9th September data update

Every week SCCR admin James Beecher puts together a summary of local, national, and international data on the coronavirus/Covid-19 pandemic. Questions, feedback, or suggestions for inclusion of data you have found useful, are welcome in our Facebook group, or email: stroudcommunitycoronaresponse@gmail.com. While the sources referenced are authoritative, the analysis is my own, and though I have some research skills – I’m not a virologist, epidemiologist or public health expert.

Key points

  • The big news this week – which is receiving a lot of national media coverage – is that the number of positive tests is rising, with one member of the government’s Scientific Advisory Group for Emergencies (SAGE) – Professor John Edmunds – saying that cases are “increasing exponentially”. While there is some justification for this, I think it’s worth trying to put this in context, both in terms of important caveats nationally, and an arguably different picture locally.
  • Across the UK, 2,563 positive tests resulted from specimens submitted on the 4th September, more than double the 1,176 positive tests associated with the 29th August. The 7-day average was 2,238.3 compared to 1,376.9 a week previously on the 28th August. The daily number of positive tests has generally been increasing since 4th July when it hit a low of 402. There is no getting around the fact that “this is broadly not a good development; no sugar coating – noone wants to see case numbers grow like this” (as Ewan Birney, Deputy Director General of the European Bioinformatics Institute put it at the start of a useful thread which I’ll draw on below)
  • Weekly positive tests in the UK (11,517) were the highest since the week-ending 2nd June (29,270). Last week’s update explained that the number of new positive tests cannot be explained only by new tests, though this might explain around half of the recent increase. However, as Birney points out, “the testing regime changed substantially in UK” in mid-May, as testing was opened up to anyone over 5 with symptoms, rather than only essential workers or even only people at point of hospitalisation previously. As Birney says, “the same level of reported cases as April XX” – even though true, it implies an equivalency which is not present“. I’ve colour coded the positive tests by week charts to try to make this clearer.
  • Last week’s update explained that the number of new positive tests cannot be explained only by new tests, though this might explain around half of the recent increase.
  • In one example of a careful and considered response to the latest data, this piece in the British Medical Journal argued that “Experts are increasingly concerned that these headline figures don’t provide a clear picture of what’s really happening in the pandemic—or how we should respond, such as with local lockdowns.”
  • While the government continues to recommend people get tested only if they are symptomatic or are asked to be tested, an increasing number of asymptomatic people are being identified through – for example – regular testing of care home staff. This testing is useful, as Allyson Pollock, co-director of the Newcastle University Centre for Excellence in Regulatory Science and an Independent SAGE committee member says “symptomatic and asymptomatic cases need to be separated out, to enable the government and local public health teams to understand what’s happening.”
  • Ultimately, what we are concerned about it avoiding serious illness and people dying. The ONS’s latest update notes that “Of the deaths registered by 28 August [in England and Wales], 52,282 mentioned COVID-19 on the death certificate”.
  • Hospital admissions may yet rise following positive tests by a lag, but the rise is much slower so far. – and there is no sign of a second rise of deaths involvcing Covid-19. Pollock says, “It’s very difficult to interpret what is going on because hospital admissions don’t seem to be rising, although we may still see a spike. Is it that we’re picking up cases in a different population—those who are healthier? Is the virus attenuating in some way? Or is there more background immunity?”
  • In a useful BBC article, Carl Heneghan, professor of evidence-based medicine at the University of Oxford is quoted as saying “the virus is circulating at a much lower level. With social distancing people are more likely to get a ‘glancing blow’ and have to deal with a much smaller amount of virus and so be less likely to get seriously ill.”
  • Heneghan adds “It is a mistake for people to think this infection is over… The virus is still circulating and if we lose our vigilance, rates will go up. I think we need simple clear messages to the public which stress the importance of handwashing and social distancing.”
  • Locally, there were 40 positive tests across Gloucestershire in the most recent full week of data (specimens provided between the 29th August and 4th September) – the same as the previous week. In the same week specimens produced 7 positive tests associated with people in Stroud district – one higher than last week. The last positive test in Gloucestershire was from a specimen provided on 6th September, and the last in Stroud was on a specimen provided on the 4th September (more recent tests may not yet have been processed).
  • The local situation- not only in Stroud and Gloucestershire but across the South West – does not appear to be driving the national increases in positive tests, nor yet be influenced by them. Large numbers of positive tests are associated with places under local lockdowns where testing capacity is being concentrated (the BBC report that “over the past week to Sunday, a quarter of new cases were in the 20 local authority areas with the highest rates. They represent just 5% of total local authorities”). This is not a cause for complacency locally – as the virus can still be brought in from elsewhere, but hopefully it can reassure people that there is little reason to worry unecessarily or panic.
  • Globally, over 27 million cases of Covid-19 have been confirmed, and nearly 900,000 people have died with their deaths attributed at least in part to Covid-19.

While the situation continues to be confusing and hard to follow, and locally the risks appear to be lower, to repeat Professor Heneghan’s point above: the virus is still circulating and risks will rise if people become complacent.

The core advice remains: please book a test if you have one or more symptoms – a new continuous cough, high temperature, or loss of smell/taste. There is a permanent unit at Hempsted Meadow in Gloucester, and mobile units tour Gloucestershire (the local team have communicated this week that people who have not booked will not be tested – even though they may have been in the past, capacity does not allow for this at the moment).

Whether or not you have symptoms, please still follow the guidelines to wear masks when appropriate (they will help prevent spread of the virus if you have it but don’t have symptoms yet, or are asymptomatic – meaning you have the virus but without ever getting any symptoms), keep distance from people, and wash your hands regularly. Access the latest government guidance and FAQ on “what you can and can’t do” online (last updated 9th September – to take account of new restrictions/advice on “how to meet people safely”).

Local statistics

Positive Tests

  • In the most recent week for which data is available (to the 4th September), specimens produced 7 positive tests associated with people in Stroud district. This number may be revised upwards slightly as some specimens submitted in that week may not have their results yet. Regardless, the number is broadly in line with positive tests since the week ending 24th July – these are slightly higher than the numbers in June and the rest of July, but it does not look to be a rising trend.
  • Across Gloucestsershire, there were 40 positive tests that week, and there does seem to be a slowly rising trend. We can hope that instead this largely represents a higher proportion of instances being picked up in testing, and that this can help to contain any further spread (unfortunately there does not seem to be local available data on test numbers or positivity rates so it is hard to tell if the rise represents more testing or more infections).
  • Nationally, while there are considerably higher numbers of positive tests these are not linked to dramatically higher hospitalisations, and while equivalent local data is not available it still appears that people most at risk from the virus are being protected from contracting it.
  • Whether in Stroud or Gloucestershire (or even the UK) as a whole, that positive tests are still being conducted does show the virus is still circulating, so it is worth taking the basic precautions. This way, we can continue to reduce the numbers of people being hospitalised and dying, and hopefully enable further opening up of restrictions.
Source: Government coronavirus dashboard data download
Source: SCCR analysis of data from the government Coronarvirus Dashboard

You can see where cases are being confirmed by neighbourhood (MSOA – an ONS geographic unit that covers areas of Stroud district like Stroud Town, Stonehouse, Nailsworth etc). Once again, the numbers in Stroud district are too low to show up on this map – though low numbers of positive tests in areas of Swindon, Bristol and Quedgeley are highlighted.

Note: we’ve heard lots of stories of people facing difficulties with tests in the past few days (with a couple of local examples receiving national attention), but while this may affect next week’s test numbers, the really significant problems seem to have emerged more recently – so shouldn’t have affected the numbers we are covering (any more so than the difficulties that have existed around testing for some time).

Estimated number of people with the virus

Alongside positive tests, we can also look to estimates that can cover people who – for whatever reason – do not get tested. The Covid Symptom Study currently estimates (9th September) that 47 people may actively have the virus in Stroud district (46 on the 4th). The Study also estimates 44 active cases in nearby Gloucester and South Gloucestershire, 36 in Cotswold district, 44 in Cheltenham, 43 in Tewkesbury and 27 in the Forest of Dean. These estimates have all barely changed recently, and are consistent with the positive test numbers to the extent we would expect a higher number of symptomatic people than are identified in testing (if people cannot access tests, do not realise they might have Covid, or do not choose to have a test even in they suspect they have Covid). Further, they are made from small samples and it would be extremely difficult to be statistically accurate at this level.

You can read about how these estimates are made on the Covid Symptom Study website.

People who have died because of Covid-19 in Stroud and Gloucestershire

National level data

As of 7th September there were 843 Covid-19 patients in UK hospitals, up slightly from 775 on the 29th August a week previously. 84 patients confirmed to have Covid-19 were admitted in England, compared to 52 on the 31st August. While numbers are higher, these are small rises – and from the lowest numbers of patients admitted/people in hospital that have been seen.

As of 8th September there were 80 patients on ventilation, compared to 82 on the 1st Sept. The number has been lower, but hasn’t been above 100 since the end of July.

More on testing and incidence estimates

The UK government coronanvirus dashboard summarises a number of datasources, and NHS Test and Trace data for England is also available. Check out the Independent SAGE weekly video summary too.

Source: coronavirus.data.gov.uk

Incidence estimates are higher than the the government’s number of “lab confirmed cases” because they are designed to estimate cases that have not been confirmed through testing. Prevalence is the total number of estimated cases at any given time, whereas incidence is the estimated number of daily new cases.

Source: COVID Symptom Study App estimates

People who have died

  • PHE report 41,594 “deaths in laboratory-confirmed positive individuals where the death occurred within 28 days” (to the 8th September). By this measure 56 people died in the most recent week, very similar to the 57 who died in the week previously.
  • Of the 41,592 people, PHE say 36,931 died in England (a rate of 65.6 per 100,000 people, compared to 50.7 in Wales, 45.7 in Scotland, and 29.9 in Northern Ireland).
  • The ONS report that “Of the deaths registered in Week 35 [ending 28th August], 101 mentioned “novel coronavirus (COVID-19)”, the lowest number of deaths involving COVID-19 in the last 24 weeks and a 26.8% decrease compared with Week 34 (37 deaths), accounting for 1.1% of all deaths in England and Wales.”
  • ONS data shows “Of the deaths registered by 28 August, 52,282 mentioned COVID-19 on the death certificate, 12.5% of all deaths in England and Wales”. The PHE data is restricted to people who tested positive, while death certificates can include clinical judgement where a test didn’t take place – which was regularly the case early on in the UK when testing was restricted.
  • While the differing PHE and ONS methods produce different results, it remains the case that tens of thousands of people have died with their deaths attributed to Covid-19. As fuller analysis of data is possible, there may be further adjustments to the total figures, but these shouldn’t be taken as an indication that Covid-19 is not a serious and regularly fatal disease, or that there is any deliberate attempt to either underestimate or overestimate the number of deaths related to the virus.

PHE surveillance report

Every week PHE publish a “surveillance report” on the pandemic. As we published our data update late last week, the PHE report we summarised last week has not been updated since. You can read the summary in last week’s update.

For the South West as a whole, PHE report 13,969 confirmed cases (up 285 from last week), and an incidence rate of 249/100,000 people. This is the lowest rate for an English region, the highest rate is 690/100,000 in the North West.

International data

It is important to say that different countries are testing and collecting data on deaths in different ways, making fair comparisons difficult. However, there are reputable sources doing their best to make data available, which we summarise below.

The European Centre for Disease Prevention and Control provides subnational data across Europe, including the following map (data for weeks ending 21st and 28th August).

hotspots across spain, in the south of France bordering Italy/Med and in parts of Romania, and generally mid-low in the UK (lowest in the South, and far north of Scotland)

The ourworldindata.org website provides lots of useful comparisons on a number of metrics, including testing, cases and deaths, through interactive charts you can control which countries are listed on, and whether data is raw or per population of a country- as well as tests per confirmed case.

People who have died with deaths attributed to Covid-19

A useful Financial Times interactive chart allows comparison of the “Seven-day rolling average of new deaths, by number of days since 3 average daily deaths first recorded“. This makes it possible to see whether the worst impacts of the virus have peaked in a country, and identify any “second waves”. In the chart below, we have picked out the UK – where the 7-day average number of daily deaths has been falling consistently for a long time, but has stabilised at a low level (broadly similar to France, where the 7-day average has possibly begun to rise again). The chart also shows the pattern in Spain – where a sharper decline in daily deaths is accompanied by a more recent uptick that looks like a “second wave” – though this is rising far more slowly than during the “first wave”.

This week, we’ve also highlighted India – where deaths continue to rise (but are still well below the relative rates per population in many other countries), Iran – where weekly deaths never fell to low levels but a second peak appears to be in decline, and Israel, where the “first wave” was much lower than for many other countries but the “second wave” has seen more people die than the first – though still not as bad in relative terms per population as in the European countries highlighted (note that the left-hand scale representing numbers of deaths is “logarithmic” – to make it easier to compare very large numbers with much smaller ones on the same chart).

Source: Financial Times

For interanational comparisons we also recommend the Office for National Statistics “Comparisons of all-cause mortality between European countries and regions: January to June 2020“, and the Financial Times’ visual narrative of the spread of Covid-19”, with charts showing comparisons between 20 countries on the best available testing measure – “excess deaths” (which avoids any issues with attribution to Covid-19 and instead explore the impact of both the pandemic and lockdown measures on the number of people dying), as well as global regional comparisons to the 13th July. Sadly this no longer seems to be being updated. We will include a chart again when there is an update.

Another Financial Times’ interactive chart can also show the “Cumulative deaths (per million), by number of days since 3 total deaths (per million) first recorded”. This shows the UK with the 3rd highest number (622.1) after Peru (922) and Belgium (862.8) – with the number of people dying in Chile (614.8), Brazil (601.6) and the United States (550.9) still increasing quickly. Other countries have far lower rates, despite the virus having been present for a similar time – such as Germany (112.2 deaths per million), Cuba (9), South Korea (6.6), and New Zealand (4.9).

Our analysis of data from the Johns Hopkins University tracker shows

As of the 2nd September, he number of people who have died is now nearly 900,000 – 897,685.

40,272 people died in the past week with their death at least partly attributed to Covid-19 (higher than last week).

There are sixteen countries where over 10,000 people have died where Covid-19 was involved (Ecaudor and Argentina have crossed this sad threshold). Rather than report the figures for each of these as we have been doing in previous weeks, we will from now on produce a summary:

  • The number of deaths attributed to Covid19 is below 100 in 2 of these 14 countries: the UK (83 – for some reason the JHU figure is different to the PHE figure) and Italy (72).
  • The number of deaths attributed to Covid19 is above 1,000 in 6 of these countries (The US, Brazil, India, Mexico, and Colombia)
  • The number of deaths this week is higher than last week in four of the twelve countries where over 10,000 people had died by last week (India – 7,557/6,884, the UK 83/57, Italy 72/46, Spain 442/228, Iran 870/652).

Recoveries

At least 18.5 million people have been deemed to have “recovered” after testing positive globally (18,541,133), an increase of nearly 1.5 million in the past week (1,456,164) – as reported by Johns Hopkins University. While there is considerable evidence of long-term impacts, many people who have not tested positive but have receovered are not included in this figure, and methods for recording “recoveries” vary by country.

The UK only reports 1,827 people have recovered, for instance – an increase of 118 on last week. However, this does not reflect the true number of people who have had the virus but recovered from it.

Confirmed Cases

Confirmation of cases is one way to measure the spread of the virus. It is worth bearing in mind that not everyone who has the virus, particularly if they do not develop senses, will get a test – so confirmed numbers are an underestimate of total instances of the virus. Further, access to testing changes and this will affected confirmation. The number of people dying is arguably a more useful way to compare the impact of the virus across different countries (though methods vary there too). Nonetheless, changes in confirmed case numbers can give us an indication of whether the virus is still spreading or is coming under control in a country. Our analysis of Johns Hopkins University data shows:

  • Over 27 million cases of Covid-19 have been confirmed (25,585,096)
  • That’s an an increase of over 1.8 million cases during the week (1,815,844), the eleventh week in a row with over 1 million cases confirmed.
  • Global confirmed cases increased by 7.0% in the past week (this percentage increase is falling slowly, a sign that global confirmation of cases may be peaking).
  • 23 countries have over 200,000 cases (Indonesia is added to the list with 200,035), and four have over 1 million confirmed cases (The US, Brazil, India and Russia. India passed 4 million this week – with 600,605 cases identified).
  • Rather than details for each of these as in previous weeks, we offer a summary:
  • The US, Brazil and India each confirmed over 200,000 new cases in the most recent week.
  • Confirmed cases this week are higher than the number last week in 14 of the 23 countries (India, Spain, Argentina, Chile, Iran, France, the UK, Bangladesh, Pakistan, Turkey, Italy, Iraq, Germany, and Indonesia)
  • Spain confirmed a total of 63,540 cases, a 13.5% increase
  • France confirmed 49,750 cases, an 15.4% increase
  • The number of cases confirmed during the week in the UK (11,517) was higher than the previous week (9,532) and the highest since the week-ending 2nd June (29,270). However, access to testing is very different, so the numbers are really ‘like for like’ – see above.

My condolences

I hope that this update helps contribute to understanding, and leads people to take care to reduce the potential impact of the virus. My best wishes and condolences to all those affected.

Notes

Your suggestions for inclusion of data in these summaries are welcome. Please submit posts to our Facebook group.

Please remember we have a list of resources to support your emotional and mental health during this time on our website (and welcome further recommendations). The following numbers may be useful:

  • Samaritans: 116 123
  • Domestic Violence Hotline: 0808 2000 247
  • Mind: 0300 123 3393
  • Age UK: 0800 169 6565
  • Childline: 0800 1111.