Coronavirus (COVID-19): framework for decision making - supporting evidence

2. Direct health impacts of COVID-19

COVID-19 causes direct and tragic harm to people's health. We are tracking daily the extent of the direct health harm being caused by the virus. Data is published every day on the Scottish Government Coronavirus webpages https://www.gov.scot/coronavirus-covid-19/

As the direct harm caused by the virus reduces, subject to effective pandemic response, we expect to see stabilisation, followed by a decline, in key measures. This includes the numbers of new cases, the numbers of new and total hospital admissions and Intensive Care Unit (ICU) admissions, and deaths (which is likely to be the final measure to fall).

By 6 May, 65,125 people had been tested for COVID-19 in Scotland. A total of 12,706 people to date have tested positive. Figure 1 shows the number of people who have tested positive since 1 March. This is in the context of increasing numbers of people being tested. Community surveillance is also underway.

Public Health Scotland analysis shows that (as of 4 May) 60% of confirmed cases were women and 40% were men^[1]. Twenty four percent were in the 15-44 age group; 33% in the 45-64 age group and 41% aged 65 years and over. While there is no evidence of an overall trend by deprivation, the highest proportion of confirmed cases (23%) was accounted for by the most deprived 20% of the population.

We are seeing a welcome reduction in the numbers of patients in ICU care. There was a total of 89 patients with confirmed or suspected COVID-19 in intensive care at midnight on 5 May, with 79 of those having tested positive. A peak in the numbers was experienced on 12 April and numbers have been declining since. Recent analysis by Public Health Scotland shows that the majority of ICU patients have been in the 45-64 age group (55%) and more men have been admitted to ICU for treatment, accounting for 71% of patients.

The numbers of patients in hospital has plateaued and fallen slightly. At midnight on 5 May there were 1,204 people in Scottish hospitals with confirmed COVID-19 (including those in intensive care), and a further 428 where it was suspected. By 5 May a total of 2,895 inpatients who had been tested positive for COVID-19 had been discharged from hospital since the 5 March.

There is concern that transmission of the virus is higher in hospitals and care homes. The National Records of Scotland (NRS) weekly report published on 6 May showed that over 43% of total COVID-19 deaths registered to date have related to deaths in care homes. In the most recent week (to 3 May) deaths in care homes made up 59% of all deaths linked to Covid-19.^[2]

As of 5 May there were 453 (42%) adult care homes with a current case of suspected COVID-19. This is where at least one resident in the care home has exhibited symptoms during the last 14 days. 585 (54%) adult care homes have lodged at least one notification for suspected COVID-19 to the Care Inspectorate since the start of the epidemic. A total of 408 of these care homes have reported more than one case of suspected COVID-19.

The NRS weekly report shows that at 3 May, there have been a total of 2,795 deaths registered in Scotland where the COVID-19 was mentioned on the death certificate. In the most recent week there were 523 where COVID-19 was mentioned on the death certificate, a decrease of 135 from the previous week (20 to 26 April). This is the first weekly reduction since the first COVID-19 death was registered in the week beginning 16 March.

Three quarters (75%) of all deaths involving COVID-19 to date were of people aged 75 or over. The highest proportion of COVID-19 deaths are in people aged 85+, representing 35% of all COVID-19 deaths. Of all deaths to date involving COVID-19, 52% were male and 48% were female. All the data are available, including breakdowns by Health Board area and council areas, at: https://www.nrscotland.gov.uk/covid19stats

We can estimate, from these and other data, the total number of people in Scotland currently likely to have the virus and the current basic reproduction rate at a point in time, or R_t, of the virus: the number, on average, of resulting infections from one infected individual. R_t must be below 1 for a sustained period in order to suppress the virus.

While there is uncertainty around the estimates, our best estimate is that as of 5 May there were approximately 26,000 people infectious in Scotland. While precision is difficult with R_t, it is likely to lie between 0.7 and 1.0. This remains too high to be confident that case numbers will continue to fall. Moreover, this number is an average for all of Scotland. The R_t number for community transmission in Scotland is assumed to be below the R_t number in hospitals and care homes. Further information was published in the Covid-19: Framework for Decision Making update earlier this week.^[3]