3rd January 2021 data update

SCCR team member James Beecher produces a summary of local and national data each week

Happy New Year to all followers of these regular data summaries from Stroud Coronavirus Community Response – fortunately there are some signs of hope for this year… but unfortunately we’re starting the year in about as bad a place with the pandemic as we could be nationally. As ever, I’ll focus on the local situation but there is some important national context to include too – in brief, things are really bad both locally and nationally, please follow the guidance to reduce the spread of the virus, the likelihood it reaches those of us most at risk, and the pressure on NHS services.

A lot has changed since the last update I did on the 20th December. I’ll cover the usual data points below but it is important to start with some key news:

[Edit – immediately after the update, since 5th January, Gloucestershire along with the rest of the country is in National Lockdown – guidance here. Easy read version and more to come in the next update on the 10th January]
Gloucestershire, including Stroud District, is in “Tier 4” of the government’s system of restrictions as of 31st December 2020. Tier 4 is a new level of restrictions introduced in London, the South East and East of England on 19th December. Read the Tier 4 guidance on the gov.uk website. In summary: “If you live in Tier 4 you must not leave or be outside of your home or garden except where you have a ‘reasonable excuse’.” Support bubbles continue (and the criteria to make them has been recently expanded), and there are important aspects and exemptions detailed in the guidance via the previous link – please ask in our Facebook group if you need help navigating the guidance. Thanks to Sharon Bishop for posting an Easy Read copy of the the Tier 4 England guidance. Details of business support are available from the County Council.

Gloucestershire will be in Tier 4 until further notice: Health Secretary Matt Hancock MP’s statement to parliament reads: “The regulations will require the government to review the allocations at least every 14 days. We will also take urgent action when the data suggests it is required.”

Gloucestershire had already been moved up from Tier 2 to Tier 3 on the 26th December. I hope the data I provide below will help to explain the rapidly changing situation, but think it is best to provide the information given by the government first – this covers the data sources that lead to the decision to move areas up (or down) in the Tier system:

“In the last week, the picture in Gloucestershire has further deteriorated with an increase in all epidemiological indicators in all 6 of the local authorities. The case rate for all ages is high across the area with the highest rates seen in Gloucester (304 per 100,000 per week), which is also showing the highest rates in people aged over 60 (246 per 100,000 per week). Increases in case rates of more than 60% have been seen in 3 of the local authorities in the past week, with the greatest increase seen in Cheltenham of 73% (to 175 per 100,00 per week). Test positivity is at or above 5% across the area with two local authorities above 8%. COVID admissions are high in the local NHS (Gloucestershire STP) and increasing whilst the numbers in bed is high and increasing, as is critical care. The rate of increase of the epidemiology indicators is concerning and warrants escalation to Tier 4.”

Source: Department of Health and Social Care, 30th December 2020

Before getting fully into the local data, I think it’s important to start by mentioning that once again there is substantial misinformation circulating locally. Sadly, the latest local example – misleading videos of Gloucester Royal Hospital made by Debbie Hicks, who has since been arrested – went viral well beyond our locality (as discussed in an Amplify Stroud article), and Gloucestershire Hospitals NHS Foundation Trust put out a response statement, which I think is worth quoting in full:

“Contrary to what you may have seen through ‘secret filming’ on Facebook, our hospitals are and remain extremely busy and colleagues at both our hospitals have been working hard throughout the festive period to care for our patients. We are currently caring for more than 200 patients with COVID-19, including many who require treatment in our critical care departments and a further 500+ non-COVID patients who need our care and expertise.Every day, we provide urgent treatment for more than 300 patients at our Emergency Departments at Gloucester and Cheltenham and this continues every day of the year. This includes patients who walk in and those who come by ambulance; of these 300 patients, around 100 will require admission or further treatment on our wards. While outpatient departments and some shops in the hospitals have been closed at times over the Christmas break, food and drink options for staff remain open in staff-only areas. Filming patients who are waiting in A&E without their consent is both intrusive and upsetting as maintaining patient confidentiality is key to our hospitals being a safe space for you to receive the care you need. We cannot stress highly enough how important it is to continue to follow hands-face-space guidance to prevent the spread of COVID-19 and to protect the most vulnerable in our community in Gloucestershire. Our Trust and our colleagues throughout the NHS are dedicated to caring for you around the clock, every day of the year. We know that the vast majority of our local community in Gloucestershire appreciates the extraordinary dedication and expertise of our NHS and we’re extremely grateful to you all for your continued support.”

Source: Gloucestershire Hospital NHS Foundation Trust

On this topic it is worth emphasising that hospital corridors are quieter because of visitor restrictions. As the local NHS community Trust explains: “General visiting to adult wards is suspended during the Tier 4 Period for Gloucestershire“. There are exemptions to allow visits in some cases– “limited visiting is allowed for adults who require support in special circumstances by an established carer who is a household member or a member of their support bubble”, “Visiting is allowed for those receiving especially bad news or for those patients who are at the end of their life. This should be limited to household members or members of the support bubble.” (see a similar webpage on visiting restrictions for Gloucester Royal and Cheltenham General Hospitals) Further,

“The Trust asks all visitors, as well as patients attending appointments, to wear a face covering and comply with social distancing and hand hygiene guidance as advised by our staff. During a period of self-isolation, visiting is not allowed under any circumstances in accordance with the national regulations. It is important that people of all ages still attend medical appointments and patients can be reassured that, due to careful infection prevention and control procedures, transmission rates in our hospitals remain very low. Those attending appointments are encouraged to attend alone whenever possible, to reduce the number of people in hospital buildings.”

Source: Gloucestershire Health and Care NHS Foundation Trust

Member of Parliament for Stroud constituency Siobhan Baillie also issued a statement condemning “Covid misinformation and anti-vax”, including the paragraph:

“Attempting to undermine our health professionals and encouraging misinformation as facts is just about as irresponsible as it can be during a pandemic. I would like the government and social media platforms to do more to stop it. This is harming our community, potentially risking lives and our recovery from the virus.”

Read Siobhan Baillie’s full statement on Facebook

Finally, before the data update:

Covid-19 testing locations: 4 – 10 January:

Covid-19 testing units are open throughout the county, including at Dursley Rugby Club on 4,5 and 6 January. The mobile unit will not be at Stratford Park this week. Please note that you must book an appointment in advance via the NHS website or by calling 119 (see our regular weekly Facebook post on test sites for more details).

Key local data:

  • 269 people from Stroud district tested positive in the most recent week of data (with tests submitted to the 1st January still likely to be waiting for results) – higher than the previous weeks 229, and much higher than the 176 (up from 141 as reported in my last update before all the results were in) and 151 in the previous weeks. This is a new high (though testing during the Spring peak was limited and numbers of infected people in April were potentially higher).
  • The situation across Gloucestershire as a whole is even worse. In the most recent week a total of 1,886 people have tested positive, a huge increase on the 1,291 from the previous week (before full data are in), and approaching double the previous high from the week ending 13th November (1,002).
  • As of the 29th December (the latest data publicly available), there were a total of 241 patients with confirmed Covid-19 in beds in Gloucestershire Hospitals. This is an increase of 19 since the previous week, and 63 in the past month. The trend is clearly rising. While 34 patients are in the community/district hospitals (like Stroud Hospital), 207 are in Gloucester Royal and Cheltenham Hospital’s General and Acute beds (most in Gloucester – the local designated Covid hospital, but apparently some cases are in Cheltenham too now).
  • Newly public NHS data means I can pass on that the 207 patients represent 26.4% of all the General and Acute beds in the two hospitals. This has risen from 22.3% a week ago and 18.7% a month ago. The proportion of beds which are unoccupied (hospitals need some unoccupied at all times to manage new patients arriving, and in case of emergencies) has fallen as low as 7.3% on the 21st December – when there were only 57 beds available. This figure was 69 on the 29th December, but has been falling since the 23rd December. Given that it isn’t just beds but staff that are needed, it should be clear to anyone that the hospitals are under pressure already, and that it is getting worse. Below I mention how this relates to the national context.
  • In the most recent week of data (to the 18th December), 33 people from Gloucestershire died with Covid-19 mentioned on their death certificate. This brings the total number of people who have died with Covid-19 mentioned on their death certificate from the county since the beginning of the pandemic has reached 750, with 168 dying since September. This is a rate of 117.7 people per 100,000 (one in every 850 people in the county). This rate is higher than 75 other equivalent local authority areas (the lowest rate is 42.3 per 100,000 in Cornwall and the Isles of Scilly), and lower than 96 (the highest rate is 247 per 100,000 in Rhondda Cynon Taff).
  • Across the UK, the ONS say (in a reduced weekly mortality bulletin because of Christmas): “In Week 51, the number of deaths registered was 12.7% above the five-year average (1,463 deaths higher). Of the deaths registered in Week 51, 2,986 mentioned “novel coronavirus (COVID-19)”, accounting for 22.9% of all deaths in England and Wales; in Week 51 deaths involving COVID-19 increased compared with Week 50 (by 230 deaths), following decreases in Week 49 and Week 50… all English regions had a higher number of deaths than the five-year average for the sixth week in a row”.
  • As of the previous week, the ONS report that: “Using the most up-to-date data we have available, the number of deaths up to 11 December 2020 was 579,491, which is 67,864 more than the five-year average. Of the deaths registered by 11 December 2020, 72,546 mentioned COVID-19 on the death certificate. This is 12.5% of all deaths in England and Wales.”
  • You should be able to enter you postcode via this link and receive up to date information for your local area, the Stroud district, Gloucestershire, the South West and more.

Further detail on data:

I’ll start with the hospital data given the local misinformation around this. The chart below shows the rapid increases in the number of confirmed Covid-19 patients occupying hospital beds in Gloucestershire since December – from an already elevated position in November. There is no sign of the rise slowly, and the rising infection numbers below would suggest the increase will continue for some time (we know that hospitalisations lag infection data as it takes a while for the people who end up needing hospital treatment to get sick enough for this to be the case).

NHS England is now making public data on how many beds in each hospital with General and Acute beds are occupied not only by Covid-19 patients but generally, together with total bed capacity. The below chart shows the numbers for Gloucestershire Hospitals NHS Foundation Trust which runs Gloucestershire Royal and Cheltenham General Hospitals. You can see the number and proportion of Covid-19 patients rising from 135 (17%) on the 17th November, to 197 and 26.4% by the 29th December. There are changes in capacity, which I do not know enough to explain myself but believe to reflect the fact that ‘beds’ does not refer only to physical beds but the staff available to treat a patient.

Earlier this week, John Burn-Murdoch – a Financial Times journalist – shared similar charts for other hospitals around the country. You can hopefully see how dramatic the shifts are in hospitals like North Middlesex (63.1%) and Medway (57.6%) where over 50% of beds are occupied by Covid-19 patients and there are no unoccuped beds, and the risks for Gloucestershire. North Middlesex was on 18.3% on the 15th December (when Gloucestershire was on 21.2%) and Medway was on 24.3% on the 17th November (see full percentages and trends in a spreadhseet image shared by Independent journalist Shaun Lintern).

Source: John Burn-Murdoch

In terms of the number of people who have died in Gloucestershire, I hope the chart below puts things in perspective. Of neighbouring/South West areas, Gloucestershire has a worse death rate – 117.7 per 100,000 or one in every 850 people, considerably worse than the more urban City of Bristol (77.3 per 100,000 or one in every 1,294 people), and Swindon (91.8 or one in every 1,089 people). However, the death rates in this part of the world are generally much less bad than in others – including some nearly places like Cardiff (137.4 per 100,000 or one in every 728 people), Newport (150 per 100,000 or one in every 667 people), and Rhondda Cynon Taff – the worst affected area in the country in terms of rate (596 people, or 247 people per 100,000, or one in every 405 people have died with Covid-19 mentioned on their death certificate this year).

The chart below shows the number of people testing positive in from Stroud district each week – from the week ending 22nd May 2020 to the seven days ending with the 1st January 2021. There is a clear and sharply rising trend.

Source: gov.uk data dashboard – daily spreadsheet downloaded and collated

I’ve been using the above style chart of my own for week, but now better data visualisations are available from the government I’m going to switch to theirs (see below). These show, an average of 38 people testing postive per day for the most recent 7 days, compared to an average of 14/day on the 27th Nov, and 4/day at the start of October (the chart is the same data as mine above, but displayed daily rather than weekly, and with a seven day average line to represent the weekly trend).

Source: gov.uk data dashboard – Stroud district filter

The government now break test data down by people testing positive above and below 60 years of age (who are, on the whole, more likely to be at risk of serious consequences from the virus). The data for Stroud district shows numbers are rising faster for people aged under 60 – but also that higher numbers of people aged over 60 are testing positive, and the clear relationship between the two trends (note that in the spring only people admitted to hospital could be tested, hence the lower numbers for people under 60 who were less likely to be admitted as a result of generally having milder symptoms).

Source: gov.uk data dashboard – Stroud district filter

We know not everyone will get tested (for a variety of reasons), so I regularly report on the Kings College London/ZOE Covid-19 symptom tracking app estimates. These numbers are generally higher, and the trends generally track (and usually anticipate) the trends for people to get tested.

In the most recent data, Stroud district as having 2,422 active symptomatic cases per million people (lower than surrounding districts, with the Forest of Dean the highest rate per million people) – see below

However, recent data suggests the number of active cases has been falling recently, with the estimate being that there are currently 286 people with active symptomatic Covid, up by 17 from last week and approximately at the level at the start of October after peaking in November… it’s important to note that this estimate now diverges quite a bit from the trend in positive test results – and I’m not entirely sure why (my best guesses are that the symptom study app isn’t accounting for the rise in either/both asymptomatic people or older people with the virus – their estimates in the past were limited to people under the age of 64, and we can expect that fewer people over this age are using the app as smartphone ownership is much lower for that age group. It may also be possible that people testing positive at the moment are less likely to be app users generally (regardless of age), or that app users are more likely to be avoiding infections… but it would seem strange for these things to be new phenomena. I will see if I Professor Tim Spector from the team responds to a tweet asking what the explanation might be.

Meanwhile, in Gloucestershire as a whole, the number of people testing positive is rising very quickly. While numbers are rising in Stroud, this essentially tells us they are rising faster in the rest of the county. I’ll look into the other districts in more detail next week.

Source: gov.uk data dashboard – daily spreadsheet downloaded and collated

The short version of the national data at the UK level is that all the trends are moving rapidly in the wrong direction:

  • The number of people testing positive in the last 7 days is – at 366,435 – up 118,326 on even the previous week’s new high, and despite the fact that thenumber of tests conducted fell by 479,224 on the previous week (likely becaus of Christmas).
  • The number of patients admitted to hospital in the last seven days is – at 14,987 – 2,463 higher than the previous week.
  • There were 23,823 confirmed Covid-19 patients in UK hospitals as of the 28th December, higher than the April peak of 21,683.
  • And data on the numbers of people dying within 28 days of a positive test and with Covid-19 recorded on death certificates are rising. In the data to the 18th December, 3,270 people died with Covid-19 mentioned on their death certificates, a rise of 7% on the previous week – and in more-up-to-date but potentially less robust 28 day measure, 4,228 people died in the past 7 days, 833 more people than in the previous week – or 25% higher. This is a really terrible situation, and I send sincere condolences to the families and friends of those affected (one of whom who lost a colleague and friend over Christmas is a friend of mine).

Lastly, I mentioned some signs of hope…
As far as I know there is no official local data available yet, but national data about vaccination progress is availabe.

At time of writing, this shows a total of 786,000 people have received their first dose – 524,439 of them aged 80+, and 261,561 aged 16-79 (likely mainly healthworkers). As of the 2018 ONS population estimate there were 2,768,734 people aged 80 or over in England, so by my caclulations approximately 19% of people aged 80 or over have received their first dose, so far (as of 27th December)

That’s all I have time for this week . For more on the national situation I – as ever – recommend the Independent SAGE weekly briefing (which as well as a 20 minute presentation on the data features frontline healthcare workers talking about their experiences and a discussion on schools). Please also see the details below regarding the guidance and some resource. I’ll try to include some international commentary next week.

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 (or if you are asked to by contact tracers or others conducting tests). There is a permanent unit at Hempsted Meadow in Gloucester, and mobile units tour Gloucestershire. If you have symptoms (or if you are asked to by contact tracers), self-isolate until you have a negative test. If you are struggling with self-isolating, please get in touch with us or with one of the local support groups. You may be able to receive financial support to self-isolate from Stroud District Council.

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. [Edit: Gloucestershire along with the rest of the country is in National Lockdown – guidance here (originally this update went out with a link to then current Tier 4 guidance)]. If there is a piece of guidance you have a question about, again – please ask in our Facebook group.

Notes

These updates are designed to improve understanding of the pandemic and its impacts, with the hope this can help us to reduce those impacts locally. I appreciate they do not involve space to properly convey the full impact of the virus nor the restrictions that are making life difficult for many people.

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.