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

Supporting evidence to inform decisions about timings of changes within Phase 3 as set out at the review point on 22 September 2020.

This document is part of a collection


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.

New Positive COVID-19 cases by specimen date - 7 day moving average
The figure shows the number of new cases each day, by when the test was taken, from March 2020 to 22 September 2020. After a rapid rise to 400 cases per day by 30 April, new cases per day were below 50 by mid-June. They stayed below this level until late August, when they rose above 50 again. The number of new cases per day has been increasing steadily since then, and was just below 250 per day by 22 September

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.

Hospital Admissions where SARS-CoV-2 is confirmed
Hospital admissions, shown both daily and as a 7-day rolling average. Daily admissions spiked rapidly from 0 at the start of March to over 200 per day by 29 March. New admissions then fell rapidly, with almost no new admissions each day during July and August. However, in September, new hospital admissions began increasing, with around 15 being admitted each day by 22nd September.

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.

New Admissions to ICU where for COVID-19
As with all hospital admissions, ICU admissions increased rapidly through March, peaking at the start of April at just above 25 admissions per day. This declines rapidly, with between 0 and 3 admissions each day during June to the review date in September. Though numbers remain low each day, there have been more consistent admissions to ICU in September than during July and August.

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.

Deaths involving COVID-19
The graph shows the number of deaths involving COVID-19 from National Records Scotland. This measure includes all deaths where COVID-19 was mentioned on the death certificate. After peaking in April at 660 deaths in week commencing 20 April, this measure declined steadily to fewer than 100 in the week beginning 1 June. There were fewer than 10 deaths per week on this measure from 13 July to week beginning 7 September.

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

Contact

Email: brian.doran@gov.scot

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