Covid Situation Report: Nov 21, 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 provides an update on the Autumn 2024 Covid booster campaign, together a summary of the latest advice given on vaccine eligibility for 2025. Finally, there is a short update on Covid levels in some other countries.
Summary.
Once again, this week continues to bring good news with the data showing Covid levels continuing to fall across England, Scotland, Wales and Northern Ireland.
In England, the Covid test positivity rate, hospital admissions and case rates all fell this week, and are at low levels below those of the other respiratory viruses. All regions saw hospital admission rates for Covid at relatively low levels.
In Scotland, Covid levels decreased across all measures, including admissions to hospital.
Over the past week, hospital admissions in Wales have decreased, and are now relatively low.
In Northern Ireland, Covid levels continued to fall to low levels and are now below the other major respiratory viruses across all indicators.
Wastewater monitoring in Germany and Denmark indicate that Covid levels are falling and are at relatively low levels.
Vaccination remains a powerful way to minimise the risk of Covid and, although the Autumn 2024 booster campaign is starting to slow down, over half of the targeted demographic aged 65 years and older have been vaccinated in England. Good progress is also being made in Scotland and Northern Ireland, although coverage in Wales is not as high.
As a reminder, the Autumn 2024 booster campaign which started on October 3, 2024 and will close earlier than previous years on Friday, December 20. Eligibility can be established and bookings made at the following link.
Eligibility criteria for future booster campaigns were published last week that recommended doses would no longer be provided through the NHS to those aged 65 to 74 years old or pregnant women.
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.
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, including Flu, Covid, RSV, and Rhinovirus.
The Covid positivity rate has dropped once more this week, and for the first time in over a year, it is lower than that other respiratory viruses. Worryingly, RSV rates are rising fast, particularly amongst those under five years old, and are now significantly higher than for Covid. Rhinovirus rates remain high and close to their peak of four weeks ago. Flu rates are beginning to show signs of rising, yet continue to be at low levels.
The following chart in this section shows weekly hospital admissions per 100,000 people in England for the main respiratory diseases.
In the past week, weekly hospital admission rates for Covid have continued to fall and are at relatively low levels. Admissions for RSV have continued to rise and are above those for Covid, whilst Flu admissions although rising remain low.
The final chart in this section shows the weekly hospital admissions for Covid per 100,000 people by region. Hover your cursor over one of the graphs to compare regions.
Over the past week, there has been a continued fall in hospital admission rates across most regions, particularly in areas such as the West Midlands and North East, which previously had higher rates of admission.
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 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 indicates that Covid case rates once again fell during the week and are now at their lowest levels for over a year. Although it is important to note, as detailed above and in Appendix 1, 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'.
The fall in weekly Covid admissions and bed occupancy from the summer peak has continued with levels now at the lower levels seen earlier in the year.
Scotland remains the only home nation that is monitoring Covid levels using wastewater sampling. Recently reporting was paused as responsibility for laboratory Covid water samples testing transferred from the Scottish Environment Protection Agency (EPA) to NHS Lothian but has now been resumed.
The wastewater sampling data indicates that the high Covid levels noted at the beginning of August have fallen significantly and during the first two weeks of November remain low.
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 have continued to fall significantly this week and are 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 indicates that Covid levels, shown in purple, have continued to fall this week and are much lower than the summer peak, and they remained lower than the rates of the other major respiratory viruses.
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 fallen significantly and are now at their lowest in a year. Meanwhile, hospital admissions for Flu and RSV have increased and currently exceed 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.
The number of booster doses administered in the week ending November 17 fell to 406,935 from 605,467 the previous week, resulting in a total of just under 8.8 million doses given in the first seven weeks of the campaign. This means that progress is now fallen behind that achieved in the two previous Autumn booster campaigns.
The final 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 indicated in brackets.
Although the data available for Wales is not as up-to-date, coverage for Wales is falling behind when compared to the other Home Nations.
Successive booster campaigns have shown a worrying decline in coverage. For example, the Autumn 2023 booster campaign in England ended with just 70% of individuals aged 65 years and older vaccinated.
Recommended eligibility for Covid vaccinations in 2025
Last week, the Joint Committee on Vaccination and Immunisation (JCVI) issued a statement outlining the recommended eligibility criteria for NHS Covid vaccinations in 2025 and Spring 2026. The JCVI recommend that the following groups should be offered Covid vaccination in Spring and Autumn 2025:
adults aged 75 years and over;
residents in a care home for older adults; and
individuals aged 6 months and over who are immunosuppressed
The main change from previous recommendations is the exclusion of individuals aged 65 to 74 years from the Autumn 2025 booster campaign.
The following chart shows that age has always been strongly associated with the risk of hospitalisation and mortality from Covid, with the oldest in the population being the most vulnerable.
While the risks are significantly higher for individuals aged 75 and older, there is still a considerable risk for those aged 65 to 74, especially since 65% of this age group had been recently vaccinated during the time the data for this analysis was gathered.
In addition, the JCVI recommend that pregnant women should no longer be offered vaccination. A full discussion on the risks associated with this decision is outlined in a recent article in The Conversation.
The reasons for these changes is that from Autumn 2025, the JCVI has resumed the use of a standard cost-effectiveness assessment, in line with other routine vaccinations in the national immunisation programme. Previously, the JCVI had used a bespoke, non-standard method of cost-effectiveness analysis developed by the Department of Health and Social Care (DHSC) to reflect ongoing uncertainty around Covid and the availability of vaccines that were procured by the Vaccine Taskforce.
The Vaccine Taskforce was funded separately from the DHSC and, although it closed in October 2022, had signed contracts and bought sufficient doses to run the present Autumn booster campaign. From 2025 the DHSC are responsible for contract negotiations and funding, hence the return to the standard cost-effectiveness methodology.
As before, the methodology accounts only for the costs of hospitalisations and deaths, omitting the impact of Long Covid. Also, the JCVI recommendation is based on their best estimate of the cost to purchase (£25) and administer (£10.25) each dose. Any change to these costs could widen or further reduce the eligibility criteria.
Finally, the JCVI does not recommend vaccination eligibility to employers. Similar to the Autumn 2024 booster campaign, it is highly likely that the DHSC will offer boosters to NHS and Care staff in Autumn 2025.
Covid levels in other countries
Wastewater monitoring is a valuable, complementary, independent, and objective approach to the surveillance and testing public health relevant pathogens like Covid. The EU Wastewater Observatory for Public Health website provides links to a number of national dashboards that publish detected Covid levels in wastewater. The website can be found here.
While not all national wastewater dashboards are user-friendly, they do offer insights into Covid levels across Europe. In general, the dashboards are not showing any significant rise in viral levels in wastewater.
As an example, the following image captures the latest data from the German wastewater monitoring website showing that Covid levels increased in October but have remained stable in the past four weeks.
A further example, taken from the Danish wastewater monitoring website, also shows that detected Covid levels are stable at relatively low levels, corresponding to a ‘no growth’ status.
This would suggest that we have yet to see any impact on Covid levels from the new XEC variant in Europe.
In conclusion
Although the amount of data currently being published has decreased, the information available for England show that Covid levels are continuing to fall and are at low levels.
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.
🙏
Those graphs are great. The way the regional ones are linked on mouse hover is impressive.
I realised after looking at you report that the numbers I have been tracking are hospital COVID which has plateaued for the last 3 weeks. I wasn't aware that GP rates had been falling. I wonder why there has been a difference.
The figures in Spain for COVID have also been falling for about 5 weeks. RSV is now bigger than COVID & flu combined. The battle for which can cause the most misery is currently being won by RSV, but I am sure that flu will catch up.
and we have to ask when will the next COVID wave come for us?