Coronavirus (COVID-19): Route Map - supporting evidence for the 22 September 2020 review

WHO criterion 1: Evidence shows that COVID-19 transmission is controlled

• R is consistently low
• Number of infectious cases is showing a sustained decline

These criteria are not met. SAGE's consensus view, as of 17 September, was that the value of R in Scotland was between 1.1 and 1.4. The various groups which report to SPI-M use different sources of data in their models (i.e. deaths, hospital admissions, cases) so their success at capturing recent local outbreaks varies from group to group, leading to increased levels of uncertainty at this point in the epidemic, however R in Scotland is now highly likely to be above 1. The SAGE consensus is updated weekly on a Thursday.

In the week up to 14 September, the picture across Scotland was one of a general and widespread increase in the number of new confirmed cases. As a result, no local authority areas recorded "significant" (>6.0, p > 0.05) levels of cumulative exceedance.

Supplementary measures

The number of new confirmed COVID-19 cases by specimen date showed a sustained decline since peaking in late April 2020, based on the 7 day moving average, up until 9 July, even in the context of increased testing and expanded eligibility. In early July there were fewer than 10 new cases a week. Since then the weekly average number of new cases has increased to 232 on 19 September, with noticeable stepped increases associated with outbreaks, firstly in Grampian and then in Tayside and around Glasgow and surrounding areas.

Source: Public Health Scotland, 21 September 2020

The number of hospital admissions per day for those with a positive COVID-19 result showed a sustained decline from 7 April 2020, based on the 7 day moving average, prior to a small increase over the latest four-week period. In the four weeks ending 7 September, there were a total of 71 hospital admissions for patients with confirmed SARS-CoV-2, compared to 19 admissions over the preceding four week period.

Source: COVID-19 Statistical Report, 16 September 2020, Public Health Scotland

The number of new daily ICU admissions showed a sustained decline from 4 April based on the 7 day moving average, but has shown signs of increasing again recently. In the week ending 13 September, there were 5 confirmed COVID-19 patients admitted to ICU, the same number as in the preceding 3 weeks.

Source: COVID-19 Statistical Report, 16 September 2020, Public Health Scotland

After peaking at 661 in the week ending 26 April (week 17), the number of deaths involving COVID-19 reduced, and is now less than 1% of the peak level.

As of 13 September, there have been a total of 4,236 deaths registered where COVID-19 was mentioned on the death certificate. In the most recent week (7 - 13 Sept), there were 5 deaths where COVID-19 was mentioned on the death certificate.

Source: https://data.gov.scot/coronavirus-covid-19/detail.html#1_direct_health_harms

The proportion of those who have a positive test for COVID-19 out of those who are symptomatic of COVID-19 in community healthcare is small but increasing. There were no swab positives for three weeks, week 27 (29 June to 5 July) to week 29 (13 to 19 July) but 19 positive swabs in the most recent week (7-13 September) which represents 2.7% of swabs.

In conclusion:

A marked increase in case numbers has been observed over recent weeks. Hospital and ICU admissions remain relatively low but are starting to increase.

This is the first time since March that the estimated range on R has been above 1 in Scotland.

On the basis of the evidence summarised above the assessment is that these criteria have not been met at this review point