Covid Situation Report: Dec 12, 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 summarising the Covid situation across the UK's home nations and the English regions.
This weeks report includes the most recent weekly test positivity rates and hospital admissions data for England. It also incorporates daily case rates from the UKHSA Covid dashboard, alongside the latest data for Scotland, Wales and Northern Ireland. The report also reviews the progress of the Autumn 2024 Covid booster campaign across the Home Nations. Finally, there is an summary of a recent paper examining the incidence of Long Covid in children and young adults.
Summary.
This week continues to bring good news, with data showing low levels of Covid across England, Scotland, Wales, and Northern Ireland.
In contrast, there has been a significant rise in Flu levels and RSV remains high, making it more likely that for those with Covid-like symptoms they are suffering from Flu or RSV rather than Covid.
In England, the Covid test positivity rate, hospital admissions and case rates remained stable, and are at levels well below those of the other respiratory viruses.
Concerningly, Flu test positivity and hospital admissions increased significantly and at a rate close to the severe 2022/23 season that led to extreme pressures on the NHS.
In Scotland, Covid levels remained low across all measures, including admissions to hospital and wastewater monitoring.
This week Covid hospital admissions in Wales fell slightly and remain relatively low.
In Northern Ireland, Covid indicators have remained at low levels and are currently much lower than those of other major respiratory viruses.
A recent report showed that although most children and young adults who experience Long Covid recover after 24 months, just over 7% still report Long Covid symptoms beyond this time.
Vaccination remains a powerful way to minimise the risk of Covid. With only two weeks left before this booster campaign closes, coverage remains lower compared to previous Autumn campaigns. Notably, coverage for those at clinical risk remains low.
Remember that the Autumn booster and Flu vaccination campaigns will close earlier this year, ending on Friday, December 20. You can verify your eligibility for the free NHS vaccinations and make appointments until December 19 by visiting these links.
For individuals not covered by the NHS, Covid and Flu vaccinations may be obtainable for a fee at local pharmacies.
As always, it’s important to remember that the risk of hospitalisation from Covid increases significantly with age and for the immunocompromised. Therefore, it is prudent to take appropriate measures such as self-isolating when experiencing Covid symptoms and enhancing ventilation or wearing masks whenever possible.
Status of main respiratory diseases in England.
This section starts with the latest available data on positivity rates for primary respiratory infections in England. It is important to understand that positivity differs from prevalence, which refers to the overall percentage of COVID-19 in the general population. Appendix 1 provides a more detailed explanation of the difference and why positivity rates are a useful indicator of trends in Covid infection levels.
The chart below displays the test positivity rates for the main respiratory illnesses in England, covering Flu, Covid, RSV, and Rhinovirus.
The Covid positivity rate has stayed stable and low this week, significantly lower than that of other respiratory viruses. Alarmingly, flu rates are climbing quickly, signalling the onset of what may be a severe flu season. While RSV rates have stopped rising, they are still high, especially in children under five and the elderly. Meanwhile, rhinovirus rates are gradually falling but are still comparatively high.
The following chart in this section shows weekly hospital admissions per 100,000 people in England for the main respiratory diseases.
Over the past week, weekly hospital admission rates for Covid remained at relatively low levels and are well below those of the other respiratory viruses. Meanwhile, admission rates for Flu continued to increase significantly while admissions for RSV fell slightly.
The chart below illustrates hospital admissions per 100,000 people, comparing the years before Covid, represented by dashed lines, with the years following Covid, indicated by dotted lines. The current year is marked with a solid red line. For clarity, the years when measures to control Covid were active and there was no flu season have been excluded.
While it is unlikely that Covid levels will reach the heights of previous winters, current trends indicate that Flu admissions may be almost as severe as they were in 2022/23, placing significant pressure on the NHS.
It is also noteworthy that post-Covid, the flu season has generally begun earlier than in the pre-Covid years. The 2022/23 flu season was especially harsh and occurred simultaneously with a surge in Covid admissions, placing severe pressure on the NHS.
The final panel chart in this section compares the hospital admission rate per 100,000 individuals for Flu by age group. Hover your cursor over the graphic to display the rates in each panel.
The charts show that while individuals aged 85 and older have the highest risk of hospitalisation, there is also a considerable risk for the very youngest aged between 0 to 4 years old.
Covid case rates in England
The UKHSA Covid dashboard continues to publish daily case rates for England on a weekly basis. As the majority of testing now occurs in hospitals or under medical supervision, these rates should closely align with hospital admissions. However, a comparison of daily case rates and daily admissions shows that this is not the case.
Appendix 2 indicates that although Covid case rates typically reflect the pattern of hospital admissions, there is a notable discrepancy in the magnitude of changes, with admissions experiencing a more pronounced fluctuation than case rates. Therefore, while case rates are helpful in signalling the general trend of Covid within the population, they do not precisely represent the degree of change.
The following chart shows daily case rate per 100,000 individuals.
The chart shows that Covid case rates have remained stable for the past two weeks, staying at their lowest point in more than a year. Although it is important to note, as detailed above and in Appendix 2, that comparisons with the peak in Winter 2023 are not recommended.
Scotland weekly hospital admissions and bed occupancy
Scotland continues to publish weekly data on hospital admissions and bed occupancy for Covid as well as wastewater monitoring data. The dashboard for Scotland’s data can be accessed here.
The following panel chart shows the most recent data for weekly Covid hospital admissions depicted in blue, together with the number of beds occupied by Covid patients, shown in orange. The number of occupied beds represent patients being treated for Covid as well as those being treated with Covid.
The charts shows that the recent 'summer' Covid wave in Scotland led to more hospital admissions and a greater number of beds occupied by Covid patients compared to the 'winter' wave. This contrasts with England, where 'summer' hospital admissions did not surpass those seen in 'winter'.
This week Covid admissions and bed occupancy remained broadly unchanged staying at the lower levels seen earlier in the year.
Scotland remains the only home nation that is monitoring Covid levels using wastewater sampling and the following chart shows the seven day average of Covid levels found up to Dec 5, 2024.
The wastewater sampling data shows that the high Covid levels observed at the start of August have significantly dropped and are now at low levels.
Wales Covid cases and hospital admissions.
Public Health Wales recently updated the published data on respiratory viruses, resulting in the currently available data being limited.
The following chart provides the trend for weekly hospital admissions in Wales.
Hospital admissions for Covid in Wales fell slightly this week and remained at comparable levels to the same period last year.
Status of main respiratory diseases in Northern Ireland.
Recently Public Health Northern Ireland began issuing a combined surveillance report on influenza, respiratory syncytial virus (RSV), and COVID-19 to offer a comprehensive view of the epidemiology of these infections within Northern Ireland. The new report, published every Thursday, can be accessed here.
The first chart in this section shows the test positivity rates in Northern Ireland for the main respiratory illnesses — Flu, RSV, and Covid.
The chart shows that Covid levels, represented in purple, have stayed stable this week and are at their lowest point in a year. Additionally, they continue to be lower than the rates of other major respiratory viruses, which are rising more rapidly, particularly the flu which is shown in green.
The chart below presents the weekly count of hospital admissions for the main respiratory illnesses where the infection was contracted in the community, thereby excluding patients who contracted Covid while in hospital. It is important to note that the hospital admissions data for other home nations include patients who contracted infections in the hospital, making them not directly comparable to the data from Northern Ireland.
The chart shows that for most of 2024, the bulk of hospital admissions for respiratory infections stemmed from Covid. In recent weeks, hospital admissions for Covid, indicated in purple, have remained stable and are now at their lowest in a year.
Meanwhile, hospital admissions for Flu and RSV have continued to increase and are currently considerably higher than those for Covid.
Covid vaccination coverage across the home nations
The Autumn 2024 Covid booster campaign started started on October 3 and will close on December 20. Similar to previous booster campaigns, eligibility is restricted to those at the highest risk of hospitalisation and death. Those eligible are older people in care homes, individuals 65 years and older, the immunosuppressed. Eligibility can be checked and boosters booked at this link. In addition, health and care workers will be offered boosters through their employers.
This year's Autumn vaccination campaign is set to end earlier than in previous years, with the majority of vaccinations scheduled to be completed by Friday, 20 December 2024. However, outreach efforts to administer vaccines in underserved communities will continue until 31 January 2025.
The following chart shows the number of Covid vaccinations given by week for each of the booster campaigns in England.
In the week ending December 8, the number of booster doses administered dropped to 140,093 from the previous week's 232,288, giving a total of nearly 9.4 million doses over the campaign's first ten weeks. This means that the current progress significantly lags behind the achievements of the past two Autumn booster campaigns. For comparison, by the tenth week of the Autumn 2023 campaign nearly 11.1 million doses had been delivered.
The next chart in this section displays the booster coverage for individuals aged 65 and over across each of the Home Nations. It is important to note that the most recent published data is used, and there are varying dates for the nations, which are shown in brackets.
With under two weeks left in this autumn's campaign, the weekly increase in booster coverage is slowing. While the data for Wales might not be up-to-date, its coverage appears to be falling behind when compared to the other Home Nations.
The final chart in this section shows the latest booster coverage for those aged under 65 years old who are clinically at risk for the Home Nations that publish this information.
Booster coverage across the Home Nations varies, but all have significantly lower rates and slower progress compared to the population aged 65 and over.
Long Covid in children and young adults
The children and young people with Long Covid (CLoCK) study is the world’s largest longitudinal cohort study on Long Covid in young people aged 11 to 17. The study surveyed people in this age group about their health at three, six, 12 and 24 months after taking a PCR test for the Covid virus between September 2020 and March 2021.
The children and young people were defined as having long Covid if they had more than one symptom – for at least three months – of tiredness, trouble sleeping, shortness of breath or headaches, alongside problems with either mobility, self-care, doing usual activities, having pain or discomfort, or feeling very worried or sad.
The following table presents the variation in reported symptom between individuals who initially tested positive for Covid and later reported additional infections (indicated in red), and those with milder histories, such as those who initially tested negative and did not report any subsequent positive tests (shown in green).
The table shows that children and young people who were re-infected reported a higher number of symptoms at 24 months compared to those with a single infection. Individuals with no reported infections had the least number of symptoms.
The next chart displays the percentages of children and young adults in the study who tested positive for Covid initially and reported Long Covid symptoms at 3, 6, 12, and 24 months.
The research indicated that whilst most children and young adults recover within 2 years, 7.2% consistently fulfilled the criteria for Long Covid at 3, 6, 12, and 24 months after infection, reporting around 5 to 6 symptoms at each time point. Older teenagers and the most deprived were less likely to have recovered. Also females were almost twice as likely to still meet the research definition of Long Covid at 24 months, compared to males.
A summary of the report can be found here and the full report can be accessed here.
In conclusion
Although the amount of data currently being published has decreased, the information available for England show that Covid levels are at relatively low levels and much lower than Flu or RSV.
Recent data indicates that Scotland and Wales, unlike England, experienced higher Covid-19 infection levels during the 'summer' wave compared to the 'winter' wave. Following a peak in the summer, infection levels have been on a downward trend and are currently at relatively low levels in Scotland and Wales. Northern Ireland Covid levels remain low.
As always, if you have any comments on this Covid Situation Report or suggestions for topics to cover, please post a message below.
Appendix 1. Test positivity rates and prevalence
Positivity rates are derived from the results of hospital laboratory tests conducted on patients exhibiting symptoms of respiratory diseases. Test positivity is the percentage of patients who test positive for Covid of the total number of patients tested. Since the individuals tested for this measure are not a representative sample of the general population it differs from prevalence, which is derived from a representative sample of the population.
Test positivity rates, while not directly estimating the number of Covid infections in the general population, can be a valuable indicator of the infection trend. The panel chart below compares the weekly test positivity rate among hospital patients with respiratory symptoms to the prevalence of Covid in the general population, as reported in the Winter Infection Survey.
The chart shows that the weekly test positivity rates for patients with symptoms of respiratory infections follows the same pattern as the prevalence for Covid reported by the Winter Infection Survey. Since the Winter Infection Survey is based on a representative sample of the general population this supports using test positivity as a useful proxy for infection trends.
Appendix 2. How reliable are Daily Covid Case Rates?
The UKHSA Covid dashboard continues to publish daily case rates for England on a weekly basis. As the majority of testing now occurs in hospitals or under medical supervision, these rates should be closely aligned with hospital admissions and the positivity rate of tests.
The first panel chart in this section tests that assumption by comparing the daily case rate per 100,000 individuals, shown in red, with daily hospital admissions for Covid reported by NHS England, depicted in blue.
The chart shows that while Covid case rates generally mirror the pattern of Covid hospital admissions, there is a significant disparity in the scale of changes. The grey shaded areas on each chart highlights the difference between the peak of the winter wave and the recent peak in June. Case rates experienced a 64% decrease, whereas hospital admissions saw a reduction of only 32% between the winter and June peaks.
In conclusion, although case rates are useful for indicating the overall trend of Covid in the population, they do not accurately reflect the extent of change. The likely reason for this is that testing levels have decreased by about a half since January.
Excellent report as usual – thank you!
Re ‘flu, a friend of ours has got a bad dose of it. She’s a dispenser and vaccinated against ‘flu, so I just wondered if there is any data (anecdotal or otherwise) about the efficacy of that vaccine.
The NHS website for finding a covid vaccination place now says the end date is 31 Jan 2025 instead of the Dec 20th date it used to display.
Also, I was told by a pharmacy that they have all been given the option of extending to 31st Jan.
However, other NHS webpages still say 20 Dec 2024.