Covid Situation Report: Jul 5, 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 is part of a weekly series that summarises the Covid situation in England and its regions.

Please be aware that this week's report has been delayed by a day due to the election 'embargo,' which postponed the publication of the data.

A reminder that not all of the data previously included in the situation update is now available on a weekly basis. Where relevant, changes to the content and data sources have been noted.

This week's report contains data on weekly Covid hospital admissions from the UKHSA surveillance report, which is now released biweekly. Additionally, it includes case rates from the UKHSA Covid dashboard. The report also provides the latest vaccination status as the Spring 2024 booster campaign comes to an end.

Summary.

This week's data indicates that the recent rise in Covid levels has reached a peak, with positivity rates, hospital admissions and case rates now stabilising. These figures are higher than those recorded during the May wave but remain significantly lower than the peaks seen in the winter of 2023.

In the past two weeks, the positivity rate for Covid increased significantly but is now showing early signs of falling. Positivity rates are highest in the older age groups.

Hospital admission rates for Covid have risen significantly in the past two weeks, though they have now stabilised at levels higher than those observed in May, yet still considerably lower than the peak seen in winter 2023.

The recent increase in daily case rates across all regions has plateaued and is starting to fall in several region, especially in the North East, which experienced the most substantial increase.

Although this wave is most likely over, this is an important reminder that Covid is not yet a seasonal disease, and we are likely to experience further waves as new variants emerge and immunity levels wane.

The Spring 2024 booster campaign in England closed on June 30. At the end of the campaign, just under than 4.3 million doses have been administered, covering an estimated 60% of the eligible population. However, immunosuppressed individuals continue to have lower vaccine coverage.

As always, it’s important to remember that the risk of hospitalisation from Covid infection increases significantly with age and for those immunocompromised. Also Long Covid remains a risk for all as shown by the recent ONS report. Therefore, it is prudent to take appropriate measures such as self-isolating when experiencing Covid symptoms and enhancing ventilation or wearing masks whenever possible.

For those who are interested, I recently published an article covering the ONS data on Long Covid in more detail which can be found here. Also a comprehensive review of the evidence in support of wearing masks is available here.

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Status of main respiratory diseases in England.

This section presents 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, including Flu, Covid, RSV, and Rhinovirus.

Over the past two weeks, the Covid positivity rate has increased significantly and reached its highest level for over a year at 12.3% for week ending Jun 23 signalling a resurgence of Covid levels in the general population. The high level has decreased slightly in the most recent week to 11.5%, indicating that the peak of this summer wave has likely been reached. However, this is an important reminder that Covid is not yet a seasonal illness and we are likely to experience further waves as new variants emerge and immunity levels wane.

Meanwhile, the flu positivity rate has continued to fall and remains significantly lower than that of Covid. Additionally, RSV rates have dropped to very low levels, accompanied by a minor decrease in Rhinovirus rates.

The next chart shows the trend for Covid positivity rate by age. Hover your cursor over one of the chart lines to display the positivity rate for all ages. For comparison the grey line shows the positivity rate for all age groups.

The chart clearly indicates that test positivity rates are highest among individuals aged 65 and older. However, it is important to note that the majority of tests are now conducted on hospital patients, who are disproportionately older since they are more likely to be hospitalised due to Covid.

The final chart in this section shows weekly hospital admissions per 100,000 people in England for the main respiratory diseases.

Consistent with the test positivity rate data, the past two weeks have seen weekly hospital admission rates for Covid increased significantly, although they have not reached the levels seen during the winter wave of infections. Once again, the most recent weeks admission rates indicate that this summer wave has likely peaked. Note that hospital admission data for Flu and RSV is no longer published.

Although age-specific data for hospital admissions are no longer released, earlier statistics on Covid hospital admissions and the current test positivity rates by age indicate that the rise in hospitalizations will primarily impact the over 65 year olds.

It's important to note that while testing policies have been updated from April 1, 2024, the guidelines for testing patients showing Covid symptoms or when a positive result would change the patient's treatment remained unchanged. Consequently, the number of Covid hospital admissions should be a dependable indicator of the virus's prevalence in the community for the period shown in these charts.

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Covid hospital admissions and bed occupancy.

This section gives a more detailed examination of the most recent daily Covid data for hospitals in England.

NHS England stopped the weekly publication of data used to create these dashboards from April 4, 2024 and have moved to a monthly publication schedule. The next update will be on July 11, 2024 covering June Covid hospital admissions and bed occupancy.

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Covid case rates

The UKHSA Covid dashboard continues to publish daily case rates on a weekly basis. As the majority of testing now occurs in hospitals or under medical supervision, these rates are closely aligned with hospital admissions and the positivity rate of tests.

The first chart in this section compares the daily case rate per 100,000 individuals, shown in red, with prevalence reported from the Winter Infection Survey, depicted in blue. As prevalence is considered the ‘gold-standard’ measure of Covid levels in the general population this provides a good indication of how well case rates measure Covid levels.

The chart indicates that the rise in Covid case rates has persisted and stabilised at levels exceeding the May peak. Nonetheless, these rates remain significantly lower than those observed during the peak of the winter 2023 wave.

The next panel chart in this section shows Covid rates for the regions of England. Hover your cursor over one of the chart lines to display the admission rates for all regions.

The panel charts show that the recent surge in case rates across all regions has halted, and in some areas has begun to decline. The North East region, which saw the sharpest increase, is now seeing the most rapid fall.

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Spring 2024 booster campaign

The Spring 2024 booster campaign started on April 15 and closed at the end of June. Considering the decline in vaccine efficacy after 15 weeks, a successful Spring 2024 booster campaign is important to protect the most vulnerable populations.

The following chart displays the weekly number of doses administered during the booster campaigns for England to date. The Spring campaigns are represented in green, the Autumn campaigns in brown, and doses administered outside of these campaigns are depicted in grey.

The Spring booster campaigns are exclusively for individuals aged 75 and above, residents of care homes, and those with compromised immune systems. According to NHS England, approximately 7.3 million people qualify for the Spring campaign in England.

The Spring 2024 booster campaign in England closed at the end of June, with 121,394 doses administered in the final week, giving a total 4,288,462 doses given over the course of the campaign. This represents 59% of the estimated eligible population; however, it is likely that the recorded number of doses will be updated in the coming weeks as the database is refreshed.

The following chart illustrates the weekly coverage for the three eligible cohorts in England since the start of the campaign.

The data shows reasonable levels of coverage for those in care homes and individuals 75 years and older. However, individuals with compromised immune systems continue to have lower vaccine coverage.

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In conclusion

Despite the reduced level of data now published, the available information indicates that the recent increase in Covid levels has most likely come to an end and we should expect to see levels falling next week.

The Spring 2024 booster campaign has now closed, with just under 4.3 million doses administered. However, the immunosuppressed remain under vaccinated.

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

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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.