Publication - Research and analysis

Coronavirus (COVID-19): state of the epidemic - 27 August 2021

Published: 27 Aug 2021

This report brings together the different sources of evidence and data about the Covid epidemic to summarise the current situation, why we are at that place, and what is likely to happen next.

Coronavirus (COVID-19): state of the epidemic - 27 August 2021
State of the Epidemic in Scotland – 27th August 2021

State of the Epidemic in Scotland – 27th August 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 19 August 2021 on Covid-19 in Scotland. This updates the previous publication published on 20 August 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 1.0 and 1.3, based on data up until 23 August. This is an increase in the lower and upper limits from last week.
  • An average of 3,961 cases were reported per day in the 7 days to 26 August, which is a 102% increase in reported cases since 19 August.
  • There were 480 weekly cases per 100,000 in the week to 23 August, which is an increase since last week and the highest since the epidemic began. This compares to 425 weekly cases per 100,000 on 3 July.
  • Case rates have gone up across all age bands over the last week. The highest case rates were observed amongst 20-39, followed by 0-19, 40-59, 60-79 and 80+.
  • As determined through the latest weekly ONS survey, the estimated proportion of people becoming infected with SARS-CoV-2 in the community in Scotland increased in the last week (week ending 20 August 2021). Scotland is currently below England, Northern Ireland and Wales.
  • Latest modelled estimates suggest there are currently between 45 and 125 new daily infections per 100,000 people in Scotland.
  • There were 41 deaths registered in Scotland where coronavirus was mentioned on the death certificate in the week ending 22 August.
  • West Dunbartonshire currently has the highest weekly case rate in Scotland reporting 866 cases per 100,000 in the week to 23 August, followed by East Dunbartonshire with 794 weekly cases per 100,000, East Renfrewshire with 684 weekly cases per 100,000, Clackmannanshire with 675 weekly cases per 100,000 and North Lanarkshire with 665 weekly cases per 100,000. All local authorities apart from the Orkney Islands reported over 100 weekly cases per 100,000 population in the last week. Orkney Islands reported 67 weekly cases per 100,000 in the same period.
  • Nationwide, the latest levels of wastewater SARS-CoV-2 RNA have approximately doubled since the previous week.
  • Hospitalisations are now rising. Future hospital occupancy and intensive care use are likely to continue rising as infections rise.
  • Over 4 million people in Scotland have been given a first vaccine against SARS-CoV-2, and over 3.6 million have now received a second dose.
  • The Delta variant of concern (VOC-21APR-02, first identified in India), remains 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 26 August and based on data up to 23 August)[2] was between 1.0 and 1.3 (Figure 1), with a growth rate of between -1% and 6%. R is now clearly above 1, and is the highest upper limit of R since 12 July.

Figure 1. R in Scotland over time
This column chart shows the estimated range of R over time, from late September 2020. The R number has varied over the pandemic with the estimated range moving above 1 in Autumn 2020, January 2021 and again in June 2021. The latest R value for Scotland is estimated to be between 1.0 to 1.3,  an increase in the lower and upper limits from last week.

An average of 3,961 cases were reported per day in the 7 days to 26 August. This is a 102% increase from the daily average cases recorded a week earlier to 19 August[3]. In the 4 week period from 24 July to 20 August 2021, 40.3% of cases (PCR testing only) were in unvaccinated individuals[4]. Our current position is 480 weekly cases per 100,000 in the week to 23 August[5]. This compares to 425 weekly cases per 100,000 on 3 July and is the highest since the epidemic began (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, the latest levels of wastewater SARS-CoV-2 RNA have approximately doubled since the previous week.

Wastewater SARS-CoV-2 RNA concentrations are now approaching the maximum level reached during the peak in July 2021. The rise in wastewater SARS-CoV-2 RNA concentrations has been greatest in the central belt and the south.

Figure 2. Seven day case rate for Scotland by specimen date. Refers to PCR testing only.
This line graph shows weekly cases per 100,000 people over time, from mid-September 2020. The case rate rose from a low of 25 in September to 170 in October 2020. It then reduced to just over 100 by the beginning of December 2020. At the end of December it rose sharply to just over 300 at the start of January 2021. It has decreased since then, but during March 2021 there was a small increase and then it plateaued for two weeks. It then started to decrease again. There has been a sharp increase observed in case rates from mid-May to beginning of July 2021 followed by a sharp decline. Case rates started to increase again at the beginning of August 2021 and increased over the past week surpassing the peak at the start of July 2021.

Case rates have gone up across all age bands this week. The highest case rates are currently being reported in those aged 20-39 followed by 0-19, 40-59, 60-79 and 80+ (Figure 3).

Figure 3. Seven day case rate in Scotland by age group by specimen date [6]. Refers to PCR testing only.
This line graph shows weekly cases per 100,000 people for five different age bands over time, from mid-September 2020. Each age band shows a similar trend with a peak in cases in January, with the 20 to 39 age band having the highest case rate, and the under 20 age band having the lowest case rate. Case rates reduced in all age groups from this peak and then started to increase again sharply from mid-May, reaching a peak at the beginning of July 2021. 7 day cases per 100,000 population then started to decrease sharply followed by a sharp increase in cases in mid-August 2021. In the week to the 26 August, case rates have gone up across all age bands.

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, based on data up to 23 August, suggest there are currently between 2,500 and 6,800 people becoming infected in Scotland each day[7]. This means that as of 23 August there were between 45 and 125 new daily infections per 100,000 people.

The number of people in hospital with confirmed Covid-19 for less than 28 days peaked at 2,053 on 22 January and decreased to a low of 58 on 6 May[8]. This has since increased and as of 26 August there were 426 patients in hospital with Covid-19. This compares to 317 people in hospital on 19 August. Daily hospital admissions for people with Covid-19 have increased from a low of 5 on 15 May and now sit at 57 on 20 August[9]. In the 4 weeks to 20 August 44.0% of acute Covid-19 hospital admissions were in unvaccinated individuals[10].

There were 41 deaths registered where Covid-19 was mentioned on the death certificate in the week to 22 August. This is the same number of deaths as the previous week, and 94% lower than the peak in April 2020 (663 deaths). The proportion of deaths in care homes decreased from 60% in April 2020 to 10% in the week to 22 August, with 4 deaths occurring in care homes. Deaths involving coronavirus have increased in those aged 15-44 (from 0 to 1 death) and 45-64 (from 10 to 11 deaths) compared to three weeks previous. Deaths decreased in those aged 65-74 (9 to 6 deaths) and 75-84 (14 to 10 deaths) in the same period[11] (Figure 4). From 29 December 2020 to 12 August 2021, 85.8% of Covid-19 deaths were in unvaccinated individuals[12].

Figure 4. Deaths by age group (weekly total by week beginning, NRS) [7]
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 2020.  In October the number of deaths started to increase and then plateaued during November and December 2020 for the four age groups over 45. At the end of December deaths rose steeply again to another peak in January 2021, 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. Since mid-June 2021 there has been a slight increase in deaths overall, with the greatest increase in the 45 plus age groups. However, the number of deaths in all age groups is now very low with 41 deaths registered where Covid was mentioned on the death certificate in the week to the 22 August. Deaths in the under 44 age groups have remained very low throughout the whole period.

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 (0.70% of people currently testing positive for SARS-CoV-2 from 14 to 20 August) has increased in the last week. The estimation is below England (1.39%), Northern Ireland (2.36%) and Wales (0.83%). In the week to 21 August the estimated rate of community infection was 1 in 140 people in Scotland, compared to 1 in 70 in England, 1 in 40 in Northern Ireland, and 1 in 120 for Wales[13]. Average daily deaths in Scotland (0.11 per 100,000) in the week to 26 August are below Northern Ireland (0.41) and England (0.17) but above Wales (0.07)[14]. Average daily cases in Scotland (72.5 per 100,000) in the week to 26 August are below Northern Ireland (88.8), but above England (47.2) and Wales (54.5).

The Coronavirus Infection Survey estimated that in the week beginning 26 July 2021, 93.5% of the adult population 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 94.2% in England, 93.2% in Wales and 89.1% in Northern Ireland[15].

An estimated 1.46% of the population 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 4 July 2021. In Scotland, 75,000 people (1.43% of the respective population) living in private households self-reported long Covid symptoms for this period. This compares to 1.61% in Wales, 1.47% in England and 0.89% in Northern Ireland[16].

Situation by local authority within Scotland

West Dunbartonshire currently has the highest weekly case rate in Scotland reporting 866 cases per 100,000 in the week to 23 August, followed by East Dunbartonshire with 794 weekly cases per 100,000, East Renfrewshire with 684 weekly cases per 100,000, Clackmannanshire with 675 weekly cases per 100,000 and North Lanarkshire with 665 weekly cases per 100,000. All local authorities apart from the Orkney Islands reported over 100 weekly cases per 100,000 population in the last week (Table 1). Case rates have increased across all local authorities over the last week and there are mostly high or very high levels of case rates across Scotland (Figure 5). The Orkney Islands have the lowest case rate in Scotland, reporting 67 weekly cases per 100,000 in the week to 23 August[17].

Table 1. Total new weekly cases per 100,000 population to 23 August 2021, in order of prevalence
Local authority Total new cases in the week, per 100,000 population Change since previous week
West Dunbartonshire 866 568
East Dunbartonshire 794 525
East Renfrewshire 684 418
Clackmannanshire 675 419
North Lanarkshire 665 376
Argyll and Bute 659 398
South Lanarkshire 646 378
Renfrewshire 646 385
Glasgow City 623 390
Dumfries and Galloway 622 239
Inverclyde 554 280
City of Edinburgh 536 314
North Ayrshire 448 159
West Lothian 437 215
Stirling 437 284
Dundee City 418 252
East Lothian 412 155
South Ayrshire 397 217
Midlothian 396 216
Falkirk 394 201
Scottish Borders 389 200
Fife 371 155
East Ayrshire 340 119
Highland 319 164
Angus 265 123
Perth and Kinross 245 86
Aberdeen City 243 122
Aberdeenshire 225 106
Na h-Eileanan Siar 132 11
Shetland Islands 127 101
Moray 125 38
Orkney Islands 67 18
Scotland 480 263
Figure 5. Map of weekly new positive cases per 100,000 people in Scotland
This colour coded map of Scotland shows the different rates of weekly positive cases per 100,000 people across Scotland’s Local Authorities. The colours range from light grey for under 150 weekly cases per 100,000, through darker grey for 150 to 200, very light orange for 200-300, darker orange for 300-500, and very dark orange for over 500 weekly cases per 100,000 people. Dumfries and Galloway is the only local authority showing as very dark orange on the map , with over 300 weekly cases. The Orkney Islands, Moray, Shetland Islands and Na h-Eileanan Siar are shown as light grey, with under 150 weekly cases per 100,000 people. Angus, Aberdeen City, Aberdeenshire and Perth and Kinross are showing as very light orange with 200-300 weekly cases. West Dunbartonshire, East Dunbartonshire, East Renfrewshire, Clackmannanshire, North Lanarkshire, Argyll and Bute, South Lanarkshire, Renfrewshire, Glasgow City, Dumfries and Galloway are showing as very dark orange with over 500 weekly cases per 100,000 people. All other local authorities are shown as darker orange with 300-500 weekly cases per 100,000.

The most recent modelling predicts, based on data up to 23 August, that for the week commencing 5 September 2021, there are 28 local authorities which are expected to exceed 100 cases per 100k with at least 75% probability. Of these, twelve local authorities are expected to exceed 300 cases per 100k with at least 75% probability. These are Argyll & Bute, Edinburgh, Dumfries & Galloway, East Dunbartonshire, East Renfrewshire, Glasgow, North Ayrshire, North Lanarkshire, Renfrewshire, South Lanarkshire, West Dunbartonshire and West Lothian. (Figure 6)[18].

Figure 6. Maps of probability of Local Authorities exceeding 50, 100, 300, 500, 1,000 and 1,500 cases per 100,000 population in the period 5 September – 11 September 2021. Data used to 23 August.
These six colour coded maps of Scotland show the probability of Local Authorities having more than 50, more than 100, more than 300, more than 500, more than 1,000 and more than 1,500 cases per 100,000 population. The colours range from very light grey for a 0 to 5 percent probability, through medium grey, dark grey, light orange, medium orange to dark orange for a 75 to 100 percent probability. These maps show that there are 28 local authorities that have at least a 75% probability of exceeding 100 cases per 100,000 population. Of those, 12 are expected to exceed 300 cases per 100,000 with at least a 75% probability. These are Argyll & Bute, Edinburgh, Dumfries & Galloway, East Dunbartonshire, East Renfrewshire, Glasgow, North Ayrshire, North Lanarkshire, Renfrewshire, South Lanarkshire, West Dunbartonshire and West Lothian.

Children and Education

Schools have resumed in Scotland. Angus went back on 11th August. East Dunbartonshire and Na h-Eileanan Siar went back on 12th August, and the rest of the local authorities returned in the week beginning 16th August.

Over the last week there was a further increase in the total number of Covid-19 cases in young people aged under 20, which has gone up from 3,094 cases in the week to 15 August to 7,181 cases in the week ending 22 August. 7 day cases per 100,000 have also increased in all age groups in the week ending 22 August (Figure 7). The percentage of cases made up of children under 12 was just under 30% (2,142 cases) compared to just over 38% (1,192 cases) in the previous week[19].

The rate of testing increased amongst all age groups in the week ending 22 August. Test positivity rates have decreased in the 5-11 year old age group. Age groups 0-1, 2-4 year olds, 12-15, 16-17 year olds and 18-19 year olds have increased. The proportion of positive cases who report having been in an education setting in the 7 day period prior to the onset of symptoms has increased to 11.6% in week ending 22 August, from 2.9% of positive cases in the previous week. Hospital admissions amongst children are decreasing, with a 3-week rolling average of 10.7 for 0-1 year olds, 1.3 admissions for 2-4 year olds, 5.3 for 5-11 year olds, and 9.7 for 12-17 year olds up to 18 August. This compares to 10.7 among 0-1 year olds, 1.7 among 2-4 year olds, 6.0 among 5-11 year olds and 11.0 among 12-17 year olds in the period ending 11 August.

Figure 7. Seven day case rate in Scotland by age group by specimen date for children (week ending 22 August). Refers to PCR testing only.
This figure shows the 7-day case rate of school pupils who tested positive for Covid-19, grouped in six age groups, during the period 14 February 2021 to 15 August 2021. The rates for all age groups have varied over time with a sharp increase in rates for the 18-19 age group in the middle of February. The rates decreased for age groups at the end of March and then levelled off during April. They then started to increase in May and peaked in early July, with the highest case rate among 18-19 year olds. The rates decreased across all age groups in late July. In the week ending 22 August, the 7 day case rates increased in all age groups.

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-19. Average contacts have increased by 15% in the last two weeks (comparing surveys pertaining to 5 August - 11 August and 19 August - 25 August) with a current level of 4.7 daily contacts.

Contacts within the work have increased by approximately 64% compared to two weeks prior. Contacts within the home and other settings (contacts outside of the home, school and work) have remained at similar levels over the same period. All age groups with the exception of those aged 18-29 have had a rise in contacts within the last two weeks, with those aged 30-39 approximately doubling. Increases across the age groups are largely driven by a rise in contacts within the work setting.

Visits to a work place have increased from approximately 14% to 19% with individuals visiting a pub or restaurant increasing from 46% to 49% 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 24-25 August, 68% of people reported ‘complete’ or ‘almost complete’ compliance[20].

Hospitalisations are now rising. Future hospital occupancy and intensive care use are likely to continue rising as infections rise (Figures 8 and 9)[21].

Figure 8. Medium term projections of modelled hospital bed demand, from Scottish Government modelling.
This line graph shows projected demand for hospital beds over time from late August to mid-September 2021, and includes three scenarios; ‘better-continues’, ‘better-drops’ and ‘worse-continues’, which are related to the success of the vaccine roll out. Markers also show the actual number of hospital beds required. Based on the recent changes in cases, hospital beds are projected to increase in all three  scenarios.
Figure 9. Medium term projections of modelled ICU bed demand, from Scottish Government modelling [22]
Similar to Figure 8, this line graph shows projected demand for ICU beds over time from late August to early mid-September 2021, and includes three scenarios; ‘better-continues’, ‘better-drops’ and ‘worse-continues’, which are related to the success of the vaccine roll out. Markers also show the actual number of ICU beds required. Based on the recent changes in cases, ICU hospital beds are projected to increase in all three scenarios.

Vaccinations are continuing across the priority groups and 91.0% of the adult population in Scotland has now been vaccinated with the first dose[23]. The first vaccines were administered on Tuesday 8 December and 4,092,295 people had received their first dose by 26 August 2021[24]. By age group, almost 100% of individuals aged 55+, 96% of those aged 50-54, 91% of those aged 40-49, 82% of those aged 30-39 and 74% of those aged 18-29 have received their first vaccination (Figure 10). 100% of the over 80s, 100% of those aged 75-79, 99% of those aged 70-74, 100% of those aged 60-69, 96% of those aged 55-59, 93% of those aged 50-54, 84% of those aged 40-49, 69% of those aged 30-39 and 45% of those aged 18-29 have received their second dose. Overall, 3,617,687 people (81.3% of those aged 18 and over) had received their second dose by 26 August[25]. There remains a low level of hospitalisations and deaths among those groups vaccinated first (Figure 4).

Figure 10. Estimated percentage of adults vaccinated by 26 August 2021
This bar chart shows the percentage of people that have received their first and second dose of the Covid vaccine so far, for 10 age groups. The six groups aged over 55 have more than 99% of people vaccinated with the first dose and more than 96% of people vaccinated with the second dose. Of those aged 50-54, 96% have received their first dose and 93% have received their second dose. Younger age groups have lower percentages vaccinated, with 91% of 40-49 year olds having received their first dose and 84% the second dose, 82% of the 30-39 year olds having received their first and 69% having received their second dose, and 74% of 18 to 29 year olds having received the first dose and only 45% having received the second dose.

The proportion of people surveyed who said they have been vaccinated for Covid-19 is high. 92% of all respondents have already received at least their first vaccine dose. Of those not vaccinated (and small base must be noted), 6% report they are likely to be vaccinated when a vaccine becomes available to them[26].

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 [27,28,29]. It quickly replaced Alpha (VOC-20DEC-01), first identified in the UK, as the dominant strain in Scotland, and 49,855 cases have now been identified as Delta to 25 August 2021.

To date there are five ‘variants of concern’ (VOCs) and eleven ‘variants under investigation’ (VUIs)[30]. 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[31,32,33]. Up to 25 August there have been 62 genomically confirmed cases of the variant Beta/VOC-20DEC-02 (first detected in South Africa), and 23 cases of Gamma, an increase of one from the previous week, in Scotland. There has also been one new case of VUI-21JUL-01 in the past 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 11).

Figure 11. Variants detected in Scotland by sequencing (data up to 25 August and reported weekly [34])
This line graph shows the number of cases of the variants of concern and variants of interest that have been detected by sequencing in Scotland each week, from the 25th of January to the 25 August 2021. Beta, also known as VOC-20DEC-02, first detected in South Africa, was increasing steadily since late January from 3 cases to 60 cases on the 7 July, and then increased to 62 cases by 11 August. Eta, or VUI-21FEB-03, first identified in Nigeria, rapidly increased since mid-March and reached 40 cases at the end of May. Eta has remained stable over the last 13 weeks. Gamma increased to 23 cases in the week to 25 August. There are also 27 cases of Kappa, or VUI-21APR-01, first identified in India, no change since mid-May. The first case of VUI-21Jul-01 emerged in the week to 4 August with one new case identified in the week to 25 August. Delta, also known as VOC-21APR-02, first identified in India, has seen a rapid increase in the past 13 weeks to 49,855 cases, an increase of 2,954 cases since the week before.

A large study from the University of Oxford and Office of National Statistics shows that with Delta, Pfizer-BioNTech and Oxford-AstraZeneca vaccines still offer good protection against new infections, but effectiveness is reduced compared with Alpha[35]. Public Health England analysis shows that vaccines are highly effective against hospitalisation from Delta variant with similar vaccine effectiveness against hospitalisation seen with the Alpha and Delta variants at 93% and 96% respectively after two doses of vaccine. There was a 14% absolute reduction in vaccine effectiveness against symptomatic disease after a single vaccine dose with Delta compared to Alpha, and a smaller 10% reduction in effectiveness after 2 doses. Vaccine effectiveness against symptomatic disease is high for both Alpha (89%) and Delta after two doses (79%)[36]. 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 effectiveness against infection appeared to be diminished when compared to those with Alpha[37].

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.

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.


Contact

Email: modellingcoronavirus@gov.scot