Coronavirus (COVID-19): Route Map - supporting evidence for the 10 September 2020 review

Progress against Phase 3 criteria

1. Evidence on the phase criteria has been gathered from across the organisation. The information below represents a summary of those reports.

WHO criterion 1: Evidence shows that COVID-19 transmission is controlled

• R is consistently low
• Number of infectious cases is showing a sustained decline

SAGE's consensus view, as of 9 September, was that the value of R in Scotland was between 1.1 and 1.5. The various groups which report to SPI-M use different sources of data in their models (i.e. deaths, hospital admissions, cases) so their success at capturing recent local outbreaks varies from group to group, leading to increased levels of uncertainty at this point in the epidemic, however R in Scotland is now likely to be above 1. The SAGE consensus is updated weekly on a Thursday.

in the week up to 7 September, the picture across Scotland was one of a general and widespread increase in the number of new confirmed cases. As a result, no local authority areas recorded "significant" (>6.0, p > 0.05) levels of cumulative exceedance. The analysis identified Dumfries and Galloway (5.4), Renfrewshire (3.7), West Lothian (3.3) and Glasgow City (3.1) as areas of higher risk of transmission, however given the rising background of positive new cases across the country, these were only slightly above expected levels.

Supplementary measures

The number of new confirmed COVID-19 cases by specimen date showed a sustained decline after peaking in late April 2020, based on the 7 day moving average, up until 9 July, even in the context of increased testing and expanded eligibility. Mid-July saw a slight increase in confirmed cases – potentially as a result of increased detection of asymptomatic cases through Test & Protect. Since then the average number of new cases has increased to 159 on 9 September, with noticeable stepped increases associated with outbreaks in Grampian and then in Tayside and around Glasgow.

Chart Description

The graph shows the moving average of new cases by when the test specimen was taken. Mid-July saw a slight increase in confirmed cases. Since then the average number of new cases has increased to 159 on 9 September, with noticeable stepped increases associated with outbreaks in Grampian and then in Tayside and around Glasgow.

Source: Public Health Scotland, 9 September 2020

The number of hospital admissions per day for those with a positive COVID-19 result has shown a sustained decline since 7 April 2020, based on the 7 day moving average, prior to a small increase over the latest two-week period. Between 20 August and 2 September, there were a total of 37 hospital admissions for patients with confirmed COVID-19, compared to 17 admissions over the preceding two week period, from 6 to 19 August.

Source: COVID-19 Statistical Report, 9 September 2020, Public Health Scotland

The number of new daily ICU admissions has shown a sustained decline since 4 April based on the 7 day moving average. Between 1 August and 6 September 2020, there were 8 confirmed COVID-19 patients admitted to ICU.

Source: COVID-19 Statistical Report, 9 September 2020, Public Health Scotland

After peaking at 661 in the week ending 26 April (week 17), the number of deaths involving COVID-19 has reduced, and is now less than 1% of the peak level.

As of 6 September, there have been a total of 4,231 deaths registered where COVID-19 was mentioned on the death certificate. In the most recent week (31 Aug – 6 Sept), there were 2 deaths where COVID-19 was mentioned on the death certificate.

Source: https://data.gov.scot/coronavirus-covid-19/detail.html#1_direct_health_harms

The proportion of those who have a positive test for COVID-19 out of those who are symptomatic of COVID-19 in community healthcare remains very low. There were no swab positives for three weeks, week 27 (29 June to 5 July) to week 29 (13 to 19 July) but two positive swabs in the most recent week (24-30 August) which represents 0.2% of swabs.

In conclusion:

Hospital admissions have increased a little recently but remain very low and there have only been 8 ICU admissions between 1 Aug and 6 September. However a marked increase in case numbers has been observed over recent weeks.

This is the first time since March that the upper limit on R has been above 1 in Scotland. Within Grampian, cases in Aberdeen and Aberdeenshire are still exceeding what would be expected at this point in the epidemic.

On the basis of the evidence summarised above the assessment is that this criterion (COVID-19 transmission is controlled) has been met at this review point, although vigilance is critical as new outbreaks emerge.