State of the Epidemic in Scotland – 19 November 2021
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 18 November 2021 on Covid-19 in Scotland. This updates the previous publication published on 12 November. 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 its impact. 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.
Please note that PCR testing might have been affected by half-term holidays throughout October. Testing and case numbers during the period 28-31 October 2021 may have been affected by a data flow issue at the Glasgow lighthouse laboratory, this was cleared on 31 October. The backlog of NHS Scotland Pillar 1 laboratory test results that Public Health Scotland (PHS) were unable to report on 2 November due to an issue affecting data flow on the afternoon of 1 November were included in newly reported figures on 3 November.
New data feeds are being established between England and Scotland, meaning that from 18 November 2021 PHS will include data from private laboratory testing within Pillar 2 figures. Future reports contain this data in real-time, however, figures reported on 18 November contained historic data from 22 October 2021 and may therefore look inflated.
- The reproduction rate R in Scotland, as of 2 November, is estimated as being between 0.9 and 1.1. This has not changed since last week.
- An average of 3,019 cases were reported per day in the 7 days to 18 November. This is a 6% increase from the daily average of 2,855 recorded on 11 November.
- In the last week 7 day case rates have increased in Scotland, but the trend varies across the country.
- There were 387 weekly cases per 100,000 in the week to 15 November (by specimen date). This is a 6% increase from 365 weekly cases per 100,000 on 8 November. This is lower than the most recent peak (825 weekly cases per 100,000 on 6 September) and lower than the peak in July (425 weekly cases per 100,000 recorded on 3 July).
- Case rates (by specimen date) have decreased for those aged 60-79 and 80+ in the week to 15 November 2021, but have increased for all other age groups in the same week. Since 1 November 2021, case rates have increased particularly for those aged 0-19, with the biggest increase still seen among those aged 5-11. As of 15 November, the highest case rates were observed amongst those aged under 20, followed by 40-59, 20-39, 60-79 and 80+.
- As determined through the latest weekly ONS survey, the trend in the percentage of people testing positive for Covid-19 in the private residential population remained level in the most recent week in Scotland (7 November to 13 November 2021).
- Latest modelled estimates suggest that as of 2 November, based on data to 15 November, there were between 86 and 112 new daily infections per 100,000 people in Scotland.
- Clackmannanshire and Moray currently have the highest weekly case rate in Scotland, with each reporting 581 weekly cases per 100,000 in the week to 15 November 2021, followed by Dumfries and Galloway with 551 weekly cases per 100,000. City of Glasgow has the lowest case rate at 255 per 100,000.
- The number of people in hospital with confirmed Covid-19 has fluctuated in the week to 18 November. The number of people in ICU (short and long stay) with confirmed Covid-19 appears to have plateaued, with daily variations throughout the week.
- Average hospital admissions (3-week rolling average) related to Covid-19 in children have decreased in age groups 12-17 and 18-19, and remained stable among those under 1, but increased in all other age groups in the three weeks leading up to 10 November 2021 compared to the previous three-week period.
- There were 115 deaths registered in Scotland where coronavirus was mentioned on the death certificate in the week ending 14 November. This is an 18% decrease from 140 deaths registered in the week to 7 November.
- Nationwide, wastewater Covid-19 RNA levels have remained approximately flat over the recent two week period. The week ending on 15 November saw a level of around 55 million gene copies per person per day (Mgc/p/d), down from 57 Mgc/p/d in the previous week.
- There continues to be uncertainty over hospital occupancy and intensive care in the next four weeks.
- Over 4.3 million people in Scotland have been given a first vaccine against Covid-19, over 3.9 million have received a second dose, and over 1.3 million people have received a booster or dose 3 by 18 November.
- The Delta variant remains the dominant strain in Scotland. Prevalence rates of AY.4.2 (Delta+) have increased in recent weeks in both Scotland and England. Clinical implications of Delta+ are still to be determined.
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 and UKHSA 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, as of 2 November (using data to 15 November), was between 0.9 and 1.1 (Figure 1), with a growth rate of between -2% and 2%. R value has not changed, however the upper growth rate limit has increased since last week.
An average of 3,019 cases were reported per day in the 7 days to 18 November. This is a 6% increase from the daily average of 2,855 recorded on 11 November. In the week 6 November to 12 November 2021, there were 481 cases (PCR testing only) per 100,000 amongst the unvaccinated individuals, compared to 294 cases per 100,000 for those that had been vaccinated with two or more doses.
In the last week 7 day case rates have increased in Scotland, but the trend varies across the country. There were 387 weekly cases per 100,000 in the week to 15 November (by specimen date). This is a 6% increase from 365 weekly cases per 100,000 on 8 November. This is lower than the most recent peak of 825 weekly cases per 100,000 on 6 September and lower than the previous peak of 425 weekly cases recorded on 3 July (see Figure 2).
The number of locations where the levels of SARS-CoV-2 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. Nationwide, wastewater Covid-19 RNA levels have remained approximately flat over the recent two week period. The week ending on 15 November saw a level of around 55 million gene copies per person per day (Mgc/p/d), down from 57 Mgc/p/d in the previous week.
Case rates (by specimen date) have decreased for those aged 60-79 and 80+ in the week to 15 November 2021, but have increased for all other age groups in the same week (Figure 3). Since 1 November 2021, case rates have increased particularly for those aged 0-19, with the biggest increase still seen among those aged 5-11 (Figure 7). In the week 8-15 November, positive cases for under 60s increased by 10% and decreased by 10% for over 60s as compared to the previous week (1-8 November). As of 18 November, the highest case rates were observed amongst those aged under 20, followed by 40-59, 20-39, 60-79 and 80+ (Figure 3).
Not everyone who has the virus will be tested, as many people do not realise they have Covid-19, or they have mild symptoms and do not come forward. Latest modelled estimates suggest that, as at 2 November, based on data to 15 November, the incidence of new daily infections in Scotland was between 86 and 112 new infections per 100,000. This equates to between 4,700 and 6,100 people becoming infected each day in Scotland.
The number of people in hospital with confirmed Covid-19 has fluctuated in the week to 18 November. The number of people in hospital with confirmed Covid-19 for less than 28 days peaked at 2,053 on 22 January, decreased to a low of 58 on 6 May, and then increased to 1,107 on 21 September. This has since decreased and as of 18 November there were 786 patients in hospital with Covid-19 (Figure 4). The number of people in ICU (short and long stay) with confirmed Covid-19 appears to have plateaued, with daily variations throughout the week.
The latest data from PHS shows 533 admissions to hospital for people with confirmed Covid-19 in the week to 14 November compared to 596 in the week to 7 November. In the 4 weeks to 12 November 24.7% of acute Covid-19 hospital admissions were in unvaccinated individuals. For context, as of 18 November, 90.5% of those aged 12+ have had at least one dose of the vaccine. Overall, individuals in the oldest age groups were most likely to be hospitalised. The age-standardised rate of hospital admissions per 100,000 were higher in unvaccinated individuals compared to vaccinated individuals in the four weeks to 12 November. Unvaccinated individuals were 2.7 times more likely to be in hospital with Covid-19 compared to individuals that had received two doses of vaccine in the period 6 November to 12 November.
As the population is increasingly vaccinated, more of the patients in hospital will be fully or partially vaccinated. Therefore, it is important that we can differentiate between patients in hospital because of Covid-19 rather than with Covid-19. Public Health Scotland estimates that as at July 2021, 75% of acute hospital admissions had a primary diagnosis of Covid-19. The trend decreased from 78% in January 2021 to a low of 66% in April 2021, but has since increased.
There were 115 deaths registered where Covid-19 was mentioned on the death certificate in the week to 14 November 2021. This is a decrease of 25 (-18%) in the number of deaths from the previous week, and 83% lower than the peak in April 2020 (663 deaths). The proportion of deaths in care homes decreased from 60% in April 2020 to 3% in the week to 14 November 2021, with 4 deaths occurring in care homes. In the same week, deaths involving coronavirus increased in those aged 15-44 (from 1 to 2 deaths) and 45-64 (from 19 to 21 deaths) compared to the week ending 24 October. Deaths remained stable among those aged 65-74 (at 32 deaths), and decreased in those aged 75-84 (from 39 to 27 deaths) and 85+ (from 40 to 33 deaths). Deaths remained at 0 in those aged under 15 in the same period(Figure 5). From 29 December 2020 to 5 November 2021, 68.5% of Covid-19 deaths were in unvaccinated individuals. Amongst those individuals who have been vaccinated with two doses of Covid-19 vaccine, 78.8% of the confirmed Covid-19 deaths occurred in the 70+ age group.
How Scotland compares with the rest of the UK
The ONS Covid-19 Infection Survey estimates that in the week 7 to 13 November 2021, the estimated percentage of the population living in private residential households testing positive for Covid-19 in Scotland was 1.06% (95% credible interval: 0.86% to 1.29%). The percentage of people testing positive for Covid-19 in the private residential population remained level in the most recent week. Estimates for the week 7 to 13 November 2021 in the other UK nations are as follows: 1.51% (95% credible interval: 1.42% to 1.60%) for England, 1.84% (95% credible interval: 1.47% to 2.24%) for Wales and 1.53% (95% credible interval: 1.16% to 1.96%) for Northern Ireland. This equates to around 1 in 95 people in Scotland, 1 in 65 in England, 1 in 55 in Wales and 1 in 65 in Northern Ireland.
The ONS Covid-19 Infection Survey estimated that in the week beginning 18 October 2021, 92.5% (95% CI: 91.0% to 93.7%) of the adult population living in private residential households in Scotland would have tested positive for antibodies against SARS-CoV-2, as a result of having the infection in the past or being vaccinated. This compares to 93.1% in England (95% CI: 91.9% to 94.1%), 91.7% in Wales (95% CI: 90.1% to 93.1%) and 90.9% in Northern Ireland (95% CI: 86.7% to 93.2%).
An estimated 1.9% of the population living in private residential households 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) in the 4 weeks ending 2 October 2021. In Scotland, 92,000 people (1.75% of the respective population) living in private households self-reported long Covid symptoms for this period. This compares to 1.90% in England, 1.56% in Wales and 1.43% in Northern Ireland.
Average daily deaths in Scotland (2 per 1 million population) in the week to 18 November were similar to England (2 per 1 million), and below Wales and Northern Ireland (3 per 1 million each). Average daily cases in Scotland (552 per 1 million) in the week to 18 November were below Northern Ireland (826 per 1 million), Wales(761 per 1 million), and England (577 per 1 million).
Situation by local authority within Scotland
The trend in case rates varies across the country. Case rates decreased in Clackmannanshire, Dundee City, East Ayrshire, Inverclyde, Na h-Eileanan Siar, North Ayrshire, North Lanarkshire, Orkney Islands, Perth and Kinross, Scottish Borders, South Ayrshire, South Lanarkshire and West Lothian over the week leading up to 15 November 2021, and increased in all other local authorities. Clackmannanshire and Moray currently have the highest weekly case rates in Scotland, each reporting 581 weekly cases per 100,000 in the week to 15 November 2021, followed by Dumfries and Galloway with 551 weekly cases per 100,000, Falkirk with 541 weekly cases per 100,000, Angus with 520 weekly cases per 100,000, Stirling with 501 weekly cases per 100,000 and Orkney with 500 weekly cases per 100,000 population. City of Glasgow has the lowest case rate in Scotland, reporting 255 weekly cases per 100,000 in the week to 15 November. Case rates remain high across Scotland with all local authorities reporting over 200 weekly cases per 100,000 population in that week (Table 1 and Figure 6).
|Local authority||Total new cases in the week, per 100,000 population||Change since previous week|
|Dumfries and Galloway||551||+59|
|Argyll and Bute||411||+6|
|Perth and Kinross||391||-102|
|City of Edinburgh||317||+78|
|Na h-Eileanan Siar||313||-211|
Due to inconsistent results from various models, UKHSA has not been able to provide case estimates for the Orkney Islands, Shetland Islands or Na h-Eileanan Siar this week. The most recent modelling predicts, based on data up to 15 November, that for the week commencing 28 November 2021, all the remaining 29 local authorities are expected to exceed 100 cases per 100,000 population with at least 75% probability. All 29 local authorities are also expected to exceed 100 cases per 100,000 with at least 75% probability. Ten local authorities are expected to exceed 300 cases per 100,000 population with at least 75% probability. These are Angus, Clackmannanshire, Dumfries & Galloway, East Ayrshire, East Dunbartonshire, East Renfrewshire, Falkirk, Fife, South Ayrshire and South Lanarkshire. There are no local authorities which are expected to exceed 500 cases per 100,000 population with at least 75% probability.
Children and Education
Schools resumed in Scotland by the week ending 20 August and universities resumed by end of September. Throughout October schools were on half-term holidays, and testing rates in children were lower during this period. The majority of children and young people have returned to full time education.
The total number of Covid-19 cases in young people aged under 22 has increased by 18% over the last week (7,741 cases recorded in the week to 14 November compared to 6,566 cases in the week ending 7 November). The number of cases has increased in all age groups except among those aged 2-4. The percentage of cases made up of children under 12 was 65.3% (5,054 cases) in the week to 14 November, a slight increase from the previous week (64.8%).
7 day case rates per 100,000 have increased in all age groups in the week ending 14 November, except for those aged 2-4 where it has decreased slightly (Figure 7). However, case rates have continued to increase more sharply in the 5-11 and 12-15 age groups.
The rate of testing increased or remained level amongst all age groups, apart from 16-17 where it decreased in the week ending 14 November. Test positivity rates have decreased in age group 2-4, however increased in other age groups in the same period.
Average hospital admissions (3-week rolling average) related to Covid-19 in children have decreased in age groups 12-17 and 18-19, and remained stable among those under 1, but have increased in all other age groups in the three weeks leading up to 10 November 2021 compared to the previous three-week period.
Vaccine uptake in 17-21 year olds as at 15 November was 80.4% for the first dose and 63.0% for the second dose. Please note that under half of Scottish students are in this age category and only Scottish students (i.e. registered with a GP in Scotland) are included in the figures. Covid-19 infection survey estimated that up to the week beginning 18 October 2021, the percentage of 16-24 year olds in the community population in Scotland testing positive for antibodies increased to 96.0%.
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-19. Average contacts were at 5.1 daily contacts in the week ending 10 November.
Mean contacts within the work setting have almost doubled in the last two weeks while contacts within the home and other setting (contacts outside home, school and work) have remained at a similar level over the same period.
All age groups increased their mean contacts within the last two weeks. This was largely driven by a rise in contacts within the work place. The largest increase was reported by the 18-29 age group, increasing overall contacts by 44%.
The proportion of individuals visiting a healthcare facility increased from approximately 22% to 26% while individuals visiting a pub or restaurant decreased from 49% to 44% in the last two weeks.
Self-reported compliance with the current regulations and guidance has decreased since January but remains at a high level. On 16-17 November, 68% of people reported 'complete' or 'almost complete' compliance.
There continues to be uncertainty over hospital occupancy and intensive care in the next four weeks (Figure 8).
Vaccinations are continuing and 90.5% of the 12+ population in Scotland has now been vaccinated with the first dose. The first vaccines were administered on Tuesday 8 December and 4,334,346 people had received their first dose by 18 November 2021. 3,933,493 people (82% of those aged 12 and over) had received their second dose and 1,307,271 people have received their dose 3 or booster vaccine by 18 November. There remains a low level of deaths amongst vaccinated individuals (Figure 5).
By age group, almost 100% of individuals aged 55+, 97% of those aged 50-54, 92% of those aged 40-49, 85% of those aged 30-39, 79% of those aged 18-29, 77% of those aged 16-17, and 57% of those aged 12-15 have received their first vaccination by 18 November 2021 (Figure 9).
Almost 100% of individuals aged 60+, 97% of those aged 55-59, 94% of those aged 50-54, 88% of those aged 40-49, 78% of those aged 30-39, 69% of those aged 18-29, 19% of those aged 16-17, and 1% of those aged 12-15 have received their second dose in the same time period.
81% of individuals aged 80+, 88% of those aged 75-79, 85% of those aged 70-74, 68% of those aged 65-69, 45% of those aged 60-64, 20% of those aged 55-59, 15% of those aged 50-54, 12% of those aged 40-49, 7% of those aged 30-39, 5% of those aged 18-29, 1% of those aged 16-17, and 0% of those aged 12-15 have received their dose 3 or booster vaccination by 18 November 2021.
The proportion of people surveyed who said they have been vaccinated for Covid-19 is high. 91% of all respondents have already received at least their first vaccine dose. Of those not vaccinated (and small base must be noted), 11% report they are likely to be vaccinated when a vaccine becomes available to them.
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   . It quickly replaced Alpha (VOC-20DEC-01), first identified in the UK, as the dominant strain in Scotland, and 107,843 cases have now been identified as Delta to 17 November 2021. A sublineage of Delta, AY.4.2, has been classified as VUI-21OCT-01, and 5,329 cases have now been identified in Scotland.
To date there are five 'variants of concern' (VOCs) and twelve 'variants under investigation' (VUIs). 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  . Up to 17 November there have been 62 genomically confirmed cases of the variant Beta/VOC-20DEC-02 (first detected in South Africa), and 23 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 10). There remains uncertainty regarding the impact of the Delta variant on severity of illness, treatment or reinfections. As more data is analysed we shall become more certain of the impact of Delta on infections, hospitalisations and disease severity and long term vaccine protection effects.
The effectiveness of vaccines
The vaccine effectiveness expert panel (VEEP) recently published their updated consensus view on the effectiveness of different vaccines on infections, symptomatic disease, and severe disease as well as some initial evidence on vaccine waning effects. The consensus view of vaccine effectiveness against infection or symptomatic disease in fully vaccinated people is between 45-95%, depending on the vaccine and when it was given. Office of National Statistics data from during the Delta period reports that two vaccine doses (14 days or more previously) reduced the risk of testing positive by 67% (95% confidence interval: 64% to 70%) compared to those not yet vaccinated (or 21 days or more before vaccination) without evidence of prior infection.
Public Health England analysis shows that vaccines are highly effective against hospitalisation and death from Delta variant with vaccine effectiveness of over 90% after two doses of vaccine. A recent report from EAVEII finds that from 1 April to 27 September 2021, there were 201 Covid-19 deaths in the group studied. In the 16-39 age bracket, 17 unvaccinated people died and no fully vaccinated people died. The Pfizer-BioNTech vaccine was 95% effective in 40-59 year olds and 87% effective in people 60 and over. The Oxford-AstraZeneca vaccine was 88% effective in 40-59 year olds and 90% effective in people aged 60 or older. In people of all ages who had been double-vaccinated at least two weeks before a positive PCR test, the vaccines offer around 90% effectiveness against Covid-19 deaths caused by the Delta variant. Vaccine effectiveness against symptomatic disease, hospitalisation and death wanes over time. The Joint Committee on Vaccination and Immunisation (JCVI) gave advice on a booster programme to re-vaccinate adults against Covid-19 in the UK and preliminary data shows an increase in vaccine effectiveness after the booster dose.
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, UKHSA, 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.
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