Covid Situation Report: Nov 7, 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.
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 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 and Wales. The report provides an update on the Autumn 2024 Covid booster campaign for the Home Nations. Finally, the latest data on Covid variants in England is covered.
Summary.
This week brings good news with the data showing Covid levels falling across England, Scotland and Wales.
In England, the Covid test positivity rate, hospital admissions and case rates all fell this week, and are at relatively low levels. All regions saw hospital admission rates fall.
In Scotland, Covid levels decreased across all measures, including admissions to hospital, relative to the most recent peak in July.
Over the past week, hospital admissions in Wales have decreased, yet they continue to be moderately high.
Regrettably, the Northern Ireland Surveillance Report for this week has not yet been released, hence no update can be provided.
Vaccination remains a powerful way to minimise the risk of Covid and the Autumn 2024 booster campaign continues it’s strong start, with over 48% of the targeted demographic aged 65 years and older already vaccinated in England. Good progress is also being made in Scotland and Northern Ireland, although coverage in Wales is not as high.
The XEC variant is now dominant in England; however, it has not yet led to an increase in Covid test positivity or hospital admissions, unlike other new variants.
As a reminder, the NHS have reconfirmed eligibility criteria for 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.
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 fallen again this week, though it remains at a moderately high level. Worryingly, RSV rates are rising quite quickly, particularly those under the age of five years old, and have now overtaken those for Covid. Rhinovirus rates remain high and are close to their peak three 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 no longer at moderately high levels. Whilst admissions for Flu remain low, and RSV admissions are starting to rise.
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 fall in hospital admission rates across all regions, especially 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 look and are now at relatively low levels. 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 waste water 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 approaching the lower levels seen earlier in the year.
Scotland remains the only home nation that is monitoring Covid levels using wastewater sampling. Recently reporting has been paused as responsibility for laboratory Covid water samples testing transferred from the Scottish Environment Protection Agency (EPA) to NHS Lothian. Last week Scotland resumed reporting Covid levels in wastewater, with the latest data now available up to the end of October.
The wastewater sampling data indicates that the elevated Covid levels noted at the beginning of August have fallen and at the end of October are relatively low.
Wales Covid cases and hospital admissions.
Public Health Wales have revised the data published on respiratory viruses, consequently there is limited data available from last week.
The following chart provides the trend for weekly hospital admissions in Wales.
The number of hospital admissions for Covid in Wales continued to fall this week but remain at a moderately high level, albeit slightly lower than the figures reported at the same time 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. Unfortunately, at the time of publishing this situation report the Northern Ireland surveillance report has not yet been updated so I am unbale to provide any information this week.
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.
During the first five weeks of the Autumn 2024 Covid booster campaign just over 7.7 million doses have been administered. Although the pace is slowing, this years Autumn campaign is still advancing faster than any of the previous campaigns.
The following table shows the cumulative Autumn 2024 coverage for each of the target groups by week for England.
While the progress in vaccine coverage is beginning to slow, the targeted groups aged 65 and older are well-covered, whereas the immunosuppressed individuals under the age of 65 are less adequately vaccinated.
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 ended with only 65% of individuals aged 65 to 74 years vaccinated, and 76% of those aged 75 and older.
Variants update
The XEC variant has received considerable attention due to its higher growth advantage over other variants and this section provides a brief update on it’s progress.
The chart below illustrates the prevalence of variants in sequenced cases up to the week ending Oct 2o, 2024. For clarity, the various JN and FLiRT (KP) variants have been grouped into 'families'.
The chart shows that the FLiRT family of variants remained dominant in September, yet the XEC variant was rapidly gaining ground. The most recent data indicates that by the end of October, the XEC variant represented approximately half of all sequenced cases in England, suggesting it has likely surpassed that figure since then.
Interestingly, in the past when a new Covid variant has grown to be over a half of the sequenced cases it has often been linked to a surge in cases. So far this has not happened for the XEC variant and may indicate that there is increased immunity in the general population through vaccination or recent infection.
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.
Recent data indicates that Scotland and Wales experienced higher Covid-19 infection levels during the 'summer' wave compared to the 'winter' wave, unlike England. Following a peak in the summer, infection levels have been on a downward trend, currently at relatively low levels in Scotland and moderately high in Wales.
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.
Thanks again for all your hard work.
Thank you! For once, our vaccs aren’t too bad in NI!