Covid Situation Report: Dec 21, 2023

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 is the sixth of the weekly Covid Situation Reports I plan to publish over the Winter 2023 / Spring 2024 season.  Each report provides an overview of the present Covid status in England and its regions using a standard set of interactive charts.   For those who want a bit more detail I will do a deeper dive on topics of interest each week.  This week I look at the latest data from the Winter Infection Survey, hospital admissions by age and a quick update on the JN.1 variant (sometimes referred to as the 'Pirola' variant).

Summary

Covid prevalence is high and increasing across England and Scotland, particularly in younger adults. With increased generational mixing across Christmas and New Year it would be a good idea to test and take appropriate precautions if you are meeting with vulnerable people.

Hospital admissions for Covid and Flu had significant week on week increases which will add pressure on a hospital system that looks like it does not have the capacity to cope.

Hospital admissions are highest and rising fastest in the oldest age groups. However, the unvaccinated youngest age group are also seeing increases in admissions although from low levels.

The JN.1 variant (Pirola) is now the dominant variant in England and is driving the recent growth in Covid infections.

With the high level of Covid prevalence, UKHSA are recommending those eligible to get vaccinated. Although the main booster program is closed in England, UKHSA advised that you may be able to get vaccinated at a walk-in site which can be found at the following link until the program closes on January 31, 2024

Finally, the next Covid situation report will be published on December 29 as the data used to prepare these reports will not be published until then.

Winter Covid Infection Study

This week UKHSA published results from the Winter Infection Study. The next release is planned for January 11, 2024. Although based on the ‘gold standard’ Coronavirus Infection Survey (CIS) that stopped in March 2023 it differs in several ways.

Data collection from participants is via online questionnaire completion and self-reported Lateral Flow Device (LFD) results. The previous CIS used nose and throat swabs tested using real-time reverse transcriptase polymerase chain reaction (RT-PCR) tests. Consequently, statistics from the two studies cannot be directly compared.

However, the Winter Infection Study is still based on testing a representative sample of the population each week so the results are not impacted by any change to testing numbers.

In this weeks report UKSHA published the estimated prevalence of Covid for England and Scotland, together with the prevalence by region and age group. It is important to note that prevalence is different from the positivity rate.

Prevalence is the estimated proportion, expressed as a percentage, of all individuals within the reported group who are infected with the the Covid virus at a given point in time. Importantly, prevalence adjust for the age profile of the sample of people responding to the survey being different from the age profile of the general population. It is different from the positivity rate which is simply the percent of people testing positive and takes no account of the age profile of those tested.

There has been a significant increase in the prevalence of Covid in England and Scotland during the two weeks leading up to Dec 13.

The following chart shows the rise in prevalence of Covid in England from Nov 14 to Dec 13, 2023.

The prevalence for Covid is currently high in England (4.3%) with an estimated 1 in 24 people infected on Dec 13. Prevalence has increased in the past 2 weeks from 1.8% on Nov 29.  Although not directly comparable, prevalence for England was 2.2% on Dec 9, 2023

The prevalence for Covid is also currently high in Scotland (4.1%) and prevalence has increased in the past 2 weeks from 1.8% on Nov 29. 

The following chart shows the prevalence by age group for England and Scotland over the past four weeks with the orange bars showing the latest week.

Across England and Scotland prevalence was estimated to be highest for individuals aged between 18 to 44 years compared to those aged 65 years and over. Prevalence has notably increased across all age groups in the past two weeks, particularly in young adults.

The next chart shows the prevalence by region over the past four weeks with the orange bars once again showing the latest week.

The prevalence has increased in every English region over the past 2 weeks and in particular for London and the South East.

To summarise, Covid prevalence is high and increasing across England and Scotland particularly in younger adults. With increased generational mixing across Christmas and New Year it would be a good idea to test and take the appropriate precautions if you are meeting up with vulnerable people.

Status of main respiratory diseases in England

The following chart shows that Covid and Flu positivity rates are rising rapidly and are at the level of Rhinovirus and RSV which have similar symptoms.  Chances are that if you have cold like symptoms it’s increasingly likely to be Covid or Flu.

Again, positivity levels for Flu rose significantly last week indicating the start of the winter flu season. On the plus side, the positivity level for RSV, which mainly effects children, continues to fall and looks to have peaked.

The following chart shows hospital admissions per 100,000 people in England for the main respiratory diseases.

Both Covid and Flu had appreciable week on week increases in hospital admission rates, with Flu increasing by 78%. Concurrent waves of Covid and flu will add pressure on a hospital system that looks like it does not have the capacity to cope.

NHS England Covid hospital admissions and bed occupancy

Turning now to look in more detail at the data on Covid in hospitals in England. The following dashboard of key Covid metrics for hospitals in England saw hospital admissions and beds occupied by patients with Covid increasing this week. However, the number of mechanically ventilated beds occupied had a week on week decrease and remained at relatively low levels.

The regional picture also shows that most regions had significant week on week increases for hospital admissions.  The following interactive dashboard gives the Covid hospital admissions per 100,000 by region.

All regions had increases in hospital admission rate this week with the highest admission rates once again in the London and South East regions. This is entirely consistent with the prevalence data which also showed these two regions with the highest level of Covid infections.

The following chart shows the number of beds occupied by Covid patients per 100,000 by region split by those being treated for Covid (red bar) and patients with Covid (green bar) but are being treated for other conditions.

As well as having the highest admission rates, London and the South East regions also have the highest number of beds occupied by Covid patients per 100,000 of population. In London, however, most Covid patients are not being treated for Covid..

Hospital admissions by age

This section looks at weekly hospital admissions per 100,000 by age group. The following chart shows the admission rates for the oldest age groups.

The chart shows that the admission rate for those 85 years and older is consistently higher than any other age group and significant increased significantly in the past week.

The next chart shows weekly hospital admissions per 100,000 for the under 55 year old age groups.

For this age group, the under 4 years have the highest hospital admission rates and are growing at the fastest rate. The under 4 year olds are unvaccinated and will have little protection against infection from Covid.

Covid Variants

Last week UKHSA reported that JN.1, also known as the ‘Pirola’ variant, had the highest growth advantage (84%) of the variants presently in circulation. This week the World Health Organisation (WHO) classified JN.1 as a separate variant of interest (VOI) from the parent lineage BA.2.86. The initial WHO risk report concludes that although the JN.1 variant has a significant growth advantage it is not more severe than other variants.

The following chart shows that the BA.2.86 family, which includes JN.1, is outcompeting all other variants and is now the dominant variant in England.

At the moment, although the the number of Covid cases is growing the number of sequenced cases is low so there is some uncertainty over the prevalence data. However, it now seems certain that the Pirola variant is the cause of the recent increase in Covid infections.

Vaccination Update

The total number of vaccinations continues to reduce with only 185,432 doses given in the week ending Dec 17, the second lowest since the start of the Autumn 2023 booster campaign.

The following table shows the latest Covid Winter vaccination coverage for the 65 year and older age group for England, Scotland and Wales.  Northern Ireland (NI) does not publish comparable data so I have shown the coverage for the over 60 year olds based on all vaccinations given after the Spring 2023 booster campaign.

Scotland and Wales made some progress with both increasing their coverage by 2% since last . However, England and Northern Ireland’s progress has slowed considerably and made hardly any progress

The latest UKHSA advice for England published on Dec 21 advised people get vaccinated if eligible in response to the rising prevalence in Covid.

Although the main vaccine delivery programme has now ceased and you can no longer book a seasonal COVID-19 vaccine online or by calling NHS 119, you may still be able to book a COVID-19 vaccine with a local NHS vaccination service, or you can find a COVID-19 vaccination walk-in site.

The last date you will be able to get your seasonal COVID-19 vaccine is 31 January 2024.

In conclusion

As we have seen, this weeks Winter Infection Survey shows that Covid prevalence is high and rising across England and Scotland particularly amongst young adults.

In addition, Covid and Flu hospital admissions are increasing in England and across all regions particularly in the older age groups. The JN.1 (Pirola) variant is now the dominant variant in England and adding variant pressure to the rising winter COVID-19 wave.

Finally, the Autumn 2023 booster campaign is slowing in England and Northern Ireland. So if you are eligible for a Covid booster and haven’t yet been vaccinated then try the link above to see if there is the opportunity in your area.

As always, if you have any comments on this Covid Situation Report or have suggestions for topics to cover then please post a message below.