Publication - Research and analysis

Coronavirus (COVID-19) state of the epidemic - 29 October 2021

Published: 29 Oct 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 - 29 October 2021
State of the Epidemic in Scotland – 29 October 2021

State of the Epidemic in Scotland – 29 October 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 28 October 2021 on Covid-19 in Scotland. This updates the previous publication published on 22 October[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 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 on 28 October 2021 may be affected by a data flow issue at the Glasgow lighthouse laboratory. Specimen date data for the most recent dates are likely to be incomplete due to reporting delays.

Key Points

  • The reproduction rate R in Scotland, as of 12 October, is estimated as being between 0.8 and 1.0. This is unchanged from last week.
  • An average of 2,436 cases were reported per day in the 7 days to 28 October. This is a 4% decrease from the daily average (2,541) recorded on 21 October.
  • There were 326 weekly cases per 100,000 in the week to 25 October (by specimen date). 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). 7 day case rates have remained relatively stable in recent weeks.
  • Case rates have continued to decrease for 0-19 year olds and have increased for those aged 20-39, 40-59, 60-79 in the week to 25 October. The case rate for those aged 80+ has fluctuated. As of 25 October, the highest case rates were observed amongst those aged 40-59, followed by under 20s, 20-39, 60-79 and 80+ Figure 3).
  • As determined through the latest weekly ONS survey, there are early signs that the percentage of people testing positive for Covid-19 in the private residential population has increased in the most recent week in Scotland (17 to 23 October 2021).
  • Latest modelled estimates suggest that as of 12 October there were between 77 and 105 new daily infections per 100,000 people in Scotland. This is a decrease in the upper limit since last week.
  • There were 130 deaths registered in Scotland where coronavirus was mentioned on the death certificate in the week ending 24 October.
  • Average hospital admissions (3-week rolling average) related to Covid-19 in children have decreased in all age groups, except for 0-1 and 18-19 year olds, compared to the previous three-week period.
  • Clackmannanshire currently has the highest weekly case rate in Scotland reporting 614 weekly cases per 100,000 in the week to 25 October 2021, followed by West Lothian with 437 weekly cases per 100,000, Stirling with 435 weekly cases per 100,000, Fife with 430 weekly cases per 100,000, North Lanarkshire with 415 weekly cases per 100,000, and East Ayrshire and Orkney with 406 weekly cases per 100,000 population each. All local authorities reported over 200 weekly cases per 100,000 population in the last week, except for Shetland. Shetland reported the lowest case rate with 70 weekly cases per 100,000 in the same period.
  • Nationwide, Covid-19 levels in wastewater were similar or slightly lower than those seen last week (13 to 19 October). This brings levels in line with recent trends in case rates.
  • Hospital occupancy has been fluctuating over the past two weeks, and over the past few days has increased slightly. ICU occupancy under 28 days has plateaued and is fluctuating but long stay Covid ICU is increasing slightly. There continues to be uncertainty over hospital occupancy and intensive care in the next three weeks.
  • Over 4.3 million people in Scotland have been given a first vaccine against SARS-CoV-2, over 3.9 million have received a second dose, and almost 600,000 people have received a booster dose by 28 October.
  • 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.

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 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 12 October (using data to 25 October)[2], was between 0.8 and 1.0 (Figure 1), with a growth rate of between -3% and 0%. This is unchanged from last week.

Figure 1: R in Scotland over time

This column chart shows the estimated range of R over time, from early September 2020. The R number has varied over the pandemic with the estimated range moving above 1 in Autumn 2020, January 2021, June 2021 and again at the end of August 2021. 

The latest R value for Scotland is estimated to be between 0.8 to 1.0, which is unchanged from last week.

An average of 2,436 cases were reported per day in the 7 days to 28 October. This is a 4% decrease from the daily average (2,541) reported a week earlier on 21 October[3]. In the week 16 October to 22 October 2021, there were 329 cases (PCR testing only) per 100,000 amongst the unvaccinated individuals, compared to 286 cases per 100,000 for those that had been vaccinated with two doses[4]. Our current position is 326 weekly cases per 100,000 in the week to 25 October (by specimen date)[5]. 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). 7 day case rates have remained relatively stable in recent weeks.

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, Covid-19 levels in wastewater were similar or slightly lower than those seen last week (13 to 19 October). This brings levels in line with recent trends in case rates.

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 which then continued to decrease until mid-May.  

There has been a sharp increase 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 surpassed the peak seen at the start of July 2021. Case rates reached the peak on 6 September and then decreased sharply, they are now lower than the peak of July, with just over 300 weekly cases per 100,000 population registered at the start of October. Case rates have been fluctuating since then but remained relatively stable over the last week.

Case rates have continued to decrease for 0-19 year olds and have increased for those aged 20-39, 40-59, 60-79 in the week to 25 October. The case rate for those aged 80+ has fluctuated. As of 25 October, the highest case rates were observed amongst those aged 40-59, followed by under 20s, 20-39, 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 case rates per 100,000 population then decreased sharply followed by a sharp increase in cases in mid-August 2021. Case rates have decreased since the start of September for all age groups. Case rates have been fluctuating or increasing slightly across all age bands since the start of October, except for the under 20s which continue to decrease.

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 12 October, the incidence of new daily infections in Scotland was between 77 and 105 new infections per 100,000[7]. This equates to between 4,200 and 5,700 people becoming infected each day in Scotland. This is a decrease in the upper limit since last week.

Hospital occupancy has been fluctuating over the past two weeks, and over the past few days has increased slightly in the week leading up to 28 October 2021. ICU occupancy under 28 days has plateaued but continues to fluctuate up and down while long stay Covid ICU is increasing slightly. 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 28 October there were 932 patients in hospital with Covid-19. This compares to 917 people in hospital on 21 October (Figure 4). The latest data from PHS shows 652 admissions to hospital for people with confirmed Covid-19 in the week to 24 October compared to 603 in the week to 17 October[9]. In the 4 weeks to 22 October 25.0% of acute Covid-19 hospital admissions were in unvaccinated individuals[10]. For context, as of 28 October, 92.4% of adults aged 18+ (92.0% of adults aged 16+) have had at least one dose of the vaccine. Overall, individuals in the oldest age groups were most likely to be hospitalised. In all age groups, the rate of admissions per 100,000 was higher in unvaccinated individuals compared to fully vaccinated individuals in the week to 22 October. Unvaccinated individuals were 2 to 4.2 times more likely to be in hospital with Covid-19 compared to fully vaccinated individuals (depending on age) in the period 16-22 October[11].

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[12].

Figure 4: Patients in hospital (including those in ICU) (with length of stay 28 days or less) and ICU [13] with recently confirmed Covid-19

This line chart shows the daily number of patients in hospital and ICU (or combined ICU/ HDU) across Scotland with recently confirmed Covid-19 with a length of stay of 28 days or less since 11 September 2020. Covid-19 patients in hospital (including those in ICU) increased sharply from the end-September 2020 reaching a peak at the beginning of November. Patients in hospital then stabilised before a decrease at the beginning of December. It then started rising sharply from the end of December, reaching a peak of over 2,000 on 22 January. The number of patients in hospital decreased sharply since then before plateauing throughout May and June. It then rose to over 500 patients in hospital in July and decreased by the end of August. It then rose again reaching a peak of over a 1,000 patients in hospital by mid-September. Since then, hospital occupancy has been fluctuating up and down, with a slight increase in the most recent week.

A line for patients in ICU follows a similar pattern with an increase seen from end-September 2020. It then reached a peak of over 100 patients in ICU with length of stay 28 days or less at the beginning of November and then decreased to just below 50 patients in ICU in December 2020. Then a sharper increase is seen in patients in ICU by the end of January before it started to decrease. The number of patients in ICU remained low throughout late spring and early summer before a slight increase in July. It then decreased a little before a further increase by mid-September. Since then, ICU occupancy has plateaued but continues to fluctuate.

There were 130 deaths registered where Covid-19 was mentioned on the death certificate in the week to 24 October. This is a decrease of 11 (-8%) in the number of deaths from the previous week, and 80% lower than the peak in April 2020 (663 deaths). The proportion of deaths in care homes decreased from 60% in April 2020 to 11% in the week to 24 October, with 14 deaths occurring in care homes[14]. In the week ending 24 October, deaths involving coronavirus have increased in those aged 45-64 (from 18 to 19 deaths) and 65-74 (from 30 to 32 deaths) compared to week ending 3 October. Deaths decreased in those aged 15-44 (from 4 to 1 death), 75-84 (from 48 to 39 deaths), and those aged 85+ (from 43 to 39 deaths). Deaths remained at 0 in those aged under 15 in the same period[15](Figure 5). From 29 December 2020 to 15 October 2021, 73.3% of Covid-19 deaths were in unvaccinated individuals[16]. Amongst those individuals who have been vaccinated with two doses of Covid-19 vaccine, 79.1% of the confirmed Covid-19 deaths occurred in the 70+ age group[17].

Figure 5: Deaths by age group (weekly total by week beginning, NRS) 12

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 remained low with only a slight recent increase seen with 130 deaths registered over the latest week. 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 ONS Covid-19 Infection Survey estimates that in the week 17 to 23 October 2021 the estimated percentage of the population living in private residential households testing positive for Covid-19 in Scotland was 1.36% (95% credible interval: 1.12% to 1.62%). There are early signs that the percentage of people testing positive for Covid-19 in the private residential population has increased in the most recent week in Scotland. Estimates for the week 17 to 23 October in the other UK nations are as follows: 2.02% (95% credible interval: 1.91% to 2.13%) for England, 2.56% (95% credible interval: 2.12% to 3.04%) for Wales and 1.31% (95% credible interval: 0.93% to 1.76%) for Northern Ireland. This equates to around 1 in 75 people in Scotland, 1 in 50 in England, 1 in 40 in Wales and 1 in 75 in Northern Ireland[18].

The ONS Covid-19 Infection Survey estimated that in the week beginning 27 September 2021, 91.3% (95% CI: 89.6% to 92.7%) 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 92.2% in England (95% CI: 90.9% to 93.3%), 90.0% in Wales (95% CI: 87.9% to 91.7%) and 90.8% in Northern Ireland (95% CI: 86.7% to 93.3%)[19].

An estimated 1.7% 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 5 September 2021. In Scotland, 79,000 people (1.5% of the respective population) living in private households self-reported long Covid symptoms for this period. This compares to 1.73% in England, 1.38% in Wales and 1.03% in Northern Ireland[20].

Average daily deaths in Scotland (3 per 1 million population) in the week to 27 October are similar to Wales and Northern Ireland (3 per 1 million each), and above England (2 per 1 million)[21]. Average daily cases in Scotland (451 per 1 million) in the week to 27 October are below Wales (836 per 1 million), England (666 per 1 million) and Northern Ireland (620 per 1 million)[22].

Situation by local authority within Scotland

Clackmannanshire currently has the highest weekly case rate in Scotland reporting 614 weekly cases per 100,000 in the week to 25 October 2021, followed by West Lothian with 437 weekly cases per 100,000, Stirling with 435 weekly cases per 100,000, Fife with 430 weekly cases per 100,000, North Lanarkshire with 415 weekly cases per 100,000, and East Ayrshire and Orkney with 406 weekly cases per 100,000 population each. All local authorities reported over 200 weekly cases per 100,000 population in the last week, except for Shetland (Table 1). Case rates have decreased in East Ayrshire, East Dunbartonshire, East Renfrewshire, Falkirk, Fife, Glasgow City, Moray, North Ayrshire, Renfrewshire, Scottish Borders, Shetland Islands, South Ayrshire South Lanarkshire Stirling and West Lothian over the last week. However, there are still very high levels (150+ weekly cases per 100,000) of case rates across Scotland (Figure 6). Shetland has the lowest case rate in Scotland, reporting 70 weekly cases per 100,000 in the week to 25 October[23].

Table 1: Total new weekly cases per 100,000 population to 25 October 2021, in order of prevalence
Local authority Total new cases in the week, per 100,000 population Change since previous week
Clackmannanshire 614 119
West Lothian 437 -35
Stirling 435 -30
Fife 430 -6
North Lanarkshire 415 31
East Ayrshire 406 -39
Orkney Islands 406 254
Aberdeenshire 383 40
Dundee City 363 16
East Lothian 361 57
Falkirk 353 -108
West Dunbartonshire 342 51
East Dunbartonshire 341 -55
Angus 338 9
Perth and Kinross 332 67
South Lanarkshire 309 -87
Argyll and Bute 307 33
Highland 302 78
Renfrewshire 296 -39
South Ayrshire 294 -18
Scottish Borders 291 -69
North Ayrshire 291 -60
Dumfries and Galloway 291 40
Inverclyde 289 23
Aberdeen City 283 21
Moray 282 -38
East Renfrewshire 275 -67
Na h-Eileanan Siar 272 64
Midlothian 257 10
City of Edinburgh 257 27
Glasgow City 231 -13
Shetland Islands 70 -4
Scotland 326 -1
Figure 6: 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 grey for under 50 weekly cases per 100,000, through very light orange for 50 to 100, orange for 100-300, darker orange for 300-500, and very dark orange for over 500 weekly cases per 100,000 people. 

Only Clackmannanshire is showing as very dark orange on the map this week, with over 500 weekly cases, and no local authorities are showing as grey for under 50 weekly cases per 100,000. Shetland is shown as very light orange, with 50-100 weekly cases per 100,000 people. Aberdeen City, City of Edinburgh, Dumfries and Galloway, East Renfrewshire, Glasgow City, Inverclyde, Midlothian, Moray, Na h-Eileanan Siar, North Ayrshire, Renfrewshire, Scottish Borders and South Ayrshire are showing as orange with 100-300 weekly cases. 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 25 October, that for the week commencing 7 November 2021, there are 29 local authorities which are expected to exceed 50 cases per 100,000 population with at least 75% probability. These 29 local authorities are also expected to exceed 100 cases per 100,000 with at least 75% probability. There are no local authorities which are expected to exceed 300 cases per 100,000 population with at least 75% probability[24].

Children and Education

Schools resumed in Scotland by the week ending 20 August and universities resumed by end of September. The majority of children and young people have returned to full time education. Throughout October schools have been on half-term holidays, which may have an effect on testing.

Over the last week there was a decrease in the total number of Covid-19 cases in young people aged under 22, which has decreased from 5,406 cases in the week to 17 October to 4,439 cases in the week ending 24 October. 7 day case rates per 100,000 have continued to decrease amongst those aged 5-11 and 12-15, whereas weekly case rates fluctuated and increased or plateaued amongst those aged 0-1, 2-4, 16-17, 18-19, and 20-21, in the week ending 24 October (Figure 7). The percentage of cases made up of children under 12 was 55.4% (2,459 cases) in the week to 24 October, a slight decrease from the previous week[25]. The percentage of cases made up of 18-21 year olds was 10% (427 cases) in the week to 24 October compared to 7% (389 cases) in the week ending 17 October. Following the return of universities, there is no evidence of an uptick in cases in the 18-21 year age group.

The rate of testing increased amongst those aged 16-17, but decreased amongst most other age groups in the week ending 24 October. Test positivity rates have increased in age groups 0-1, 2-4 and 20-21, decreased in age groups 5-11, 12-15 and 16-17, and remained stable in those aged 18-19, in the same period. In the week ending 24 October, 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 remained similar to the previous week at 7.7%, compared to 7.6% in the week ending 17 October. Hospital admissions (3 week rolling average) in children and young adults decreased amongst all age groups, except for 0-1 and 18-19 year olds, in the period 30 September – 20 October compared to the previous three-week period (23 September – 13 October).

Vaccine uptake in 17-21 year olds as at 25 October was 79.4% for the first dose and 60.0% for the second dose[26]. 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 27 September 2021, the percentage of 16-24 year olds in the community population in Scotland testing positive for antibodies increased to 95.4%[27].

Figure 7: Seven day case rate in Scotland by age group by specimen date for children and young people (week ending 24 October). Refers to PCR testing only.

This figure shows the 7-day case rate of school pupils and younger adults of under 22 years of age who tested positive for Covid-19, grouped in seven age groups, since 14 February 2021. Markers also show all Scotland case rate for comparison.

The rates for all age groups have varied over time. Case rates remained relatively low from mid-February to May. 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. Case rates then started to rise at the beginning of August 2021, reaching the peak early September. These then started to decrease. In the latest week ending 24 October, 7 day case rates per 100,000 have continued to decrease amongst those aged 5-11 and 12-15, however fluctuated and increased or plateaued amongst those aged 0-1, 2-4, 16-17, 18-19, and 20-21.

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 remained at a similar level in the last two weeks (comparing surveys pertaining to 30th September - 6th October and 14th October - 20th October) with a current level of 4.6 daily contacts.

Mean contacts within the work and home setting have decreased by around 16% and 6% respectively in the last two weeks. Contacts in the other setting (contacts outside home, school and work) have increased by 6% over the same period.

Those aged between 30-39 have reported the biggest decrease in interactions with those aged under 18 in the last two weeks whereas interactions between the 18-29 age group with each other have doubled in the last two weeks.

Visits to a non-essential shop have increased from approximately 41% to 46% with individuals attending an pub or restaurant increasing from 47% to 52% 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 19-20 October, 71% of people reported 'complete' or 'almost complete' compliance[28].

Hospital occupancy has been fluctuating over the past two weeks, and over the past few days has increased slightly. ICU occupancy under 28 days has plateaued and is fluctuating but long stay Covid ICU is increasing slightly. There continues to be uncertainty over hospital occupancy and intensive care in the next three weeks (Figure 8)[29].

Figure 8: Medium term projections of modelled hospital bed demand, from Scottish Government modelling [30]

This line graph shows projected demand for hospital beds over time from October to mid-November 2021, and includes three scenarios; ‘better’, ‘central’ and ‘worse’. Markers also show the actual number of hospital beds that were required until start October. Based on the recent changes in cases, hospital beds are projected to decrease or plateau in ‘better’, increase in ‘worse’ and slightly increase in ‘central’ scenarios.

Vaccinations are continuing and 92.0% of the 16+ population in Scotland has now been vaccinated with the first dose[31]. The first vaccines were administered on Tuesday 8 December and 4,312,204 people had received their first dose by 28 October 2021[32].

By age group, almost 100% of individuals aged 55+, 97% of those aged 50-54, 92% of those aged 40-49, 84% of those aged 30-39, 78% of those aged 18-29, 75% of those aged 16-17 and 53% of those aged 12-15 have received their first vaccination (Figure 9).

Almost 100% of individuals aged 60+, 97% of those aged 55-59, 94% of those aged 50-54, 87% of those aged 40-49, 77% of those aged 30-39, 67% of those aged 18-29, 16% of those aged 16-17 and 1% of those aged 12-15 have received their second dose. Overall, 3,900,427 people (85.7% of those aged 16 and over) had received their second dose and 599,510 people have received their booster vaccine by 28 October[33]. There remains a low level of deaths amongst the vaccinated individuals (Figure 5).

Figure 9: Estimated percentage of adults vaccinated by 28 October 2021

This bar chart shows the percentage of people that have received their first and second dose of the Covid vaccine so far, for twelve age groups. The six groups aged over 55 have more than 99% of people vaccinated with the first dose and more than 97% of people vaccinated with the second dose. Of those aged 50-54, 97% have received their first dose and 94% have received their second dose. Younger age groups have lower percentages vaccinated, with 92% of 40-49 year olds having received their first dose and 87% the second dose, 84% of the 30-39 year olds having received their first and 77% having received their second dose, 78% of 18 to 29 year olds having received the first dose and 67% having received the second dose, 75% of the 16-17 year olds having received their first dose and 16% their second dose, and 53% of 12-15 year olds having received their first dose and 1% having received their second dose of the vaccine.

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), 5% report they are likely to be vaccinated when a vaccine becomes available to them[34].

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 [35] [36] [37]. It quickly replaced Alpha (VOC-20DEC-01), first identified in the UK, as the dominant strain in Scotland, and 93,475 cases have now been identified as Delta to 27 October 2021. A new sublineage of Delta, AY.4.2, has been classified as VUI-21OCT-01, and 3,129 cases have now been identified in Scotland.

To date there are five 'variants of concern' (VOCs) and twelve 'variants under investigation' (VUIs)[38]. 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[39] [40] [41]. Up to 27 October 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.

Figure 10: Variants detected in Scotland by sequencing (data up to 27 October and reported weekly) [42]


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 25 January to 27 October 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. Beta has remained at 62 cases since then. 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 22 weeks. Gamma increased to 23 cases in the week to 25 August but has not yet increased further. 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 three new case identified in the week to 1 September, however no change over the last 8 weeks. Delta, also known as VOC-21APR-02, first identified in India, has seen a rapid increase in the past 23 weeks to 93,475 cases. Delta+ variant emerged by the end of October with  3,129 cases having been identified in Scotland by 27 October.

The effectiveness of vaccines

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[43]. 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%)[44]. 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[45]. The latest data released from the EAVE II study revealed that vaccination is over 90% effective at preventing deaths from the Delta variant of Covid-19 (Pfizer-BioNTech 90% effective, Oxford-AstraZeneca 91%)[46]. The vaccine effectiveness expert committee recently published their consensus view on the effectiveness of different vaccines on infections, symptomatic disease, and severe disease[47]. The protective effects of vaccines wanes over time, and recently the Joint Committee on Vaccination and Immunisation (JCVI) gave advice on a booster programme to re-vaccinate adults against Covid in the UK[48].

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, 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.


Contact

Email: modellingcoronavirus@gov.scot