Covid Situation Report: Apr 4, 2024
Update on Covid providing information on prevalence and hospital admissions for England and its regions. This post is best viewed using the browser or Substack app.
Introduction.
This report belongs to a weekly series that I have released throughout the Winter 2023/Spring 2024 season to offer a summary of the ongoing Covid situation in England and its regions.
As mentioned in earlier posts, the data available for this report is changing, and this week marks the final newsletter with all of the regular data charts. Certain data will become unavailable, while some will move from a weekly to a monthly reporting schedule. In this report I highlight these changes and, where possible, identify potential alternative sources. Finally, I cover the changes being made to Covid testing from April 1, 2024.
Summary.
The news this week continues to be positive, with most Covid metrics indicating that the winter surge is over. However, Covid has not completely disappeared, as we are still seeing stable, albeit low, levels of hospital admissions.
The positivity rate for Covid is stable and fell for Flu this week with both at low levels.
Weekly hospital admission rates for Covid remained unchanged but continued to fall for Flu.
The latest daily Covid hospital admissions increased slightly from a low level but the number of occupied beds fell confirming the trend seen in the other metrics.
An analysis of Covid admission trends and bed occupancy since April 2022 shows a decrease in both the frequency and severity of peak admissions over time.
A reminder that the Spring 2024 booster campaign is due to start in April for people aged 75 years and over, those in care homes, and individuals aged 6 months and over with a weakened immune system.
It is always important to remember that the risk of hospitalisation increases significantly with age and for those who are immunocompromised. Therefore, it is prudent to take appropriate measures such as self-isolating when experiencing Covid symptoms and enhancing ventilation whenever possible.
Status of main respiratory diseases in England.
The chart below displays the positivity rates, which are the percentages of tests that are positive, for the primary respiratory illnesses in England, including Flu, Covid, RSV, and Rhinovirus.
This week saw a decrease in the positivity rate for Flu, which fell to 3.8% but remained stable for Covid at 3.5%/ The rates for RSV and Rhinovirus also remained unchanged.
The following chart shows hospital admissions per 100,000 people in England for the main respiratory diseases.
Hospital admission rates for flu have decreased by 14% weekly, while Covid and RSV admission rates have remained stable and relatively low over the past three weeks.
The positivity rates and weekly hospital admissions for Flu and Covid have fallen to relatively low levels. It is more probable that Covid-like symptoms may indicate a Rhinovirus infection rather than Covid.
Covid hospital admissions and bed occupancy.
This section gives a more detailed examination of the most recent daily Covid data for hospitals in England. Regrettably, NHS England will publish this data on a weekly basis for the last time this week, as outlined in the subsequent note.
The following charts use data from the NHS England Weekly Covid Hospital Activity Report. This report will now move to a monthly publication schedule, with the data for April set to be released on May 9, 2024. Additionally, certain data will no longer be published , including the count of mechanically ventilated beds used by Covid patients, confirmed Covid patients under primary treatment for the virus, and the age distribution of Covid admissions and diagnoses.
Currently, the UKHSA Data Dashboard also publishes weekly data on daily Covid hospital admissions and bed occupancy. Should this continue I will use this source for ongoing reporting.
The following dashboard of key Covid metrics saw daily hospital admissions increase slightly but the number of beds occupied by Covid patients continued to fall. When reviewing the dashboards, it is important to consider that as the absolute numbers decrease, the weekly percentage change in the data may seem disproportionately large.
The next dashboard gives the Covid hospital admissions per 100,000 by region.
Regional hospital admission rates showed a mixed picture with the South East having the largest increase. Nonetheless, regional admission rates remain at historically low levels.
Trends in Covid hospital admissions and bed occupancy
With the content and reporting frequency of daily Covid hospital data changing this week, it’s timely to take a look at the data’s reliability and what we can learn from the longer term trends.
The protocols for Covid testing for hospital admissions and inpatients have changed over time. Before April 2023, routine testing was conducted for all patients admitted to hospitals to prevent asymptomatic spread. As of April 2023, the focus shifted to primarily testing patients exhibiting Covid symptoms or when a positive result would alter the patient's treatment regimen. This raises the question of the effectiveness of using hospital admissions for Covid as a proxy for its prevalence in the broader community.
The following panel chart compares Covid prevalence from the Winter Infection Study with daily Covid hospital admissions. The trends for both follow the same broad pattern with the hospital admissions peaking 10 days later than prevalence.
Importantly, the prevalence data comes from testing a randomly selected, representative sample of the population, thus remaining unaffected by testing policies. Since hospital admissions generally mirror this trend, we can regard them as a reliable indicator of prevalence within the broader community.
The following chart shows the number of daily hospital admissions for Covid from April 2022 to March 2024. Asymptomatic testing for hospital admissions was stopped on Apr 1, 2023 and this change of testing policy is marked on the chart.
While the change in testing policy will have lowered the total number of Covid hospital admissions reported, it's evident that the frequency of peak admissions has diminished over time. This is likely due to the emergence of fewer new variants and increased immunity from vaccinations and infections.
The next chart shows the count of beds occupied by patients undergoing treatment for Covid (indicated by the red line) and those receiving treatment with Covid (represented by the blue line). This chart mirrors the pattern observed in hospital admissions both for patients being treated for Covid and those with Covid. Since the number of occupied beds is less likely to be influenced by changes in testing policy, this provides stronger evidence that the severity of the waves has diminished over time.
Finally, the chart also shows a decline over time in the percentage of beds occupied by patients being treated for Covid relative to the total number of Covid patients. This trend suggests a diminishing health impact, likely due to factors such as enhanced immunity from vaccinations, more effective treatments shortening hospital stays, and the emergence of less severe virus variants.
Changes to Covid Testing from April 2024
Starting from April 1, 2024, there have been several changes to Covid testing in England. Full details of the changes can be found here but the main points are:
End of Routine LFD Testing for Outbreak Management: As of April 1, 2024, the routine provision of free Covid lateral flow device (LFD) tests for managing outbreaks in higher-risk settings will no longer be available. However, free PCR testing will continue where it is appropriate to find the cause of an acute respiratory infection outbreak in higher-risk settings.
Eligibility for Covid Treatments Continues: Individuals at the highest risk of getting seriously ill and eligible for Covid treatments can still access free Covid LFD tests from their local pharmacy. Details of those eligible can be found here.
End of Asymptomatic Testing on Discharge from Hospital: Routine asymptomatic Covid LFD testing on discharge from hospital into care or hospice settings will end. However, NHS Trusts will have local discretion to reintroduce this or other forms of testing as clinically appropriate following a risk assessment.
Limited Testing in Healthcare Settings: Within healthcare settings, limited testing will continue. This includes symptomatic testing of staff working on inpatient wards focused on treating profoundly immunocompromised individuals.
Importantly, there is no change to the guidance for testing patients exhibiting Covid symptoms or when a positive result would alter the patient's treatment. Therefore, the number of Covid hospital admissions should continue to be a dependable indicator of the virus's prevalence in the community.
In conclusion
This week's situation report is the final one based on the weekly NHS England Weekly Covid Hospital Activity Report, which is moving to a monthly publication schedule. It is hoped that data on daily hospital admissions and bed occupancy will remain accessible via the UKHSA dashboard, allowing the situation report to continue to report this information.
As always, if you have any comments on this Covid Situation Report or suggestions for topics to cover, please post a message below.
Excellent work. You do a better report than the ones I sometimes publish. I prefer to read it on the website rather than in email because of the hover over 'tooltips' in the online versions of the graphs.
In email, with my color vision, I can't tell which line is which. In some graphs I see 3 bluish lines and one dark line that could be red. This is a routine problem with thin colored lines.
I have been using the weekly flu & COVID report taking the changes in hospitalisation and applying those to the last of the ONS prevalence/incidence numbers to estimate current prevalence/incidence. Do you find that method to be of interest?
(So if there were 4 per 100,000 at the time of the ONS data & there are now 3.5 per 100,000, I would adjust the 0.7% prevalence by 3.5/4)
The last incidence of 73 in 100,000 implies that living an average life means having roughly a 1 in 1,350 risk of catching COVID each day which is about an average of once every 4 years. At the peak I think it was once every 4 months or so. Once every 4 years, seems to me to be several times more common than flu.
During the last 4 years what I always wanted was an estimate of risk of ordinary activities such as shopping or travel. I had to invent my own estimates as no one seemed to produce this. I cobbled together data and excerpts from studies, but never really solved this.
Now there isn't really much data to build on. The risk is obviously much lower than it had been, and is now harder to calculate due to lack of data.
Amusing math, it looks like COVID currently is about ten times less than at its peak, but about 10 times higher than during lockdown. (Not sure of the ratios there, I may be cheating.)