Published by Public Health Scotland on 13th April 2023 is the weekly national respiratory and Covid-19 surveillance report.
COVID
Changes in PCR testing guidance has reduced the numbers of tests available for sequencing compared to earlier in the pandemic.
The Office for National Statistics (ONS) published their final COVID-19 Infection Survey report on 24 March 2023. Therefore, COVID-19 surveillance will use a range of indicators including wastewater concentration levels, reported COVID-19 cases (PCR/LFD) and hospital activity.
Waster water Analysis – The last test in Orkney (Kirkwall) was published on 10th March 2023.
The purpose of COVID-19 testing has now shifted from population-wide testing to reduce transmission, to targeted, symptomatic testing in clinical care settings which has led to a reduction in the quantity and quality of available testing data. This makes it difficult to draw any conclusions from these data on community prevalence and caution is therefore advised when making comparisons between metrics and comparing trends over time. In the week ending 09 April 2023, there were 1,629 reported positive COVID-19 cases (compared to 2,149 in week ending 02 April 2023)
In the latest week ending 09 April 2023, there were 371 new COVID-19 admissions to hospital. Hospital admissions for the most recent week are provisional and should be treated with caution. At the time of publication there were no data available for one NHS Health Board, and the previous week’s figures have been rolled forward.
There were 34 COVID-19 admissions (3.4%) per 1,000 emergency admissions. In the same week, the 75-79 age group had the highest rate of COVID-19 admissions (5.8%) and the 18- 29 age group had the lowest rate (1.3%).
The number of COVID-19 patients in hospital is an indicative measure of the pressure on hospitals, as these patients still require isolation from other patients for infection control purposes.
There were 1,203 patients in hospital with COVID-19 which is a 7.4% decrease from the previous week ending 02 April 2023, when on average there were 1,299 patients.
There were 19 new admissions to ICU, an increase of 7 from the previous week (02 April 2023) when there were 12 admissions. There were on average 212 patients in ICU, of which 9.4% (20 patients) had a positive SARS-CoV-2 result.
The COVID-19 pandemic has direct impacts on health as a result of illness, hospitalisations and deaths due to COVID-19. However, the pandemic also has wider impacts on health, healthcare, and health inequalities.
VACCINATION
COVID-19 is a highly infectious respiratory infection.
This spring, COVID-19 booster vaccinations will be offered to those who are eligible:
- residents in care homes for older adults
- adults aged 75 years and over (or will turn 75 by 30 June 2023)
- people aged 5 years and over with a weakened immune system
Learn more about this year’s spring vaccination programme on NHS inform (external website).
Globally, as of 10:11am CEST, 12 April 2023, there have been 762,791,152 confirmed cases of COVID-19, including 6,897,025 deaths, reported to WHO. As of 11 April 2023, a total of 13,340,275,493 vaccine doses have been administered. (World Health Organisation)
Globally, 3 million new cases and over 23 000 deaths were reported in the last 28 days (13 March to 9 April 2023), a decrease of 28% and 30%, respectively, compared to the previous 28 days (13 February to 12 March 2023).
Contrary to the overall trend, important increases in reported cases and deaths were seen in the South-East Asia and Eastern Mediterranean regions and in several individual countries elsewhere. As of 9 April 2023, over 762 million confirmed cases and over 6.8 million deaths have been reported globally.
Categories: Uncategorized
For the ones (like myself) who continue to feel “uneasy” about the whole situation, there’s some food for thought… and some interesting links in this context.
It always sounds good to hear about decreases… in hospital patients, in deaths and so forth. Some risks for severe disease and death for the majority of people have certainly changed over time, due to a range of factors such as vaccination, immunity, treatments and variant characteristics. The at the beginning of the pandemic in many communities demonstrated solidarity with the more vulnerable and the elderly was apparently also shortlived and the persisting risks for them are now less considered amongst the wider population.
Health services are (currently) not in disaster mode, but still in crisis mode (at least in this country), the latter for many reasons of which some have to do with Covid, others do not.
The risk to die from Covid if you are unlucky enough to end up in hospital is still much higher than with influenza. The commonly made comparison with the seasonal influenza therefore is not appropriate.
Conclusions from a study in the US (https://jamanetwork.com/journals/jama/fullarticle/2803749):
‘This study found that, in a VA population in fall-winter 2022-2023, being hospitalized for COVID-19 vs seasonal influenza was associated with an increased risk of death. This finding should be interpreted in the context of a 2 to 3 times greater number of people being hospitalized for COVID-19 vs influenza in the US in this period. However, the difference in mortality rates between COVID-19 and influenza appears to have decreased since early in the pandemic; death rates among people hospitalized for COVID-19 were 17% to 21% in 2020 vs 6% in this study, while death rates for those hospitalized for influenza were 3.8% in 2020 vs 3.7% in this study. The decline in death rates among people hospitalized for COVID-19 may be due to changes in SARS-CoV-2 variants, increased immunity levels (from vaccination and prior infection), and improved clinical care.’
Conclusions from a Swiss study (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801464):
‘This study shows that the COVID-19 due to the Omicron variant was associated with a higher risk of in-hospital mortality compared with patients with influenza. This indicates that the SARS-CoV-2 Omicron variant should still be taken seriously, and improved prevention and treatment strategies are still highly relevant, although overburdening of the health care system has become less likely over time.’
It should be noted that these rates refer to deaths within a short time frame (in hospital). Deaths after the follow up period or after discharge (for example after a few months) are not included.
I would also argue that health services should function properly, not only avoid to be overwhelmed.
Then there is the issue of mortality rates which are difficult to interpret. When trying to put into context the Case Fatality Rate for Orkney for the first months of this year, one should probably first do some background reading, such as https://coronavirus.jhu.edu/data/mortality or the very good explanation here: https://ourworldindata.org/mortality-risk-covid
Only then one can attempt an interpretation of Orkney’s data (extracted from gov.uk and NRS): 115 confirmed cases since the beginning of the year and 5 deaths which would result in an extraordinary CFR but we know that this cannot be true because so many cases go undetected.
On the other hand this should give us an indication that we certainly do not test enough, we clearly lack surveillance.
In their Policy Brief: COVID-19 surveillance from April 11th (can be downloaded here: https://www.who.int/publications/i/item/WHO-2019-nCoV-Policy_Brief-Surveillance-2023.1), the WHO states:
‘At this stage of the pandemic, it remains critical to sustain robust surveillance despite prevailing impressions that the pandemic is over. Several countries continue to have worrisome increases in the number of reported new COVID-19 cases and deaths due to the emergence of new Omicron subvariants, inadequate vaccination coverage, waning immunity and a lack of access to life- saving COVID-19-specific therapeutics.’
Waning immunity is another keyword: Some will receive a booster in April, the majority will not. Seasonality will also have a dampening effect over the coming summer months. What happens in autumn? If there isn’t enough surveillance we have no idea how we should prepare for autum when virtually everybody’s immunity will have waned?
The WHO expresses other concerns too: ‘… there is concern about the establishment of new animal reservoir(s) and potential virus evolution in novel hosts…’
Simple logic and common sense should tell us that the more uncontrolled and unrestricted the virus can spread, the greater this risk may become. If we allow this virus to fly under the radar only because there are currently not many thousands of patients in hospital, we are gambling.