Coronavirus (COVID-19): Scotland's Strategic Framework update - June 2021

Sets out how and why our COVID-19 response strategy will change in light of new conditions and what a move beyond Level 0 will look like.

The growing effectiveness of vaccination

Figure 6 below shows that, compared with the first peak in COVID-19 deaths, the early effects of the vaccination programme were beginning to reduce the proportion of deaths in older age-groups in the second peak. Combined with the success of protective measures in suppressing the second peak, this progress permitted us to consider the increased relaxation of restrictions in certain activities and settings, with important wide-ranging positive benefits for individuals, families and businesses.

Figure 6: Deaths involving COVID-19 by age group from 2 March 2020 to 13 June 2021
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 7 deaths registered where Covid was mentioned on the death certificate in the week to the 13th of June. Deaths in the under 44 age groups have remained very low throughout the whole period.

By prioritising the most vulnerable groups, vaccination should significantly reduce COVID-19 morbidity and mortality, illustrated in Figure 7 below.

Figure 7: Age distribution of all COVID-19 deaths and cases up to 16 June 2021
These two bar charts show the total number of COVID deaths (on the left) and cases (on the right) since the beginning of the pandemic in eight different age groups. There is a red line across these charts marking the age groups that have been offered the COVID vaccine to date (those aged 30 and over). The left bar chart shows that almost all COVID deaths in Scotland have occurred in age groups that have now been offered the vaccine. The right bar chart shows that around two thirds of cases to date have occurred in these age groups.

In part as a consequence of the vaccine's protection of older people (who have been prioritised), a higher proportion of new coronavirus cases are occurring among younger people who are less susceptible to severe COVID-19 disease. This is shown in the increase in the proportion of cases in younger people in the following two charts (from January and June 2021). The larger proportion of cases in the youngest age group may indicate a different pattern of infections caused by the Delta variant.

Figure 8: Changing demography of new infections: Cases by age group and sex in week ending 17 January and 13 June 2021
These two back-to-back bar graphs show the number of COVID cases in eight different age groups, among males and females. The left hand graph shows this for the week ending 17th January 2021, and the right hand graph shows this for the week ending 13th June 2021. The number of COVID cases is fairly similar for males and females of each age group at both points in time, and much smaller for all age groups in June than it was in January. However in June a smaller proportion of COVID cases are in age groups over 45, and a larger proportion of cases is among those aged under 25, compared to January.

The evidence also indicates that there has been an important change in the relationship between infections and hospital admissions (which can be seen as a proxy for more serious COVID-19 disease). This change may still be continuing as shown in Figure 9:

Figure 9: Relationship between reported cases and hospital admissions
This line graph shows the number of COVID hospital admissions divided by the number of COVID cases the week before, averaged over 7 days, from the 1st of May 2020 to the 14th of June 2021. This suggests that the proportion of COVID case that have resulted in hospital admission has decreased from around 20% in June and July 2020, to around 10% from September 2020 to February 2021, and then to around 5% from April to June 2021.

As the chart above shows, the number of people being admitted to hospital with COVID-19 (with a 7 day lag after the specimen date for a positive case) has fallen as a percentage of reported cases during 2021 from around 10% in January 2021 to around 4% in June.

As well as a lower proportion of cases now resulting in hospitalisation, there is evidence that those who do require hospital care are, on average, discharged more quickly. The reduced length of stay, in combination with reduced rates of admission, is why hospital bed use in Scotland has increased more slowly during May 2021 than in comparable earlier growth phases of the epidemic where positive case numbers have risen quickly. The relationship between infections and hospital occupancy appears to have changed significantly since the start of 2021 but we continue to learn more about the impact of the Delta variant, which may change this relationship again.



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