Step 4 of the government’s reopening roadmap – to include the end of legal limits of contacts – was due “no earlier than 21st June”, and is now due to take place on the 19th July. Current government guidance, which is in place until the next step takes place, is available on the gov.uk website – click for full details. Some restrictions have been eased, relating to weddings, civil partnerships and commemorative events; care home visits; overnight school trips; and large event pilots. The government will outline final reopening steps later today. (5pm)
In vaccination news:
- All adults aged 18 and over can now book to be vaccinated at one of the mass vaccination sites (those other than Rowcroft, Beeches Green and The Vale – which are accessed via GP invite/walk-in), as can anyone who meets the criteria for other top priority groups.
- Walk-in vaccination sessions have been taking place for first and second doses of Pfizer and AstraZeneca around the district and county.
Key data:
- No-one from Stroud district has died with Covid-19 mentioned on their death certificate for over 9 weeks (no death certificate mentions since 16th April – to 18th June, the most recent data). No-one from Stroud district has died within 28 days of a positive test for coronavirus (SARS-COV-2) for three and a half months – since 20th March, nor in Gloucestershire for over two months – since 17th April (data to 3rd July).
- The number of people testing positive by PCR or Lateral Flow Device in Gloucestershire has risen substantially and quickly – to 1,394 in the past week – to 30th June (this is the 5th highest number for any week during the pandemic – though many cases were missed in the first wave when testing capacity was limited). Rates are highest in Gloucester, Tewkesbury, and Cheltenham (all over over 250 people pre 100,000 testing positive in the past week – equivalent to more than one in every 400 people), and among people aged 20-24 (689 per 100,000), but they are rising in Stroud district too (to 160 per 100,000, with 211 people testing positive for the first time in the past week). Across Gloucestershire the number of people to test positive in the most recent week is around 214 per 100,000 people or one in every 470 people.
- Across the UK, the number of people to have tested positive in the past 7 days is 173,662 – 69,610 more people testing positive in the week compared to the previous week (a 67% increase).
- There are 14 people in Gloucestershire hospitals with Covid-19 (as of 29th June, the most recent data – double the 7 last week). However, there are now no patients in mechanical ventilation beds (there were two last week. We hope they are recovering/have been safely discharged). 29 patients were admitted/diagnosed in hospital with Covid-19 in the week to the 27th June – this is the highest in a week since the week to 16th March, and the number appears now to be on a rising trend (18 were admitted in the previous week), but the trend is erratic, and it appears most people are being discharged quickly (but in the week to 2nd June just 2 patients were admitted).
- The number of people in hospital with the virus nationally has been rising, albeit at relatively low numbers (1,905 on 1st July, a little more more than double the 932 on the 3rd June). We know hospitalisations lag infections, but across the country and county the proportion of people testing positive who go on to stay in hospital seems much lower than it has been in the past. Doubling of numbers of people in hospital would have to continue past October to reach numbers approaching the peak in January.
- Across Stroud district, around 58% of the population are fully vaccinated, with a further 16% having received a first but not a second dose. People aged 16-29 have only recently started to be invited, but already 62% have had a first dose.
- Further detail and charts on the above and more are below:
People who have tested positive
Rates are highest in Gloucester, Tewkesbury and Cheltenham, and among people aged 20-24, but they are rising rapidly in Stroud district too. Across Gloucestershire the number of people to test positive in the most recent week is around 214 per 100,000 people or one in every 470 people. For the Stroud district, the current rate is 160 per 100,000 of one in every 625 people. The district is following the same trend as Gloucester, just about two weeks later – and there’s little reason to believe they won’t keep rising. The Forest of Dean’s rate appeared to stopped rising, but has since increased and appears to just be behind by another week.. You can view daily numbers for Gloucestershire, or districts within it, on the government’s dashboard.
The number of people testing positive by PCR or Lateral Flow Device in Gloucestershire has risen substantially and quickly – to 1,394 in the past week – to 30th June. The rise has been very steep – steeper than in the autumn last year, and to a level in line with the number just before Christmas last year. While we’ve no expertise in predicting when the current ‘wave’ will peak, at the moment – with restrictions being eased, it seems plausible we will see a the highest ever numbers of people testing positive in a week either next week or the week after. Importantly, the age profile of those testing positive in the current ‘wave’ is very different – see chart below.
Though there has been a very considerable increase, this appears to be associated mainly with younger people. The chart below shows the difference between people aged over and under 60. Those over 60 have a rate of testing positive of 26 per 100,000 across Gloucestershire, less than a tenth of the rate for those under 60: 286 per 100,000. It’s hard to think of any explanation other than the high levels of full (both dose) vaccination among people aged 60+. Other data shows positive tests are concentrated particularly among those aged 20-24 (689 per 100,000), who we know are much less likely to be vaccinated (unless clinically vulnerable, acting as an unpaid carer for someone who is, or working in health or social care). We would expect (and the data below appears to bear out so far – though there is a lag), that these people will be less likely to need to be admitted to hospital.
The highest rate in Gloucestershire is in Springbank, Cheltenham – where 35 people have tested positive in the past week (nearly double the 18 in the previous week), giving a rate of 548 per 100,000 (or more than 1 in every 185 people). The government’s interactive map now shows people testing positive in every part of Stroud district – the area with the highest rate is Ebley & Randwick, with 24 people testing positive in the past week (double the 12 in the previous week, giving a rate of 202 per 100,000, or roughly one in every 500 people).
You can enter your postcode into the government’s dashboard to get more data on your local area.
If we look at the number of PCR tests being done in Gloucestershire, we can see the rise in the number of people testing positive isn’t just about more testing being done. There has been a notable rise in the proportion of tests that return positive results (5.4% of the 25,345 people tested by PCR in the 7 days to 29th June tested positive, compared to a low of 0.2% between 24th April – 13th, and 16-21st May). There are a few things to say about the chart below:
- There’s been a dramatic rise in people getting PCR tests (which are mostly used when people have symptoms, or to confirm the results of ‘rapid’ Lateral Flow Device tests when they return positive results for people without symptoms). This implies there are more people with symptoms at present.
- The proportion testing positive is rising despite more tests being done – this tells us the virus is spreading.
- There were more PCR tests done in the last week than during the peak in January (highest previous 7-day total was 25,484), but the proportion testing positive is half as high – 5.4% compared to 9.9%). This helps us understand that the number of positive tests isn’t driven by false positives (which seems very unlikely when recently just 0.2% of tests returned positive results), but also gives us a clear indication there are fewer people infected than at the January peak. Though, when the positiveity rate is above 5% in particular, we know infections are being missed.
- The trend is clear, but as you can see from the previous peaks, it can turn very quickly. In previous instances this appears to have been primarily because of the introduction of stricter restrictions, but this time infections should eventually hit a wall of vaccinated people – and together with those with current or prior infections, should run out of ‘susceptible’ people to infect.
In Stroud District specifically, 211 people tested positive in the most recent week – to 30th June June. This is more than double the previous week (98). There have only been 5 weeks during the pandemic where a higher number of people tested positive – though, as for Gloucestershire as a whole, the age breakdown is now very different (see below).
The data by age from Stroud is strongly suggestive of a vaccination effect: far fewer people aged 50 or over have tested positive since 29th March – while there have continued to be cases among younger age groups. In June, a total of 383 people have tested positive from Stroud district: 96% have been aged under 60 (365). Seventeen people aged 60 or over have tested postive. These could be among unvaccinated people, or among people who have either one or two doses and should get much milder symptoms as a result – which would also help explain the relatively low hospitalisation figures. The chart below has rows for each age band with older age groups at the top. Yellow areas show no cases, with colours going through green, to blue, to purple and black for higher numbers of cases. The red line shows age bands above and below 50.
We do know that not everyone can get a test or gets one even if they can. The Kings College London/Zoe Covid-19 symptom study app reports estimates for Stroud district – based on reporting of symptoms by people using the app (of whom there are over 3,000 in Stroud district). This week they estimate 611 people with active symptomatic infections in the district – up 250 in the week, rising very rapidly by their measure, but up far more than double from the 178 we reported from them a week ago. Again, while the rate can turn sharply, with restrictions being loosened it seems plausible rates will go to the highest ever levels in the days and weeks to come.
Local Hospitals
There were 14 people in Gloucestershire Hospitals with COVID-19 as of the 29th June, up from 7 the week before (and compared to around 800 patients in Gloucestershire Royal and Cheltenham General hospitals General and Acute beds in total). No patients are in Mechanical Ventilation beds, which is good news
The chart below shows how the number of people being admitted /diagnosed over the previous 7 days period (29 in the week to the 27th June) has fluctuated recently but is starting to show signs of an upward trend (it’s the highest number for a week since the week to 16th March , though still nowhere near the peak of 202 in the week to 18th January). The increase in admissions is likely to relate to infections acquired at least a week previously, so it is possible we will see a rise related to the dramatic increase in infections across Gloucestershire in the last few weeks – but because the age profile of people testing positive recently is younger, and younger people are, on average, much less likely to be at risk of developing severe illness, we may not see an increase in the number of people admitted to/in hospital. While the number staying in hospital is also up a little, it’s clear most people are being discharged fairly quickly.
This week, the Gloucestershire Hospitals Business Intelligence Team (led by Sarah Hammond and Joe Green) shared a chart on how the number of Covid patients in their hospitals on any given day compares to the number of people testing positive. You can see how – even granting for a lag, there are far fewer people in Gloucester Royal now with Covid than there were in November/December. As Director of Quality & Chief Nurse Steve Hams said when sharing the chart on twitter, “the COVID Vaccination is working”
Vaccinations
Data from the NHS on vaccinations shows that, in total and as of the 23rd May (the most recent available data) there had been 793,707 Covid-19 vaccine doses delivered in Gloucestershire. 17,572 doses were delivered in the week, making it the ‘slowest’ week for doses since 24th January – when the vaccination programme was only beginning. Roughly the same number of people have received a second dose as received a first 12 weeks ago (339,839 compared to 338,166, green line on chart). Second doses have been running ahead, and are being due to be brought forward for people in the first priority groups (to 8 weeks rather than 12), so the similarlity is a concern – and probably why NHS Gloucestershire have been encouraging people who’ve had a first dose to get their second dose when invited to complete the course and ensure long-lasting protection this week. The chart below also shows how the rate at which first doses are being delivered picked up quickly in May and June after a flat April, though the need to focus on second doses means the first dose rollout is a little slower than in February and March. Because the first dose roll-out was slower in April, the number of people to have received a second dose is not that much lower than the number to receive a first dose 8 weeks ago (red line on chart, to 352,276 first doses by 2nd May).
The chart below shows how the total population of Stroud district breaks down by age band (in the National Immunisation System population estimate). The rows below show the number of people in each age band who have been partially or fully vaccinated. The colours match down the rows, with blank/white gaps where people are yet to be invited or had not (yet) taken up an invitation as of 27th June. As you can see, essentially everyone aged 50+ is fully vaccinated (there are an estimated 2,938 people aged 50+ in the district who have not had a first dose). People aged 16-29 have only recently started to be invited, but already 62% have had a first dose. There are around 1,174 people aged 50+ who have had their first but not second dose, as of 27th June. People aged under 16 are not eligible for vaccination (at least, at the moment – the MHRA has approved Pfizer vaccination for 12-15 year olds, but the JCVI and government are yet to say whether people in these age groups will be vaccinated as part of the rollout).
Public Health England are publishing weekly estimates of vaccine effectiveness based on the real-world data they have about who is testing positive, being admitted to hospital, or dying – which they combine with data on the likely impact of vaccines on transmission. Data isn’t available for some questions (ie, two doses of both vaccines, and particularly for Oxford-AstraZeneca) because it takes time to conduct studies with samples of sufficient size to draw firm conclusions. This is also why the level of confidence is higher for some estimates of effectiveness than others. In brief, the latest data (to 30th June) shows:
- One dose of either Pfizer or AstraZeneca reduces hospitalisation by 75-85% (high confidence)
- One dose of either Pfizer or AstraZeneca reduces mortality by 70-80% (medium confidence).
- One dose of either Pfizer or AstraZeneca reduces transmission by 35-50% (low confidence).
- Two doses of either Pfizer or AstraZeneca reduces hospitalisation by 80-99% (low confidence)
- Two doses of either Pfizer or AstraZeneca reduces mortality by 75-99% (low to medium confidence)
People aged 18 and over can now book to be vaccinated at one of the mass vaccination sites via this link, as can anyone who meets the criteria for other top priority groups. Making a booking at a mass vaccination site (Cainscross Pharmacy/Britannia Dance Studio, Cirencester, Gloucester, Bristol, Bath, Malvern, Oxford etc) will not affect whether you receive a GP surgery invite to a local vaccination hub or site in the district. You can cancel bookings at mass vaccination sites via the link (under “manage your bookings“). Please ensure to do this with time for people to take the slot so vaccine isn’t wasted. If you are able to travel to a mass vaccination site, you free up space for people who cannot travel at the local hubs.
- NHS Gloucestershire have a website where you can “Find the information you need about the COVID-19 vaccination programme in Gloucestershire in one place.Visit the site for the latest updates, info on priority groups, FAQs and more”.
- Gloucestershire County Council have a hub for information on vaccines, including “a new online form for vaccination queries from the public and stakeholders“.
We’ve published five videos of clips from an interview with Dr Tom Malins (click to watch on Youtube). Please watch/share on Facebook via the link. And check out our previous videos with Dr Jim Holmes and Practice Manager Karen Pitney from Rowcroft Medical Centre on “why you should get vaccinated“, “the process for receiving your vaccination” and “second doses“.
If you’ve had your jab recently, please do read advice on continuing to be cautious after receiving your vaccination.
National context
There will no doubt be a presentation on national data by the government and chief scientific advisors, so the below is only brief. You can see a summary of the trends on the government dashboard at this link.
AAcross the UK, the number of people to have tested positive in the past 7 days is 173,662 – 69,610 more people testing positive in the week compared to the previous week (a 67% increase).
Using a logarithmic plot to show exponential growth rates, cases are rising on trend, and if they continue to do so will hit 50,000 a day within a week.
Across the UK, the KCL/ZOE app team estimate around 370,769 274,356 people had a symptomtic infection on the 4th July, based on symptom reporting by up to 4.6 million app users. This is a sizeable increase on 274,356 last week (27th June), but far from doubling we saw ta few weeks ago. Nonetheless, it is now approaching half the peak in January (801,461).
The total number of people with the virus in UK hospitals has risen considerably: 1,905 on 1st July, a little more more than double the 932 on the 3rd June). We know hospitalisations lag infections, but across the country and county the proportion of people testing positive who go on to stay in hospital is much lower than it has been in the past (peaking at 39,254 on the 18th January).
The number of patients being admitted also appears to be rising– 1,903 in the last 7 days, compared to 1,557 in the previous 7 days . The daily number of 358 on the 29th June is the highest daily number since 366 people were admitted on the 23rd March. We send our best wishes to all these patients.
The number of Covid-19 patients in mechanical ventilation beds, the sickest patients, is still rising: 300 on the 1st July, more than double the 134 on 3rd June. However, this is still much lower than the peak of 4,077 people on 24th January 2021. The lowest last summer was 60 on 28th August. We send our best for the recovery of all Covid-19 patients in hospital.
Data from the Covid-19 Actuaries Response Group shows how the age profile of people admitted to hospital is changing – with fewer people in the older age groups being admitted as a proportion of the total. As a result “We can see that the average age decreased significantly over the period, by around 20 years from 66 (in mid-February) to 46 (last week of June). This is a major shift, and reflects the high vaccination proportions achieved at higher ages.”.
The numbers of people dying are still low – 116 people had Covid-19 mentioned on their death certificate in the week to 18th June. However, we know it takes time for people to get sick, and certainly sick enough to die, and so these numbers do not reflect the recent rises in infections/hospitalisations (though a rise in deaths on track with these is far from certain – as most of those most at risk have now been vaccinated).
The number dying within 28 days of a positive test (a more up to date but less robust measure) is flat – 122 in the week to 4th July, compared to 124 in the week to 27th June. While every death is sad, it is important to see these numbers in context – at the peak in winter, 9,000 people died within 28 days of a positive test (to the 21st January).
International context
There is a long way to go globally before the pandemic is over – the 7-day average number of people testing positive per day has stopped falling, having been in sharp decline since the high on April 25th of 826,374 (driven by falling numbers in India). The number of people testing positive is still very high at 377,000 daily (7-day-rolling average to July 3rd) – driven by rises in countries across Africa.
Globally, over 3.9 million people have now died with their death attributed to Covid-19 at least in part (subject to different counting methods in different countries. The Economist has published analysis estimating the true figure is around 10 million). South America is set to overtake Europe as the worst affected contintent in terms of numbers of deaths, having recently passed North America.
In terms of the number of confirmed COVID-19 deaths relative to the population, the United Kingdom has a fairly high rate (1,891), but lower than the worst hit countries – such as Peru (5,844 per million, or around one in every 171 people), Hungary (3,105), Bosnia and Herzegovina (2,947), and Czechia (2,830). The UK rate is lower than for the continent of South America (2,356 Covid-19 deaths per million), but slightly higher than that for the European Union as a whole (1,664), and for North America (1,527) as a whole – but broadly in line with those continents (and this may reflect differences in testing/attribution). However, there are some countries with lower deaths rates – including Germany (1,087 – not much over half the UK rate), or much lower rates – Finland and Norway have rates 10 times lower than the UK (176 and 147 per million), and South Korea, Australia, Thailand, New Zealand, Taiwan, and Vietnam have rates that barely register compared to the worst hit areas (though some of these countries have current outbreaks that may increase mortality, hopefully outbreaks can be controlled / vaccination can rollout before they reach the levels seen in other parts of the world).
In terms of vaccination, the UK has a very high proportion who have received at least one dose (66% of population) – behind only Canada (68%) and Chile (66%) among larger countries (in the chart below). The UK’s rate for full vaccination (49%) is also very high in terms of global comparisons: four times as high as South America (13%), and more than 5 times higher than the proportion across Asia (8.3%). Across Africa, just 2.7% of the population have received any vaccination, and only 1.2% are fully vaccinated.
There is a real need to plan to improve global vaccination. You can Donate to treat, vaccinate and support people worldwide – which a few members of our Facebook group have reported doing to mark getting their own vaccination.
Notes
The core advice remains: please book a test. You can now do this whether or not you have symptoms. The link will tell you which type of test to book if you have symptoms or not. Twice weekly rapid tests are available to everyone in England without symptoms. If you have symptoms, there is a permanent unit at Hempsted Meadow in Gloucester, and a walk-in unit in Stratford Park. See this link for details of testing locations in Gloucestershire. If you have symptoms (or if you are asked to by contact tracers), self-isolate until you have a negative test – or for 10 days since your symptoms appeared if you test positive or are asked to by Test and Trace. 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 meet outside when possible, keep indoor spaces well ventilated with fresh air, 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.
A summary of key changes and similarities with the government guidance starting June 21st is copied below:
“The government has announced a 4-week pause at Step 3. Step 3 restrictions remain in place, and you should follow the guidance on this page, which explains what you can and cannot do.
It is expected that England will move to Step 4 on 19 July, though the data will be reviewed after 2 weeks in case the risks have reduced. The government will continue to monitor the data and the move to Step 4 will be confirmed one week in advance.
How the rules changed on 21 June
The rules on weddings and civil partnership ceremonies and wedding receptions or civil partnership celebrations changed on 21 June. See the weddings and civil partnership ceremonies and wedding receptions or civil partnership celebrations section of this guidance.
The rules on commemorative events following a death such as a wake, stone setting or ash scattering changed on 21 June. See the funerals and linked commemorative events of this guidance.
The rules on care home visits changed on 21 June. See the care home visits section of this guidance.
The rules on domestic residential visits for children changed on 21 June. See the childcare section of this guidance.
Large events pilots from 21 June
A limited series of pilot events will take place to produce additional evidence on reopening events safely. Attendees will need to show proof of vaccination or a recent negative test.
This will include some UEFA EURO 2020 matches at Wembley and a small number of other sports, arts and music performances. The full list of pilots, and further details about the events, will be announced shortly.”
If there is a piece of guidance you have a question about, again – please ask in our Facebook group.
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. We 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. We’re also volunteers with no public health expertise – collating and signposting to other sources for guidance.
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.
Your suggestions for inclusion of data in these summaries are welcome. Please submit posts to our Facebook group.