19th July 2021 data update

Today, Step 4 of the reopening roadmap comes into force, removing many legal restrictions – though retaining guidance (copied at the end of this update). There is information online about the new guidance. You can watch a video recording of the press conference. Please also read our SCCR statement – “we can still choose to act conscientiously and with compassion for others“, when numbers of infections locally are high and rising, and there are people in our community who have do not have the protection granted by vaccination (including those who cannot have jabs, or do not benefit as much from them because of a health condition/treatment).

Key data:

• No-one from Stroud district has died with Covid-19 mentioned on their death certificate for over 11 weeks (no death certificate mentions since 16th April – to 2nd July, the most recent data). No-one from Stroud district has died within 28 days of a positive test for coronavirus for four months – since 20th March. Across Gloucestershire, there have been no new instances where someone has died with Covid-19 mentioned on their death certificate (in the week to 2nd July, though two deaths were recorded in the previous week).
• The number of people that tested positive by PCR or Lateral Flow Device in Stroud district and Gloucestershire was again very high in the past week – to 14th July: 291 in Stroud district, and 2,009 across Gloucestershire. However, these numbers are much closer to the previous weekly numbers than they have been (in other words, the spread appears not to be accelerating anymore). The ZOE app estimates 605 people in Stroud district have active symptomatic infections – which is actually down from last week’s 730 around 1 in every 200 people in the district (about half as high as the rate for England as a whole estimated by the ONS last week: 1 in every 95 people)
• Across Gloucestershire the number of people to test positive in the most recent week is around 315 per 100,000 people or roughly one in every 320 people.
• Rates are highest in the Forest of Dean, where they were lowest until recently (around 414 people per 100,000 people testing positive in the week – more than 1 in every 250 people in the district) and among people aged 20-24 (911 per 100,000 – approaching 1 in every 100 people of that age in Gloucestershire), but they are rising in Stroud district too (to 242 per 100,000, with 291 people testing positive for the first time in the past week). In Stroud district, the area with the highest rate is Dursley, with 30 people testing positive in the past week (more than double the 11 in the previous week, with a rate of 392 per 100,000, or roughly one in every 250 people).
• Across the UK, the number of people to have tested positive in the past 7 days is 322,170 – 93,981 more people testing positive in the week compared to the previous week (a 41% increase). After a slower increase last week (28%), the rate of increase seems to be picking up again. The ONS estimate that in England in the week to 3rd July, 1 in every 95 people had the virus (compared to 1 in 160 the week before)
• 35 patients were admitted/diagnosed in hospital with Covid-19 in the week to the 11th July – compared to 26 in the week to the 4th July, and just 2 patients in the week to 2nd June). It still seems to be the case that most people are being discharged fairly quickly, however. There are 10 people in Gloucestershire hospitals with Covid-19 (as of 13th July, the most recent data). This is lower than the 14 last week, and there are no patients in mechanical ventilation beds (hopefully the person who was in one till the 7th July is recovering).
• The number of people in hospital with the virus nationally has been rising. At 4,094 on the 16th July, it is more than double the 1,996 on the 2nd July (14 days later). We know hospitalisations lag infections, so this number can be expected to continue rising for at least a few weeks. If the number doubles again in the next fortnight, there will be as many people in hospital as on the 22nd October 2020 – which was 10 days before the second lockdown was introduced.
• Across Stroud district, around 60% of the population are fully vaccinated, with a further 14% having received a first but not a second dose. People aged 18-29 have only recently started to be invited, but already 70% have had a first dose.
• There is a long way to go globally before the pandemic is over. The number of people testing positive has been rising since June 19th to 515,000 daily (7-day-rolling average to July 18th) – driven by rises in countries across Asia, Europe, Africa, and North America.
• Further detail and charts on the above and more are below.

The first chart shows a comparison of the key data for Gloucestershire. you can see how the number of people testing positive has shot up recently – to around the numbers seen in January. The age profile is very different – in large part because of vaccination, and – so far – far fewer people are ending up in hospital – again, in part because many people are vaccinated, and experiencing milder cases if they test positive as a result (though, as we can see with the delay in the ‘second wave’, it may still be too early to tell if we will avoid another ‘wave’ of people in hospital as well we testing positive locally. Though two people did die with Covid-19 mentioned on their death certificate in the week ending on the 26th June, there’s little sign of a local increase yet (although based on the delay we can see in the ‘second wave’ it could be too early to tell yet…)

People who have tested positive

Rates are highest in the Forest of Dean and Gloucester, but they are rising in Stroud district too. Across Gloucestershire the number of people to test positive in the most recent week is around 315 per 100,000 people or roughly one in every 317 people. There’s some sign rates are stalling or dropping in Tewkesbury – though again it’s probably still too early to say for definite, as you can see on the chart – where Stroud district, Cheltenham, and Gloucester all experience declines before dramatic rises started again (this could be because of transmission being interrupted by isolation, but some infections still getting out again… or it could be because people delayed getting tested, only to pass on the virus while waiting for a PCR result). You can view daily numbers for Gloucestershire, or districts within it, on the government’s dashboard, and there is more information below.

The number of people testing positive by PCR or Lateral Flow Device in Gloucestershire has risen substantially but may be slowing down – 2,009 people tested positive for the first time in the week to 14th July. The only week when more people living in Gloucestershire tested positive was the peak in the week to 1st January. We’ve no expertise in predicting when this wave will peak, though see some further analysis from ZOE below. The age profile of those testing positive in the current ‘wave’ is very different to January – 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. Over the week to the 14th July, 1,898 people aged under 60 tested positive (95% of those to test positive), compared to 110 people aged 60 or over (5% of the total). We would expect, that these people will be less likely to need to be admitted to hospital (and the data below appears to bear out so far – though there is a lag, and cases are clearly rising among people aged 60 and over now – if not as extremely dramatically among 20-24s).

The highest rate in Gloucestershire is in Cinderford – where 114 people have tested positive in the past week (up 94! on the previous week), giving a rate of 870 per 100,000 (or more than 1 in every 115 people). The government’s interactive map now shows people testing positive in every part of Stroud district – the area with the highest rate is Dursley, with 30 people testing positive in the past week (more than double the 11 in the previous week, giving a rate of 392 per 100,000, or roughly one in every 250 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 (though more people are getting tested). There has been a notable rise in the proportion of tests that return positive results (7.8% of the 26,348 people tested by PCR in the 7 days to 14th July 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:

• The number of people being tested is falling. It’s not the case that we’re only finding more cases because more people are being tested.
• The proportion testing positive is continuing to rise. At the level being reached, this suggests cases might be being missed (the WHO suggests this can be the case when the proportion rises above 5%). The proportion is close to as high as it was in the January peak when testing capacity was overloaded.
• 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, 239 people tested positive in the most recent week – to 7th July. This is, thankfully, not another doubling since the previous week. Nonetheless, there have only been 1 week 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) – and more people will have had the virus in the first wave but not been tested.

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 605 people with active symptomatic infections in the district – down 66 on a week ago, but down by more from the recent ‘peak’ of 730 by their measure. Again, while the rate can turn sharply, with restrictions being loosened it seems plausible rates will increase again in the days and weeks to come (hard to see on the first graph below but the fall has already stopped – see second chart below, which covers only April to July (and looks much more like the trend on the testing positive chart above).

Local Hospitals

There were 10 people in Gloucestershire Hospitals with COVID-19 as of the 13th July, down from 15 the week before. This compares to around 800 patients in Gloucestershire Royal and Cheltenham General hospitals General and Acute beds in total. We wish all patients in local hospitals well.

The chart below shows how the number of people being admitted /diagnosed over the previous 7 days period (35 in the week to the 13th July) has fluctuated recently but is starting to show signs of a slowly rising trend. 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 as dramatic an increase in the number of people admitted to/in hospital. It’s clear most people are being discharged fairly quickly at the moment as only 10 people are in hospital despite 108 being admitted in the past month.

Vaccinations

• Everyone 18 or over should’ve been contacted by their GP surgery and invited to book their vaccination at either The Vale, Beeches Green or Rowcroft, depending on which surgery they’re registered with. If anyone has not been contacted, please ring your GP.
• Alternatively, use the national booking system for other sites (including beyond Stroud district) or “Find a walk-in coronavirus (COVID-19) vaccination” website and enter your postcode to find dates and times of sessions and the vaccines being offered (first doses or seconds eight weeks after your first, Pfizer, AZ, or Moderna – the latter in Bristol at least)
• The Joint Committee on Vaccination and Immunisation has issued new advice that some children should be offered vaccination for COVID-19. Government hasn’t adopted this advice yet, but they’ve implemented the rest of what the JCVI have said, so it’ll be a matter of time. The JCVI list is:
  • children and young people aged 12 years and over with specific underlying health conditions that put them at risk of serious COVID-19,
  • children and young people aged 12 years and over who are household contacts of persons (adults or children) who are immunosuppressed
  • children who are within three months of their 18th birthday

Data from the NHS on vaccinations shows that:

Across Stroud district, around 60% of the population are fully vaccinated, with a further 14% having received a first but not a second dose. People aged 18-29 have only recently started to be invited, but already 70% have had a first dose.

Rates are slightly lower across Gloucestershire, the South West, and England as a whole – where 52% are fully vaccinated and 16% have had one dose (leaving 32% unvaccinated – many of whom are not eligible due to being under 16). Rates locally and nationally are much higher than for the world as a whole – where only 12% are fully vaccinated and just 1 in 4 have received at least one dose.

As of the 23rd May (the most recent available data) there had been 825,498 Covid-19 vaccine doses delivered in Gloucestershire. 14.986 doses were delivered in the week, making it the ‘slowest’ week for doses we have data for. Roughly the same number of people have received a second dose as received a first 9 weeks ago (360,499 compared to 362,871).

What has the impact of these vaccinations been? The chart below, from Gloucestershire Hospitals (shared by both their Chief Nurse and ICU consultant Dave Windsor) compared the Covid vaccination status of the adult Gloucestershire as of July 2021 with the same status for admissions for Covid to the hospitals between April and July 2021 (with around 65% of adults double vaccinated, and another 20% sinble vaccinated, leaving 15% of adults unvaccinated). Around 65% of admissions have been unvaccinated people – though they only make up 15% of adults. On the other hand, only 15% of admissions have been in double vaccinated people, even though they make up 65% of adults, and include the people most at risk from the virus.

Public Health England are publishing weekly estimates of vaccine effectiveness based on stuies on the real-world data. The latest report (to 15th July) shows, for example:

• One dose of either Pfizer or AstraZeneca reduces mortality by 70-85% (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 to medium confidence)

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). And check out our previous video with Dr Jim Holmes and Practice Manager Karen Pitney from Rowcroft Medical Centre on “why you should get vaccinated“.

If you’ve had your jab recently, please do read advice on continuing to be cautious immediately after receiving your vaccination.

National context

You can see a summary of the trends on the government dashboard at this link, and watch the government press conference in the video below:

Across the UK, the number of people to have tested positive in the past 7 days is 228,189 – 50,061 more people testing positive in the week compared to the previous week (a 28% increase). While the number testing positive each week is still rising, it is rising at a slower rate (67% increase last week).

Using a logarithmic plot to show exponential growth rates, cases are rising on trend, and if they continue to do so will have hit 50,000 a day today (July 19th – the data from specimens submitted for testing today obviously isn’t in yet). After a hint of a slowdown a week ago, the seven day average is now rising fast again. If sustained, a doubling time of 16 days would lead to around 200,000 people testing positive a day in around a month…

Across the UK, the KCL/ZOE app team estimate around 471,794 people had a symptomtic infection on the 19th July, based on symptom reporting by up to 4.6 million app users. This is a small increase on 452,757 last week (12th July), far from the doubling we saw ta few weeks ago. Nonetheless, it is now over half the peak in January (801,461). Based on the reporting of symptoms and positive test results, Zoe estimate positivity rates much higher among unvaccinated people, and lowest among those fully vaccinated (and Zoe report that there are less severe infections).

The number of people in hospital with the virus nationally has been rising. At 4,094 on the 16th July, it is more than double the 1,996 on the 2nd July (14 days later). We know hospitalisations lag infections, so this number can be expected to continue rising for at least a few weeks. If the number double again in the next fortnight, there will be as many people in hospital as on the 22nd October 2020 – which was 10 days before the second lockdown was introduced.

The number of patients being admitted is rising fast – 4,317 in the last 7 days. The daily number of 742 on the 13th July is the highest daily number since 834 people were admitted on the 2nd March, and is more than double the 364 on the 29th June (doubling in 14-15 days). 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: 673 on the 16th July, around double the 336 on the 4th (doubling in 12 days). This is still some distance from the peak of 4,077 people on 24th January 2021, but only 3 doublings away. The lowest last summer was 60 on 28th August. We send our best for the recovery of all Covid-19 patients in hospital.

The numbers of people dying are still relatively low – 131 people had Covid-19 mentioned on their death certificate in the week to 2nd July. 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 rising – 296 in the week to 19th July, compared to 200 in the week to 12th July. 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 (week to the 21st January).

The government’s 12th July press confernce included the following slide presented by Chris Whitty – showing that, by comparison with the Autumn wave, the number of cases is rising in a similar way (despite fewer restrictions, and a more transmissable variant – but offset by the number of people who are now vaccinated), though less quickly – as we’d expect thanks to vaccination reducing the level of risk.

However, as John Burn Murdoch from the Financial Times notes, in England, “hospital & ICU admissions are now above the level where restrictions were introduced last year and continue to rise at the same rate as in previous waves” (a phenomenon visible when plotting on a log scale to see the rate of change, even though raw numbers are lower)

International context

John Burn Murcoch provides two further important charts, showing the “stark divide in outcomes between countries with high vaccine coverage and those without”.

the chart shows how “In two well-vaccinated European countries [the UK and Portugal], weeks of surging cases [blue shapes] are reflected by only a sliver of deaths [red shapes]. In eight countries where very few are vaccinated, surging cases are mirrored in surging deaths as before” [Namibia, Tunisia, South Africa, Georgia, Malaysia, Russia, Indonesia and Zimbabwe]

Burn Murcoch continues: “For those of us in the UK, US and Europe it’s easy to feel like the pandemic is on its way out. But tell that to the people of Gauteng province in South Africa (home to Johannesburg and Pretoria), where the current wave has produced more deaths than any wave before.” [chart also shows has produced more covid patients in hospital, and a much higher number of people testing positive, than in previous waves too]

The number of people testing positive has been rising since June 19th to 515,000 daily (7-day-rolling average to July 18th)

The numbers of people dying with their deaths attributed to Covid-19 continue to rise, particularly in South America, Asia, and Africa.

In terms of the number of confirmed COVID-19 deaths relative to the population, the United Kingdom has a fairly high rate (1,900 – around one in every 525 people), but lower than the worst hit countries – such as Peru (5,916 per million, or around one in every 170 people), Hungary (3,107), Bosnia and Herzegovina (2,946), and Czechia (2,833). The UK rate is lower than for the continent of South America (2,446 Covid-19 deaths per million), but slightly higher than that for the European Union as a whole (1,668), and for North America (1,541) 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 death rates – including Germany (1,090 – not much over half the UK rate), or much lower rates – Finland and Norway have rates 10 times lower than the UK (177 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 (68% of population) – behind only a few countries such as Canada (69%), Chile (69%) and UAE (76% – see the chart below). The UK’s rate for full vaccination (53%) is also very high in terms of global comparisons: three times as high as across South America (17%), and more than 5 times higher than the proportion across Asia (9.6%). Across Africa, just 3% of the population have received any vaccination, and only 1.4% 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: 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.

Book a test via this link. 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.

Whether or not you have symptoms, please still follow the public health advice 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.

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.

Current government guidance and changes to it:

Read the latest announcement on changes to guidance in full – below are the introductory sections: “While cases are high and rising, everybody needs to continue to act carefully and remain cautious. This is why we are keeping in place key protections:

• testing when you have symptoms and targeted asymptomatic testing in education, high risk workplaces and to help people manage their personal risk.
• isolating when positive or when contacted by NHS Test and Trace.
• border quarantine: for all arriving from red list countries and for those people not fully vaccinated arriving from amber list countries.
• cautious guidance for individuals, businesses and the vulnerable whilst prevalence is high including:
  • whilst Government is no longer instructing people to work from home if they can, Government would expect and recommend a gradual return over the summer
  • Government expects and recommends that people wear face coverings in crowded areas such as public transport;
  • being outside or letting fresh air in
  • minimising the number, proximity and duration of social contacts.
  • encouraging and supporting businesses and large events to use the NHS COVID Pass in high risk settings. The Government will work with organisations where people are likely to be in close proximity to others outside their household to encourage the use of this. If sufficient measures are not taken to limit infection, the Government will consider mandating certification in certain venues at a later date.

Although most legal restrictions have been lifted at step 4, and many people have been vaccinated, it is still possible to catch and spread COVID-19, even if you are fully vaccinated, and we are still in the third wave of this pandemic in the UK.

COVID-19 will be a feature of our lives for the foreseeable future, so we need to learn to live with it and manage the risk to ourselves and others.

As COVID-19 restrictions are lifted, it is important that we all use personal judgement to manage our own risk. All of us can play our part by exercising common sense and considering the risks. While no situation is risk free, there are actions we can take to protect ourselves and others around us. Following this guidance will help you stay safe and protect others by controlling the spread. Every action to help reduce the spread will reduce any further resurgence of the virus in the coming months.”

Lifting restrictions

“Most legal restrictions to control COVID-19 have been lifted at step 4. This means that:

• You do not need to stay 2 metres apart from people you do not live with. There are also no limits on the number of people you can meet.
• However, in order to minimise risk at a time of high prevalence, you should limit the close contact you have with those you do not usually live with, and increase close contact gradually. This includes minimising the number, proximity and duration of social contacts.
• You should meet outdoors where possible and let fresh air into homes or other enclosed spaces.
• The Government is no longer instructing people to work from home if they can. However, the Government expects and recommends a gradual return over the summer.
• The requirement to wear face coverings in law has been lifted. However, the Government expects and recommends that people wear face coverings in crowded areas such as public transport.
• There are no longer limits on the number of people who can attend weddings, civil partnerships, funerals and other life events (including receptions and celebrations). There is no requirement for table service at life events, or restrictions on singing or dancing. You should follow guidance for weddings and funerals to reduce risk and protect yourself and others.
• There are no longer restrictions on group sizes for attending communal worship. COVID-19 has not gone away, so it’s important to remember the actions you can take to keep yourself and others safe. Everybody needs to continue to act carefully and remain cautious.”