Coronavirus (COVID-19): state of the epidemic - 16 July 2021

State of the Epidemic in Scotland – 16^th 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 15 July 2021 on Covid-19 in Scotland. This updates the previous publication published on 9 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 1.1 and 1.4, based on data up until the 12^th July. This is lower than last week. The R and growth rate indicators lag by two to three weeks, as a result the estimates cannot fully reflect the significant increase in daily cases seen over the past few weeks.
• An average of 2,406 cases were reported per day in the 7 days to 15 July, which is a 20% decrease in reported cases since the 8 July.
• There were 320 weekly cases per 100,000 in the week to 12 July, which is a decrease since last week. This compares to 302 weekly cases per 100,000 on 8 January.
• Case rates have gone down across all age bands over the last week except for the over 80s. The highest case rates were observed amongst 20-39, followed by 0-19, 40-59, 60-79 and 80+ this week.
• As determined through the latest weekly ONS survey, the estimated proportion of people becoming infected with Covid in the community in Scotland has continued to increase in the most recent week (week ending 10 July 2021). Scotland is currently above England, Wales and Northern Ireland.
• Latest modelled estimates suggest there are currently between 105 and 192 new daily infections per 100,000 people in Scotland.
• There were 30 deaths registered in Scotland where coronavirus was mentioned on the death certificate in the week ending 11 July. Deaths have increased in those aged 15-44 (from 0 to 2 death), 65-74 (from 2 to 4 deaths), 75-84 (from 5 to 14 deaths) and 85+ (from 3 to 7 deaths) over the 3 weeks to 11 July.
• Average daily deaths per 100,000 population in Scotland (0.12) are above England (0.05), Northern Ireland (0.02) and Wales (0.01).
• Midlothian currently has the highest weekly case rate in Scotland reporting 637 cases per 100,000 in the week to 12 July, followed by Dundee with 514 weekly cases per 100,000. There were 29 other local authorities reporting over a 100 weekly cases per 100,000 population in the last week. Na h-Eileanan Siar reported 60 weekly cases per 100,000 in the same period.
• Modelled rates of positive tests per 100,000 population using data to 12 July indicate that for the week commencing 25^th July 2021, there are 26 local authorities with at least a 75% probability of exceeding 100 cases per 100,000. Of these, 4 local authorities have at least a 75% probability of exceeding 300 cases per 100,000. These are Angus, Edinburgh, Midlothian and West Lothian.
• The overall level of wastewater (WW) Covid-19 rose rapidly in the last week, reaching the highest level observed.
• Following the upsurge in cases in the last few weeks, case numbers have started to decrease. There is considerable uncertainty about what this means to projections for future weeks.
• Over 3.9 million people in Scotland have been given a first vaccine against SARS-CoV-2, and over 2.9 million have now received a second dose.
• The Delta variant of concern, (VOC-21APR-02, first identified in India), is now 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 15 July and based on data up to 12 July)^[2] was between 1.1 and 1.4 (Figure 1), with a growth rate of between 2% and 6%. The R and growth rate indicators lag by two to three weeks, as a result the estimates cannot fully reflect the significant increase in daily cases seen over the past few weeks.

An average of 2,406 cases were reported per day in the 7 days to 15 July. This is a 20% decrease from the daily average cases recorded a week earlier to 8 July^[3]. Average daily cases reported are 4% higher than the peak of 2,323 in the week to 7 January. Our current position is 320 weekly cases per 100,000 in the week to 12 July^[4]. This compares to 302 weekly cases per 100,000 on 8 January (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. The level of wastewater (WW) Covid-19 levels continued to rise rapidly, reaching the highest levels observed. Increases are seen in a broad range of local authorities. At Hatton, which covers Dundee, wastewater levels in the last week rose to extremely high levels, substantially higher than in January. While this displays a large amount of variability, this shows a clear departure from case trends and represents the highest levels recorded in a major site.

Case rates have gone down across all age bands this week except for the over 80s. The highest case rates similarly to last week 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, or they have mild symptoms and do not come forward. Latest modelled estimates, based on data up to 12 July, suggest there are currently anywhere between 5,700 and 10,500 people infected in Scotland each day². This means that as of 14 July there were between 105 and 192 new daily infections per 100,000 people.

The number of people in hospital with confirmed Covid for less than 28 days has started to increase. After peaking at 2,053 on 22 January, this figure decreased to a low of 58 on 6 May. This has since increased and as of 15 July there were 543 patients in hospital with Covid-19. Daily hospital admissions for people with Covid follow a similar pattern, having decreased from a peak of 241 on 11 January to a low of 4 on 28 April, and have since increased to 64 on 11 July^[6].

There were 30 deaths registered where Covid was mentioned on the death certificate in the week to 11 July. This is higher than the 22 deaths the week before (+36%), and 95% lower than the peak in April 2020 (663 deaths). The proportion of deaths in care homes decreased from 60% in April 2020 to 7% in the week to 11 July, with 2 deaths occurring in care homes. Deaths involving coronavirus have increased in those aged 15-44 (from 0 to 2 deaths), 65-74 (from 2 to 4 deaths), 75-84 (from 5 to 14 deaths) and 85+ (from 3 to 7 deaths) over the 3 weeks to 11 July^[7] (Figure 4). However, this variation in age and location is expected when death numbers are low.

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 (1.14% of people currently testing positive for Covid-19 from 4 to 10 July) has continued to increase in the most recent week. The estimation is above England (1.06%), Northern Ireland (0.34%) and Wales (0.28%). In the week to 10 July the estimated rate of community infection was 1 in 90 people in Scotland, compared to 1 in 95 for England, 1 in 290 for Northern Ireland and 1 in 360 for Wales^[8]. Average daily deaths in Scotland (0.12 per 100,000 in the week to 15 July) are above England (0.05), Northern Ireland (0.02) and Wales (0.01). The Coronavirus Infection Survey estimated that in the week beginning 14 June 2021, 84.7% 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 89.8% in England, 91.8% in Wales and 87.2% in Northern Ireland^[9].

81,000 people in Scotland (1.53% of the respective population) living in private households were experiencing self-reported long COVID symptoms for any duration as of 6 June 2021. This compares to 1.51% in England, 1.41% in Wales and 0.97% in Northern Ireland^[10].

Following the ONS analysis of new positive infection after COVID-19 vaccination at the UK level, 0.5% of those who had been vaccinated had a new infection after vaccination to 31 May 2021. A lower proportion (0.1%) tested positive after two vaccinations^[11].

Situation by local authority within Scotland

Midlothian currently has the highest case rate in Scotland with 637 weekly cases reported per 100,000 in the week to 12 July, which is a 41% decrease from the week to 5 July^[4]. It is followed by Dundee with 514 weekly cases per 100,000 population. In the week to 12 July there were 29 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 levels of cases across Scotland (Figure 5). Na h-Eileanan Siar has the lowest case rate in Scotland, reporting 60 weekly cases to 12 July^[4].

Table 1. Total new weekly cases per 100,000 population to 12 July 2021, in order of prevalence.

Local Authority	Total new cases in the week, per 100,000 population (12th July)	Change since previous week (5th July)
			Midlothian	637	-83
Dundee City	514	-360
Angus	442	-66
Inverclyde	431	-67
City of Edinburgh	430	-137
East Lothian	418	-164
East Renfrewshire	383	-99
Glasgow City	374	-118
North Lanarkshire	367	-19
West Dunbartonshire	364	-134
Renfrewshire	343	-149
West Lothian	339	-50
Fife	333	-126
Perth and Kinross	332	-198
Aberdeen City	319	-115
Falkirk	314	-22
East Dunbartonshire	294	-189
South Lanarkshire	243	-80
Stirling	242	-5
Scottish Borders	221	-60
North Ayrshire	208	-90
Aberdeenshire	204	-28
Highland	201	-60
East Ayrshire	189	-178
South Ayrshire	183	-70
Clackmannanshire	167	-41
Argyll and Bute	155	-47
Moray	146	+54
Orkney Islands	144	+90
Shetland Islands	113	+79
Dumfries and Galloway	112	-26
Na h-Eileanan Siar	60	+22
Scotland	320	-96

The most recent modelling predicts, based on data up to 12^th July, that for the week ending 31 July there are 26 local authorities that have at least a 75% probability of exceeding a 100 cases per 100,000 population. Of those, 4 local authorities have at least a 75% probability of exceeding 300 cases (Angus, Edinburgh, Midlothian and West Lothian) (Figure 6)^[2].

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^[2]. From this survey we can say that average contacts have decreased by approximately 18% in the last two weeks (comparing surveys pertaining to 17th June - 23rd June and 1st July - 7th July) with a current level of 3.8 daily contacts. Contacts within the work and other setting (contacts outside of the school, home and work) have decreased compared to two weeks prior by 37% and 13% respectively. Average contacts within the home setting have remained at similar levels over the same period. Mean contacts across all age groups have shown a reduction in comparison to two weeks prior with those aged between 18-29 reporting the largest decrease of 37%. The biggest decrease in interactions is seen between those aged 18-49 with those under 18, decreasing by at least 55%.

Self-reported compliance with the current regulations and guidance has decreased since January but remains at a high level. On 13-14 July, 65% of people reported ‘complete’ or ‘almost complete’ compliance^[12].

Following the upsurge in cases in the last few weeks, case numbers have started to decrease. There is considerable uncertainty about what this means to projections for future weeks (Figure 7)^[2].

Vaccinations are continuing across the priority groups and 88.7% of the adult population in Scotland has now been vaccinated with the first dose^[6]. The first vaccines were administered on Tuesday 8 December and 3,956,549 people had received their first dose by 15 July 2021, a 1% increase from 1 July^[3]. By age group, almost 100% of individuals aged 55+, 94% of those aged 50-54, 89% of those aged 40-49, 80% of those aged 30-39 and 67% of those aged 18-29 have received their first vaccination (Figure 8). 95% of the over 80s, 99% of those aged 75-79, 100% of those aged 70-74, 98% of those aged 65-69, 100% of those aged 60-64, 96% of those aged 55-59, 89% of those aged 50-54 and 63% of those aged 40-49 have received their second dose. Overall, 2,927,130 people (65.8% of those aged 18 and over) had received their second dose by 15 July^[6]. There remain low levels 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. 88% of all respondents have already received at least their first vaccine dose. Of those not vaccinated, 29% report they are likely to be vaccinated when a vaccine becomes available to them^[14].

How the virus is changing

The variant of concern Delta, also referred to as VOC-21APR-02 (first identified in India) is spreading rapidly and has fast replaced Alpha (VOC-20DEC-01, first identified in the UK) as the dominant strain in Scotland, and 32,708 cases have now been sequenced as Delta to 14 July 2021.

To date there are five ‘variants of concern’ (VOCs) and ten ‘variants under investigation’ (VUIs)^[15]. 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^{[16] [17] [18]}. Up to 14 July there have been 60 genomically confirmed cases of the variant Beta/VOC-20DEC-02 (first seen in South Africa) and 22 cases of Gamma in Scotland, no increase for Beta and an increase of 1 for Gamma, since last 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 9).

The Delta/VOC-21APR-02 variant is more transmissible than Alpha/VOC-20DEC-01^{[20] [21]} and R is currently estimated to be 40–80% higher for delta than for alpha (B.1.1.7), although this is highly uncertain^[22]. The secondary attack rate for non-household contacts of cases with Delta/VOC-21APR-02 and no travel history is comparable with those for non-household contacts of non-travel cases with Alpha/VOC-20DEC-01. The secondary attack rate amongst household contacts of cases with Delta continues to fall with an estimate of 10.3%^[23]. Public Health England recent study shows that after a single 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^[24], which is in line with previous studies^[25]. Public Health England preliminary analysis also shows that vaccines highly effective against hospitalisation from Delta variant^[26] with similar vaccine effectiveness against hospitalisation seen with the Alpha and Delta variants^[27]. 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^[28].

There remains uncertainty regarding the impact of the Delta variant on severity of illness, treatment or reinfections. Updated Risk Assessment for Delta variant suggests that vaccine effectiveness against hospitalisation is maintained^[22]. Current data from the EAVEII project shows that compared to the Alpha variant, the Delta variant is associated with an increase in the risk of Covid-19 hospitalisation in Scotland by 85% (95% CI 39-147)^[29]. 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.