scotland. 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 Delta, Public Health England preliminary analysis shows that vaccines are highly effective against hospitalisation from Delta variant^[37] with similar vaccine effectiveness against hospitalisation seen with the Alpha and Delta variants^[38]. A recent study from Public Health England shows that after a single vaccine dose there was a 14% absolute reduction in vaccine effectiveness against symptomatic disease with Delta compared to Alpha, and a smaller 10% reduction in effectiveness after 2 doses^[39], which is in line with previous studies^[40]. 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^[41].

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^[42]. As more data is analysed we shall become more certain of the impact of Delta on hospitalisations and disease severity.

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.