Covid Situation Report: May 23, 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.
A reminder that not all of the data that was 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 article includes updates on the Spring 2024 booster campaign as well as the latest wastewater data from Scotland.
Summary.
This week there are signs that the recent increases in Covid levels have reversed as the Covid positivity rate has peaked and weekly hospital admissions have plateaued across most regions and age groups.
There has been a significant drop in the Covid positivity rate this week, and the rates for Flu and RSV continued to fall.
Weekly hospital admission rates in England for Covid decreased very slightly, and have now stabilised at low levels for Flu.
Over the past week, all regions weekly hospital admissions due to Covid remained broadly unchanged with the exception of the North East which increased.
Weekly hospitalisation rates plateaued for those aged 65 years and older although remaining highest for those older than 85 years.
A new variant, KP.2, has emerged which is quickly replacing the current JN.1 variants; however, early reports from the UKHSA show it does not have a significant relative growth advantage.
Over the past month, Covid levels detected in Scottish wastewater have been stable and low.
Considering the recent increased Covid levels, the notable decline in vaccine efficacy after 15 weeks and the emergence of a new variant, a successful Spring 2024 booster campaign is important to protect the most vulnerable populations.
The Spring 2024 booster campaign in England, which began on April 15, has had a good start, with over 3.3 million doses administered in the first five weeks. However, vaccination rates for the immunosuppressed and ethnic minorities remain low.
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.
Further analysis of the ONS data on Long Covid was covered in a recent article I posted which can be found here. Also a comprehensive review of the evidence in support of wearing masks can be found here.
Status of main respiratory diseases in England.
This section presents the latest 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.
The Covid positivity rate fell to 6.4% this week indicating that the recent Covid wave is likely to be over. Meanwhile, the flu positivity rate has declined further and remains significantly lower than that of Covid. Additionally, RSV rates have continued to drop to very low levels, accompanied by a minor decrease in Rhinovirus rates.
The following chart shows weekly hospital admissions per 100,000 people in England for the main respiratory diseases.
Weekly hospital admission rates for Covid have started to fall slightly whilst admissions for Flu have stabilised and are at low levels. Typically, weekly hospital admissions lag the trend seen in positivity so we should expect to see a further decline in admissions next week. Also, the Spring Booster campaign should provide increasing protection against hospitalisation for those eligible over the next months.
The next panel chart in this section shows Covid hospital admissions per 100,000 people by region. Hover your cursor over one of the chart lines to display the admission rates for all regions.
Hospital admission rates have remained broadly unchanged across the regions, with the exception of the North East region which saw a large rise and now has the highest rate of all regions.
The final panel chart in this section shows Covid hospital admissions per 100,000 people by age. Each panel represents one age group and the title and lines are colour coded. The grey lines show all of the other age groups to provide context.
The recent increase in hospital admission rates for individuals over 65 years old has stopped, and the numbers are largely the same as last week. However, admission rates continue to be highest in the oldest age groups.
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.
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. As a result, the next update of the daily Covid data for hospitals in England will be on June 13, 2024.
Spring 2024 booster campaign
The Spring 2024 booster campaign started on April 15. Considering some signs of increasing Covid levels and 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 chart shows the difference between the Spring and Autumn campaigns, each with its unique eligibility requirements. The Spring booster campaign is 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 is progressing well, with more than 3.3 million doses administered in the first five weeks and the number of doses administered per week exceeding the previous Spring campaigns.
However, the following tables show that there are disparities amongst the eligible groups in England, Scotland and Wales.
The first table compares the latest coverage of the Spring 2024 booster campaign by eligible group to the final coverage of the 2023 booster campaigns where data is available. The Spring 2024 coverage for England is based on the eligible populations from the Autumn 2023 booster campaign. In addition, the eligible population for the immunosuppressed in Wales covers all age groups whereas the for England and Scotland it only includes those under 75 years old. Consequently, these coverages are not comparable.
The table clearly shows that although good progress is being made for those in care homes and 75 years and older, vulnerable individuals with compromised immune systems are again falling behind on vaccine coverage.
The final table in this section shows Spring 2024 coverage by ethnicity for England.
The Spring 2024 booster campaign has seen much lower uptake among ethnic minority groups for those aged 65 and older, continuing a trend observed in previous campaigns.
You can check to see if you are eligible and book a booster at the following link.
Covid levels in Scottish wastewater
Environmental surveillance in wastewater for Covid is an effective approach to monitor community level circulation of the virus as a complementary method to other public health surveillance strategies. Covid levels in wastewater have continued to be measured in Scotland. However, wastewater testing in England was paused from March 2022 and in Wales from July 2023. Testing was reinstated in Wales over Winter 2023 but that has now stopped.
The following panel chart plots levels of Covid found in Scottish wastewater by week day hence the breaks in the trend line for weekends. The bottom panel shows the prevalence of Covid in Scotland from the Winter Infection survey for comparison.
Comparing the charts shows that Covid levels in wastewater follows the same trend as prevalence confirming that it is a good indicator of the level of Covid in the wider population. Since the Winter Infection Survey stopped, wastewater levels of Covid have remained low and stable indicating that the prevalence of Covid in Scotland is likely to be low.
In conclusion
Despite the reduced level of data now published, the available information indicates that the recent rise in Covid levels have peaked.
A new variant, KP.2, is widely circulating although, at present, it does not appear to have a significant relative growth advantage over other variants in circulation.
The Spring 2024 booster is progressing well, with over 3.3 million doses administered in the first four weeks. 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.
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.
If +65s are mostly entering hospital shouldn't the covid vaccine be offered to everyone over 65?
Thanks for a very helpful summary written in a very accessible way with the right level of detail for me. Appreciated as always!