COVID-19 Statistical Report, Public Health Scotland, As at 26 September 2022
Summary
A COVID-19 Statistical Report from Public Health Scotland, as at 26 September 2022, published 28 September 2022 as a Management Information release for Scotland. Its main points state that in the week ending 13 September 2022 an estimated 98,800 people in Scotland tested positive (1.88% of the population, around 1 in 55), that in the week ending 25 September 2022 there were 248 new COVID-19 hospital admissions, an average of 664 patients in hospital (a 5.2% increase from 631) and 8 new ICU admissions, and that in the week ending 18 September 2022 there were 40 deaths involving COVID-19. It also reports 3,007 reported positive cases in the week ending 25 September 2022 and a UKHSA consensus R estimate of between 0.9 and 1.1 as at 30 August 2022. Further sections cover variants, vaccination, vaccine effectiveness and COVID-19 in pregnancy, with four appendices.
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Public Health Scotland COVID-19
Statistical Report
As at 26 September 2022
A Management Information release for Scotland
Publication date: 28 September 2022
Translations and other formats are available on request at:
phs.otherformats@phs.scot
0131 314 5300
Public Health Scotland is Scotland's
national agency for improving and
protecting the health and wellbeing
of Scotland's people.
© Public Health Scotland 2022
This publication is licensed for re-use
under the Open Government Licence v3.0.
For more information, visit
www.publichealthscotland.scot/ogl
www.publichealthscotland.scot
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This is a Management Information Publication
Published management information are non-official statistics which may be in the
process of being transitioned into official statistics. They may not comply with the UK
Statistics Authority’s Code of Practice with regard to high data quality or high public
value but there is a public interest or a specific interest by a specialist user group in
accessing these statistics as there are no associated official statistics available.
Users should therefore be aware of the aspects of data quality and caveats
surrounding these data, all of which are listed in this document. Therefore, the data
presented are subject to change.
Find out more about Management Information on the UK Statistics Authority
website.
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Contents
This is a Management Information Publication 3
Introduction 5
Main Points 6
Incidence of Variants of Concern and Variants Under Investigation 7
Estimated Infection Levels 8
Reported COVID-19 Cases 13
Severity of Illness 16
COVID-19 Vaccine 25
Flu and COVID-19 Winter 2022 Vaccinations 26
Vaccine Effectiveness 28
COVID-19 Infection in Pregnant Women and Neonates 36
COVID-19 Vaccination in Pregnancy 49
Wider Impact of COVID-19 58
Contact 60
Further Information 60
Next Release 60
Open Data 61
Rate this Publication 61
Appendices 62
Appendix 1: Testing Policy in 2022 62
Appendix 2: Wastewater Analysis Notes 62
Appendix 3: Notes 63
Appendix 4: Early Access Details 66
4
Introduction
This report aims to present accurate, timely and relevant information on the status of
the pandemic as we have now transitioned from an emergency response to living
with COVID-19.
Public Health Scotland (PHS) monitor a number of key indicators to assess the
impact of the virus, including demands on the health system. COVID-19 testing
policy changes mean we have now moved to targeted testing of specific groups,
and because of this, there has been a reduction in the quantity and quality of
available testing data. Caution is therefore advised when making comparisons
between metrics and comparing trends over time.
This report summarises the current COVID-19 data in Scotland, presenting statistics
on estimated infection levels from the ONS COVID Infection Survey, which is
currently our best understanding of community population prevalence. The report
also presents data on wastewater infection levels, reproduction (R) number, reported
COVID-19 cases, COVID-19 hospital and ICU admissions and COVID-19 vaccine
effectiveness.
Additional information and supporting data can be found in the following places:
• COVID-19 Statistical Report interactive dashboard
• Public Health Scotland COVID-19 Dashboard updated weekly
(Wednesday)
• Deaths involving coronavirus in Scotland – National Records of
Scotland
• Coronavirus (COVID-19) Modelling the Epidemic - Scottish Government
• Enhanced Surveillance of COVID-19 in Scotland
• Hospital Onset COVID-19 Cases in Scotland
• Coronavirus (COVID-19) Infection Survey - Office for National Statistics
5
Main Points
• In Scotland, in the week ending 13 September 2022, the estimated number of
people testing positive for COVID-19 was 98,800 (95% credible interval:
80,300 to 119,100), equating to 1.88% of the population, or around 1 in 55
people (Source: Coronavirus (COVID-19) Infection Survey, UK - Office for
National Statistics)
• In the latest week ending 25 September 2022, there were 248 new COVID-19
admissions to hospital
• In the week ending 25 September 2022, there were on average 664 patients
in hospital with COVID-19, a 5.2% increase from the previous week ending 18
September 2022 (631)
• In the week ending 25 September 2022 there were 8 new admissions to
Intensive Care Units (ICUs) with a laboratory confirmed test of COVID-19, a
decrease of 9 from the previous week (18 September 2022)
• In the week ending 18 September 2022, there were 40 deaths involving
COVID-19 (the same as the previous week) (Source: National Records of
Scotland)
• By week ending 25 September 2022, 308,351 eligible adults received a Flu
vaccine, 288,199 eligible people received a COVID-19 vaccine and 93.7% of
COVID-19 vaccines were co-administered with Flu at the same vaccine
appointment
• To date, 45,098 COVID-19 vaccinations have been given in 32,314
pregnancies to 31,903 women, COVID-19 cases occurring in unvaccinated
women are much more likely to be associated with a hospital or critical care
admission. Among the 149 confirmed cases of COVID-19 in pregnancy
occurring in December 2020 to April 2022 that were associated with a critical
care admission, 129 (87%) occurred in unvaccinated women
6
Incidence of Variants of Concern and Variants Under
Investigation
On 18 May 2022, the UK Health Security Agency (UKHSA) designated COVID-19
variants Omicron BA.4 and Omicron BA.5 variants of concern (VOCs). This was
based on observed growth and Omicron BA.5 is now the predominant variant in
Scotland.
Public Health Scotland (PHS) continues to monitor COVID-19 variants of concern, in
collaboration with other Public Health Agencies in the UK.
The latest information on the number of such variants detected by genomic analyses
across the UK is published by UK Health Security Agency (UKHSA).
7
Estimated Infection Levels
Infection survey
The Office for National Statistics (ONS) publish results from the COVID-19 Infection
Survey which aims to estimate how many people test positive for COVID-19 infection
at a given point. The ONS survey results are Scotland’s current best understanding
of community population prevalence.
The Infection Survey invites private residential households to test whether they have
the infection, regardless of whether they have symptoms, using a PCR test. Data are
based on confirmed positive COVID-19 test results of those living in private
households, excluding those living in care homes or other communal establishments.
All data are provisional and subject to revision.
Figure 1 below shows the trend in official weekly reported estimates of the
percentage of people living in private residential households in Scotland testing
positive for COVID-19.
In the most recent week (07 September 2022 to 13 September 2022), the estimated
percentage of the population living in private residential households that had COVID-
19 was 1.88% (95% credible interval: 1.53% to 2.26%). The percentage of people
testing positive for COVID-19 decreased in Scotland in the most recent week.
There is a degree of uncertainty in these estimates as indicated by the credible
intervals; results should be interpreted with caution.
In the same week, the ONS estimate that 98,800 people (95% credible interval:
80,300 to 119,100)2 living in private residential households in Scotland at any given
time had COVID-19. This represents around 1 in 55 people (95% credible interval: 1
in 65 to 1 in 45 people)2.
For more details and further breakdowns on the Infection Survey please refer to
Coronavirus (COVID-19) Infection Survey, UK - Office for National Statistics.
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Figure 1: Trend of official weekly reported estimates of the
percentage of people living in private residential households in
Scotland testing positive for COVID-19 (as at 13 September 2022)
Source: Coronavirus (COVID-19) Infection Survey, UK - Office for National Statistics.
2 - A credible interval gives an indication of the uncertainty of an estimate from data analysis based on a sample population.
95% credible intervals are calculated so that there is a 95% probability of the true value lying in the interval.
In the same week, estimates for the other nations of the UK can be seen in Figure 2.
The percentage of people testing positive for coronavirus (COVID-19) increased in
England and Wales, and decreased in Northern Ireland and Scotland in the most
recent week.
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Figure 2: Trend of official weekly reported estimates of the
percentage of people living in private residential households in the
UK testing positive for COVID-19, by UK nation (as at 13 September
2022)
Reproduction (R) number
These data are updated every two weeks and will next be refreshed within this report
on 05 October 2022.
The reproduction (R) number is the average number of secondary infections
produced by a single infected person. The R number is a useful measure in
assessing if the epidemic is growing or shrinking. If R is greater than one the
epidemic is growing, if R is less than one the epidemic is shrinking. The higher the R
is above one, the more people an infectious person is likely to further infect.
Please note that R lags by two or three weeks.
Figure 3 below shows the trend of The UK Health Security Agency’s (UKHSA)
consensus estimate for R in Scotland. As at 30 August 2022 (reported 15 September
2022) the UKHSA’s consensus estimate is between 0.9 and 1.1. The lower and
upper limits of the R value have increased since the last publication.
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For more information, please visit the UK Government website.
Figure 3: R estimate in Scotland over time by reporting date
Source: COVID-19 Modelling the Epidemic
Wastewater analysis
These data are updated every two weeks and will next be refreshed within this report
on 05 October 2022.
COVID-19 outbreaks and general trends can be monitored by measuring
concentrations of the virus in wastewater. Sewage samples are taken from sample
sites across Scotland and used to calculate the number of COVID-19 markers,
reported as million gene copies per person per day (Mgc/p/d). Samples are
representative of wastewater from between 70-80% of the Scottish population. Data
are adjusted for population and environmental factors such as flow through the
sewage works, which is affected by rainfall. See Appendix 2: Wastewater analysis
notes for more information.
Figure 4 shows the national running average trends in wastewater COVID-19 from
the beginning of 2022. In Scotland, during the period 27 August to 9 September,
Wastewater Covid-19 levels remained in the range of 52 to 92 million gene copies
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per person per day (Mgc/p/d), compared to the previous two-week period (12 August
to 26 August) of 50-70 Mgc/p/d.
Figure 4: Average trends in wastewater COVID-19 from 03 January
2022 to 08 September 2022
Source: COVID-19 Modelling the Epidemic
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Reported COVID-19 Cases
While the ONS COVID-19 Infection Survey is our best understanding of community
population prevalence, monitoring the number of reported positive COVID-19 cases
offers a valuable early insight into trends of infection rates in Scotland because
LFD/PCR data precedes the ONS data by approximately two weeks.
The purpose of COVID-19 testing has now shifted from population-wide testing to
reduce transmission, to targeted, symptomatic testing in clinical care settings
which has led to a reduction in the quantity and quality of available testing data. This
makes it difficult to draw any conclusions from these data on community prevalence
and caution is therefore advised when making comparisons between metrics and
comparing trends over time.
Data are continuously updated, therefore figures for previous weeks may differ from
published data in previous weeks’ reports. For more information, please see
Appendix 1: Testing Policy in 2022.
In the week ending 25 September 2022, there were 3,007 reported positive COVID-
19 cases. Figure 5 below shows the weekly trend in positive cases reported with a 4-
week average from October 2020 to September 2022.
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Figure 5: Number of positive cases per week with 4-week average,
by specimen date
1 Correct as at 27 September
2 Data are continuously updated, therefore, figures for previous weeks may differ from published data in the previous week’s
report.
Trend data since the start of the outbreak can be found on the Public Health
Scotland COVID-19 Dashboard. Additional breakdowns and longer term trends can
also be found on the COVID-19 Statistical Report interactive dashboard.
Of the 3,007 positive cases, 2,315 (77%) were reported using an LFD test and 692
(23%) were reported using a PCR (polymerase chain reaction) test. Figure 6 below
illustrates the trend of test type used and shows the number of positive PCR and
LFD tests recorded have remained low in recent weeks.
Furthermore, 70.7% (2,127) of reported positive cases were taken at home.
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Figure 6: Number of cases by test type, week ending 03 April 2022
to 25 September 2022, by reporting date
In the week ending 25 September 2022, 49.6% of the reported cases were assigned
to the LFD Universal Offer. These data rely on individuals accurately recording their
testing reason via the gov.uk website.
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Severity of Illness
COVID-19 hospital admissions
Alongside the estimated infection levels and reported COVID-19 cases presented
earlier in the report, it is important to monitor COVID-19 hospital admissions as it is a
measure of severe disease and captures pressures facing NHS hospitals.
This section of the report now presents statistics on PCR confirmed community-
acquired infections admitted as an emergency to medical specialties (excluding
admission types specifying an injury-related admission). This new method is a more
robust, real-time indicator of COVID-19 hospital admissions ‘because of’ COVID-19.
Figure 7 below shows the weekly trend of COVID-19 hospital admissions from week
ending 03 January 2021 to 25 September 2022.
In the latest week ending 25 September 2022, there were 248 new COVID-19
admissions to hospital. Hospital admissions for the most recent week are provisional
and should be treated with caution. At the time of publication there were no data
available for three NHS Boards, and the previous week’s figures have been rolled
forward. These provisional data will be refreshed next week. More information can
be found in Appendix 3: Notes.
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Figure 7: Trend of COVID-19 hospital admissions in Scotland
Source: RAPID (Rapid and Preliminary Inpatient Data)
Correct as at 27 September 2022, most recent week of data is provisional and previous weeks’ data may differ from previously
published data.
* Changes in hospital testing policy in Scotland from 28 September 2022. For more information, please see Appendix 1:
Testing policy in 2022
Figure 8 below shows the rate of COVID-19 admissions per 1,000 emergency
admissions to hospital by age. In the latest week ending 25 September 2022, for
every 1,000 emergency admissions there were 31 COVID-19 admissions (3.1%) in
all age groups. In the same week, the 80+ age group had the highest rate of COVID-
19 admissions (4.9%) and the 50-54 age group had the lowest rate (1.3%).
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Figure 8: Rate of COVID-19 hospital admissions per 1,000
emergency admissions by age band, weeks ending 04 September
2022 to 25 September 2022
Source: RAPID (Rapid and Preliminary Inpatient Data)
* Most recent week of data is marked as provisional. Please refer to Appendix 3: Notes for explanatory notes regarding
RAPID hospital admissions
Denominator data is sourced from RAPID and includes all emergency admissions to hospital for any reason
Length of stay of COVID-19 hospital admissions
While there are a variety of factors influencing the length of time a patient spends in
hospital (for instance: age, reason for admission, co-morbidities and hospital
pressures), monitoring the length of stay of admissions is important to assess the
burden on NHS hospitals.
Figure 9 below shows the breakdown of length of stay by proportion of all COVID-19
stays in hospital.
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In the latest week ending 25 September 2022, 72 stays (43.9%) were greater than or
equal to 48 hours, whereas 52 stays (31.7%) were less than 24 hours. Figure 9
below shows the trend over time of length of stay of all hospital stays.
Please note, longer term trends on LOS in all age groups can be found on our
interactive dashboard, in the severe illness tab.
Figure 9: Length of stay of COVID-19 admissions in Scotland,
weeks ending 03 January 2021 to 18 September 2022
Figure 10 below shows that the length of stay of COVID-19 hospital admissions
tends to increase with age. In the latest week, 59.6% of hospital stays in the 80+ age
group were equal to or greater than 48 hours, while 56.0% of hospital stays in the
Under 18 age group were fewer than 24 hours in length.
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Figure 10: COVID-19 hospital admissions by length of stay and age
group, week ending 18 September 2022
Source: RAPID (Rapid and Preliminary Inpatient Data)
Please refer to Appendix 3: Notes for explanatory notes regarding RAPID hospital admissions.
Hospital occupancy (COVID-19 patients in hospital)
The number of COVID-19 patients in hospital is an indicative measure of the
pressure on hospitals, as these patients still require isolation from other patients for
infection control purposes.
Information is collected from NHS Boards on the number of COVID-19 patients in
beds at 8am the day prior to reporting.
Figure 11 shows a snapshot of the number of patients in hospital with COVID-19
along with the seven-day average each Sunday. Following a fall in cases since mid-
July, the average number of patients in hospital with COVID-19 has continued to be
similar each week throughout September.
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In the most recent week ending 25 September 2022, on average there were 664
patients in hospital with COVID-19 which is a 5.2% increase from the previous week
ending 18 September 2022, when on average there were 631 patients.
Alternative daily breakdowns of this data are available on the COVID-19 dashboard.
Figure 11: Number of beds occupied with COVID-19 in hospital
each Sunday in Scotland from 17 September 2020 to 25 September
2022
Intensive Care Unit (ICU) admissions
The severity of COVID-19 varies from very mild symptoms through to those who
require intensive care treatment and supported ventilation. Monitoring the admission
frequency to critical care units in Scotland (ICU) is therefore an important measure of
the severity of COVID-19. All patients admitted to ICU are routinely tested using a
PCR test.
Figure 12 below shows the weekly trend of new SARS-CoV-2 PCR positive
admissions to ICU. Following a fall in the number of new ICU admissions since July,
the average number of ICU admissions has continued to be similar each week in
September.
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In the week ending 25 September 2022 there were 8 admissions to ICU, a decrease
of 9 from the previous week (18 September 2022) when there were 17 admissions.
Figure 12: Weekly trend of COVID-19 ICU admissions in Scotland
Table 1 below shows the daily average number of patients in ICU and HDU in the
week ending 25 September 2022. Over the past week there were on average 209
patients in ICU, of which 6.7% (14 patients) had a positive SARS-CoV-2 result.
Table 1: Average number of patients in ICU and HDU by SARS-CoV-
2 result, week ending 25 September 2022
SARS-CoV-2 7 day average ICU 7 day average HDU
Result patients patients
Positive 14 (6.7%) 10 (5.3%)
Negative 143 (68.4%) 108 (57.4%)
Unknown 52 (24.9%) 70 (37.2%)
Total 209 (100.0%) 188 (100.0%)
Intensive Care Unit (ICU) occupied beds
Figure 13 below shows the daily trend in the number of ICU beds by SARS-CoV-2
PCR status and the clinical diagnosis on ICU admission from the start of the
22
pandemic to 25 September 2022. Most ICU SARS-CoV-2 inpatients have a non-
COVID-19 or unknown clinical diagnosis, and those with a clinical diagnosis of
COVID-19 remain low.
All data are recorded in the Scottish Intensive Care Society Audit Group (SICSAG)
database and extracted from WardWatcher. Every Monday, a full extract up until the
most recent Sunday is taken from WardWatcher. Therefore, any subsequent
changes that are made locally following that extract, will be reflected in future
reports. See Appendix 3: Notes for further definitions.
Figure 13: Daily number of ICU beds occupied by patients by
SARS-CoV-2 PCR status3 and clinical diagnosis from 01 March
2020 to 25 September 2022
3 In the SARS-Cov-2 PCR positive with non-COVID-19/unknown diagnosis group, the diagnosis is unknown in less than 5% of
patients
Deaths involving COVID-19
National Records of Scotland publish weekly information on deaths involving COVID-
19. These are deaths where COVID-19 has been identified as being involved in the
death by a doctor, either as the underlying cause of death or as a contributory cause
of death.
23
In the week ending 18 September 2022, there were 40 deaths where COVID-19 was
mentioned on the death certificate (with or without laboratory diagnosis). Of these
deaths, there were 16 (40%) deaths where COVID-19 was the underlying cause of
death. The number of deaths involving COVID-19 has generally remained steady in
recent weeks.
There were 0 fewer deaths in the week ending 18 September 2022 compared to the
week prior (40 deaths in the week ending 11 September 2022).
In addition to reporting on the number of deaths involving COVID-19, National
Records of Scotland publish excess mortality statistics. This is another important
measure as it presents seasonal variation in deaths and describes the difference
between the number of deaths in the current year and the ‘expected number of
deaths’.
Further breakdowns of deaths involving COVID-19 and excess mortality can be
found on NRS website.
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COVID-19 Vaccine
On 08 December 2020, a COVID-19 vaccine developed by Pfizer BioNTech was first
used in the UK as part of national immunisation programmes. The AstraZeneca
(Vaxzevria) vaccine was also approved for use in the national programme, and
rollout of this vaccine began on 04 January 2021. Moderna (Spikevax) vaccine was
approved for use on 08 January 2021 and rollout of this vaccine began on 07 April
2021. These vaccines have met strict standards of safety, quality and effectiveness
set out by the independent Medicines and Healthcare Products Regulatory Agency
(MHRA).
For the latest information on COVID-19 vaccines, including information on eligibility,
please see our COVID-19 vaccine information and resources pages.
Information on uptake across the vaccine programme is available on a weekly basis
via the PHS COVID-19 Dashboard, every Wednesday at 12pm. This provides a
cumulative picture of the position nationally and locally.
The dashboard provides total uptake nationally with breakdowns by Joint
Committee on Vaccination and Immunisation (JCVI) age based cohorts and non-
age based cohorts for priority groups 1-9.
The vaccination content of this weekly publication is kept under continual review and
specific editions have contained more in-depth analyses of uptake by particular
groups or characteristics, including uptake by ethnicity and deprivation category, for
teachers, for prisoners and for pregnant women.
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Flu and COVID-19 Winter 2022 Vaccinations
The Winter 2022 Flu & COVID-19 vaccine programmes commenced at the start of
September 2022. Following advice from the Joint Committee on Vaccination and
Immunisation (JCVI), eligible groups are being invited for vaccination at different
times during September and October. Therefore, the data in this publication reflect
the numbers among those groups who have been invited for vaccination and for
whom this has been recorded.
The data presented indicate the estimated uptake of seasonal Flu (Adult 18+) and
COVID-19 vaccines from the current living Scotland population up to week 38 (week
ending 25th September 2022). Data on flu vaccine uptake for the childhood,
including the schools’ programme will be available in future weeks.
Table 1: Number of Flu and COVID-19 vaccinations administered to
eligible adults in Scotland by week to end of week 38, 2022*
Week Ending Flu (Adult 18+) COVID-19
11/09/2022 66,593 66,781
18/09/2022 62,260 61,461
25/09/2022 179,498 159,957
Total 308,351 288,199
Source: National Clinical Data Store
Date of extraction: 26/09/2022
*Figures are representative of the current living Scottish population. Deaths and leavers from Scotland have been removed.
Further information available in winter covid and vaccination dashboard.
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Co-administration
People eligible for a COVID-19 vaccine can also be given a Flu vaccine at the same
vaccination appointment. Of the 288,199 people vaccinated for COVID-19 by week
38 (week ending 25th September 2022), 93.7% were vaccinated for Flu at the same
vaccination appointment.
Table 2: Total number of influenza and COVID-19 vaccinations
administered to eligible adults in Scotland to week 38, 2022*
JCVI Group Flu (Adult 18+) COVID-19
Aged 65+ 202,363 (18.2%) 185,548 (17.4%)
Current residents of care 19,994 (70.1%) 19,158 (69.5%)
homes for older adults**
* Figures are representative of the current living Scottish population. Deaths and leavers from Scotland have been removed.
Other cohorts currently being invited for vaccination (including health and social care staff, pregnant women, and those at
clinical risk) will be presented in future weeks. The number of vaccines given to these eligible groups is presented in the total
number of vaccinations.
** Individuals currently living in Scotland and identified as permanent residents in a care home for older adults within the
Community Health Index (CHI) database. The CHI extract is updated on a monthly basis, the latest extract was taken 14th
September 2022. This cohort is a subset of 65+.
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Vaccine Effectiveness
Please note this is the last week that the Vaccine Effectiveness Section will be
published in the weekly COVID-19 statistical report. From next week, this
section will be located on the PHS website within the COVID-19 vaccine
surveillance webpages.
Public Health Scotland (PHS) in collaboration with EAVE II – Early Pandemic
Evaluation and Enhanced Surveillance of COVID-19 is monitoring the
effectiveness of all approved COVID-19 vaccines in Scotland and their impact on
infections and serious outcomes. Even with a highly effective vaccine, some
vaccinated individuals will develop COVID-19 and have severe outcomes of
infection.
Vaccine effectiveness is a scientific method used to measure how well a vaccine
protects people against infection, symptoms, hospitalisation, and death. PHS uses
methods to account for complicated vaccine and test data and better understand risk
factors for COVID-19 such as age, sex, prior infection, co-morbidities, socio-
economic status, time since vaccination, and virus variant. This method is the most
robust way to measure how well a vaccine is working.
Vaccinated individuals can still be infected with COVID-19
The current evidence suggests that you may test positive for COVID-19, or be
reinfected even if you are vaccinated, especially since the emergence of the
Omicron variant in the UK. The major benefit of COVID-19 vaccination is to protect
from severe disease, see below. For the latest COVID-19 guidance, please visit the
NHS Inform website.
COVID-19 vaccines protect most people against severe outcomes, but some
people will still get sick because no vaccine is 100% effective
Evidence suggests the COVID-19 vaccines are very effective at preventing a
severe outcome of COVID-19. COVID-19 hospitalisations and deaths are strongly
driven by older age, with most deaths occurring in those over 70 years old and those
28
with multiple other illnesses. Overall, you are less likely to be hospitalised if you
are vaccinated with a booster.
Vaccine effectiveness against symptomatic disease
Analyses from Scotland show that the booster and third dose of the COVID-19
vaccines are associated with 57% reduced risk of symptomatic infection with the
Omicron variant compared to those who are more than 25 weeks post-second dose
of COVID-19 vaccine. However, vaccine effectiveness against symptomatic infection
for the Omicron variant is thought to wane (reduce) over time. In children and
adolescents (12-18 years old), a study from the USA during the Omicron period
estimated effectiveness of two doses of Pfizer (Comirnaty) against symptomatic
infection was approximately 60% in the two to four weeks following dose two. This
decreased to between 17-29% two months after the second dose. Studies
comparing the Omicron variant sub-lineages known as BA.1 and BA.2 (VUI-22JAN-
01) show no difference in vaccine effectiveness against symptomatic disease (1, 2,
3, 4).
To note, the studies described above do not account for severity of symptoms. For
example, one person may only have mild symptoms such as a runny nose for one
day and another person severe symptoms such as long-term fatigue and breathing
issues. These people would have different outcomes of infection, but they would
both be recorded as having symptoms. This could result in an under or overestimate
of vaccine effectiveness.
Vaccine effectiveness against hospitalisation
A number of studies have found high levels of vaccine protection against COVID-19
hospitalisation with the Alpha and Delta variants (1, 2, 3, 4). Vaccine effectiveness
against hospitalisation with the Omicron variant is slightly lower than the Delta
variant, but the booster or third dose of COVID-19 vaccine still provides excellent
protection against COVID-19 related hospitalisation.
If people test COVID-19 positive on admission to hospital, it may not be the primary
reason for admission, and instead an incidental finding. This causes a problem when
trying to calculate vaccine effectiveness against COVID-19 hospitalisation as
29
inclusion of incidental cases may result in lower estimates than reality. To try and
account for this issue, the UK Health Security Agency (UKHSA) have conducted
studies using stricter definitions of COVID-19 hospitalisation to identify patients
hospitalised with severe respiratory disease and found that vaccine effectiveness
estimates against COVID-19 hospitalisation are high, with less evidence of vaccine
waning over time since vaccination.
In Finland, they are able to exclude incidental COVID-19 hospital admissions from
their analysis, and a study (preprint) of over 70 year olds found the COVID-19
vaccine was approximately 90% effective against COVID-19 hospitalisation in the
first few months following vaccination during the emergence of the Omicron variant.
In the USA, a study published in July 2022 examined emergency department/urgent
care visits and hospitalisations with a COVID-19 like illness across 10 states
between 18 December 2021 and 10 June 2022. They evaluated the vaccine
effectiveness of two, three, and four doses of COVID-19 vaccine (Pfizer (Comirnaty)
or Moderna (SpikeVax) compared with unvaccinated adults aged 18+, excluding
individuals who are immunocompromised. Vaccine effectiveness against
hospitalisation and emergency department/urgent care visits was lower during the
Omicron BA.2 period than the BA.1 period. However, a third vaccine dose was
associated with a higher vaccine effectiveness against emergency
department/urgent care encounters and hospitalisation with a COVID-19 like illness
during both periods. Similarly, a fourth dose increased this vaccine effectiveness
finding further among eligible adults aged 50 and over.
A collaborative study from Brazil and Scotland, observed waning vaccine
protection of Pfizer (Comirnaty) against symptomatic COVID-19 infection among
adolescents aged 12–17 years in Brazil and Scotland from 27 days after the second
dose. However, protection against severe COVID-19 outcomes (hospitalisation or
death) remained high (greater than 80%) at 98 days or more after the second dose
in the Omicron-dominant period for Brazil. The analysis of severe COVID-19
outcomes was restricted to Brazil due to the small number of severe outcomes in
adolescents aged 12–17 years Scotland.
30
A study in Singapore conducted between 01 January and 08 April 2022 (when
Omicron variant was spreading rapidly) assessed incidences of COVID-19-related
hospitalisations among children aged 5-11 years who were either unvaccinated,
vaccinated with one Pfizer (Comirnaty) dose or vaccinated with two Pfizer
(Comirnaty) doses. Vaccine effectiveness against hospitalisation was highest at
82.7% in children with two doses, compared with 42.3% in children with one dose of
Pfizer (Comirnaty).
Omicron BA.4 and Omicron BA.5 were designated as variants of concern on 18
May 2022 on the basis of an apparent growth advantage over the previously
dominant Omicron BA.2 variant. Omicron BA.5 is now the predominant circulating
variant in the UK. A study in England (preprint) estimated the vaccine
effectiveness against hospitalisation following infection with Omicron sub-lineages
BA.4 and BA.5 in those that received four doses of a COVID-19 vaccine. Compared
to BA.2, there was no evidence of reduced vaccine effectiveness against
hospitalisation for BA.4 or BA.5.
Vaccine effectiveness against death
Evidence has shown that vaccination is highly effective in protecting against death
from COVID-19. A small number of COVID-19 deaths are still expected in vaccinated
people, especially in vulnerable individuals where the vaccine or the immune
response may not have been effective.
A study in Israel found that adults who had received their Pfizer (Comirnaty) booster
dose five months after their second dose had a 90% lower risk of mortality due to
COVID-19 than adults who hadn’t received their booster dose five months after their
second dose.
Data from UKHSA also shows a vaccine effectiveness of approximately 85-98%
against mortality two weeks to three months following a primary course of Pfizer
(Comirnaty), with a COVID-19 booster of either Pfizer (Comirnaty) or Moderna
(Spikevax), when compared to unvaccinated people.
A study of electronic health records in Portugal (preprint) found that for Omicron
BA.5, vaccine effectiveness was 77% and 88% against COVID-19 hospitalization
31
and death respectively, in individuals that had received a booster. For Omicron BA.2,
vaccine effectiveness was 93% and 94% against COVID-19 hospitalization and
death respectively, for boosted individuals. Although less effective compared with
Omicron BA.2, COVID-19 booster vaccination still offers substantial post-infection
protection against severe outcomes following Omicron BA.5 infection.
Vaccine effectiveness in at-risk groups
Care Home Residents
A study from England (VIVALDI) found the COVID-19 vaccines were 85% effective
against COVID-19 hospitalisations and 94% against COVID-19 death among care
home residents between two and 12 weeks after the second dose. This declined to
54% against hospitalisations and 63% against death from 12 weeks after the second
dose. However, a booster vaccination restored protection with vaccine effectiveness
estimated to be 90% against hospitalisations and 98% against death among care
home residents.
In Israel, a study of people living in long-term care facilities compared those
who had received a fourth dose of Pfizer (Comirnaty) vaccine to those who had
received a third dose over the same time period. They found that those with a fourth
dose had a 34% increase in protection against infection, 64% to 67% increase in
protection against hospitalizations for mild-to-moderate and severe illness, and a
72% increase in protection against death up to four months after vaccination
compared to those that had three doses. Another study from Israel found similar
observations with a fourth dose of Pfizer (Comirnaty) conferring high protection
against COVID-19 hospitalization and death among residents of long-term care
facilities during the Omicron variant wave.
A study in Canada found similar improvements in protection when looking at over
60s in long term care facilities. A fourth dose improved protection against infection,
symptomatic infection, and severe outcomes during an Omicron dominant period,
compared to those with three doses.
32
Older Age Groups
Evidence from studies in Israel in over 60s who have had a fourth dose show greater
protection than those who have only had three doses, with reduction in severe
infection, hospitalisation, and death due to COVID-19 (1, 2, 3, 4, 5). A study in
Singapore showed similar results, finding that eligible adults over 80 who had
received a fourth dose of Pfizer (Comirnaty) or Moderna (Spikevax) had additional
protection against symptomatic infection, hospitalisation, and severe illness
compared with those who had only received three doses. This study was conducted
for the period April to June 2022 when the Omicron variant was dominant.
Other vaccine studies
A review by UKHSA shows that people who have had one or more doses of a
COVID-19 vaccine are less likely to develop long COVID-19 than those who remain
unvaccinated. In addition, a UK study found a 12.8% decrease in incidence of long-
covid after a first dose of vaccine, with further reductions after a second dose.
Vaccine effectiveness summary
UKHSA publish a summary of current vaccine effectiveness in their monthly
COVID-19 vaccine surveillance report. The latest evidence can be found below,
which suggests the COVID-19 booster/third dose vaccine lowers your risk of a
severe outcome compared to the second dose.
The Office for National Statistics (ONS) has also published research into the risk of
testing positive for COVID-19 by vaccination status and deaths involving COVID-
19 by vaccination status.
33
Figure 14: UKHSA consensus estimates of vaccine effectiveness against BA.1 or BA.2 Omicron for two
and three doses of COVID-19 vaccine compared to unvaccinated individuals
Booster data is based on use of the Moderna or Pfizer vaccines as a booster. This table provides overall estimates but there may be variation by age group or other clinical or demographic factors.
34
Figure 15: UKHSA consensus estimates of vaccine effectiveness against BA.1 or BA.2 Omicron for a
fourth dose of COVID-19 vaccine compared to 6+ months since the third dose*
*Note: This table is relative VE of 4th doses against 6+ months since the third dose
**Any refers to Pfizer or Moderna only
Key: Confidence rating scale
35
COVID-19 Infection in Pregnant Women and
Neonates
Confirmed cases of COVID-19 in pregnant women and neonates
Data and commentary on confirmed cases of COVID-19 in pregnancy have been
included in previous versions of this report published on 6 October 2021, 3
November 2021, 8 December 2021, 2 February 2022, 9 March 2022, and 11 May
2022 (with the May report providing information on cases of COVID-19 in pregnancy
occurring up to the end of March 2022). This report provides updated data on this
topic, covering cases of COVID-19 in pregnancy occurring up to the end of April
2022.
This report provided information on confirmed cases of COVID-19 in neonates
(babies up to 28 days old) on 2 February 2022, 9 March 2022, and 11 May 2022.
This report provides updated data on this topic, covering cases of COVID-19 in
neonates occurring up to the end of April 2022.
This report also includes a separate section on COVID-19 Vaccination in
Pregnancy.
Guidance on testing for COVID-19 changed from April 2022 onwards. From mid-
April 2022, individuals in the community with no symptoms of COVID-19 were no
longer encouraged to undertake twice weekly LFD tests. From the end of April 2022,
individuals in the community with symptoms of COVID-19 were no longer asked to
take a PCR test, and community-based testing centres were closed. Testing has
remained available for certain groups however, for example healthcare workers and
individuals requiring admission to hospital.
The data on the numbers of pregnant women and neonates with COVID-19
presented here are based on the results of viral testing. The changes to the
availability of testing outlined above mean that data for May 2022 onwards would
substantially underestimate the actual number of infections, and the data would not
36
be comparable to that for previous months. Data is therefore only presented for
COVID-19 cases occurring up to the end of April 2022.
These data are produced from the COVID-19 in Pregnancy in Scotland (COPS)
study which has undertaken surveillance and research on COVID-19 infection and
vaccination in pregnant women throughout the pandemic. The COPS study finishes
at the end of September 2022; hence this is the last planned publication on COVID-
19 infection and vaccination in pregnancy in this format. Plans are ongoing to monitor
the uptake of COVID-19 and flu vaccinations offered to pregnant women as part of
the autumn 2022 booster programme.
How have we identified confirmed cases of COVID-19 in pregnancy for this
report?
To identify women with confirmed COVID-19 in pregnancy, we have linked national
SARS-CoV-2 viral PCR and (for 6 January 2022 onwards) LFD testing data to the
COVID-19 in Pregnancy in Scotland (COPS) study pregnancy cohort, which includes
a record of all pregnancies in Scotland from 1 March 2020 (the start of the pandemic)
onwards.
Detailed information on the data sources and methodology used has been provided
in previous versions of this report, and notes are also included in the Excel data
tables that accompany this report. Additional information on the COPS study is
available on the study website.
In brief, up to 5 January 2022, confirmed cases of COVID-19 were identified by a
positive SARS-CoV-2 viral PCR test result. From 6 January 2022 onwards, confirmed
cases have been identified by a positive SARS-CoV-2 viral PCR test result or a
positive LFD test result (unless the positive LFD result was followed by a negative
viral PCR result within 48 hours).
This change reflects a change to the national guidance on testing and is in line
with the approach to reporting of confirmed cases used across Public Health
Scotland. Up to and including 5 January 2022, anyone with a positive LFD test result
was asked to take a follow up PCR test to confirm the result. From 6 January 2022
onwards, asymptomatic individuals with a positive LFD test result were no longer
37
asked to take a follow up PCR test - the positive LFD test result was considered
sufficient to indicate confirmed infection for isolation and contact tracing purposes.
As outlined above, the availability of LFD and PCR testing for asymptomatic and
symptomatic individuals was reduced from mid-April 2022 onwards, hence this
report covers infections occurring up to the end of April 2022 only.
For any individual, the date that their first positive test sample was collected has
been taken as the date of onset of their first episode of COVID-19. Subsequent
positive tests taken <90 days after a first positive test have been discounted. To allow
for the possibility of re-infection, if an individual has a positive test taken ≥90 days
after their first positive test, this has been taken as the date of onset of their second
episode of COVID-19, with the clock then reset as for the first episode, and so on.
Confirmed cases of COVID-19 have been identified as occurring in pregnancy if the
date of onset of the episode of COVID-19 occurred at any point from the date of
conception (at 2+0 weeks gestation) to the date the pregnancy ended, inclusive. To
minimise the chance that we have identified a case of COVID-19 as occurring ‘in
pregnancy’ when it actually occurred after a pregnancy has ended, we have
discounted any cases with date of onset at 44+0 weeks gestation or over. It is very
likely that these women have completed their pregnancy, but the end of pregnancy
record has not yet been received by PHS.
As identification of confirmed cases of COVID-19 in pregnancy depends on SARS-
CoV-2 viral test results, the proportion of all COVID-19 infections that have been
detected as a confirmed case will depend on the availability, take up, and accuracy of
testing, and (for 6 January 2022 onwards) the proportion of all positive LFD results
that are logged on the UK Gov website.
How have we identified the hospital and critical care admission status of
women with confirmed COVID-19 in pregnancy?
We have linked national hospital discharge records to the pregnancy and viral testing
data to identify women who were admitted to hospital around the date of onset of
their COVID-19. Admissions to general acute units (SMR01 records) and maternity
units (SMR02 records) have both been included. We have also linked national adult
38
critical care (SICSAG) records to identify women who were admitted to critical care
around the date of onset of their COVID-19. Completed admissions to all intensive
care units (ICUs) and general (non-obstetric) high dependency units (HDUs) across
Scotland have been included. Completed admissions to the 7 obstetric HDUs that
contribute data to SICSAG (collectively covering around 60% of deliveries in
Scotland) have also been included.
If a woman has an episode of COVID-19 with an associated (general or critical care)
admission, it cannot be assumed that the admission was due to the COVID-19. The
woman may have had COVID-19 then a subsequent unrelated admission, for
example for delivery of her baby. Alternatively, a woman may be incidentally found to
have COVID-19 following routine testing after admission for an unrelated reason.
Routine SARS-CoV-2 testing of all individuals admitted to hospital as a planned or
emergency patient was instigated across Scotland from December 2020.
How have we identified the vaccination status of women with confirmed
COVID-19 in pregnancy?
We have linked national vaccination records to the pregnancy and viral testing data
to identify the vaccination status of women at the date of onset of their COVID-19.
Vaccination status has been defined as:
• Unvaccinated for women with no COVID-19 vaccination prior to the date of
onset of COVID-19, or with one dose of vaccination ≤21 days prior to the date
of onset
• Vaccinated (1 dose) for women with one dose of vaccination >21 days prior to
the date of onset of COVID-19, or two doses of vaccination with the second
dose ≤14 days prior to the date of onset
• Vaccinated (2 doses) for women with two doses of vaccination with the second
dose >14 days prior to the date of onset of COVID-19, or three doses of
vaccination with the third dose ≤14 days prior to the date of onset
• Vaccinated (3 or more doses) for women with three or more doses of
vaccination with the third dose >14 days prior to the date of onset of COVID-19
39
Vaccinations given during or prior to pregnancy are included. The time lags included
in the definitions above reflect the time required after vaccination for the immune
response, and hence protection against infection or severe disease, to develop.
Number of confirmed cases of COVID-19 in pregnancy
For this publication, we have used the COPS pregnancy cohort as updated in late-
August 2022 linked to records of SARS-CoV-2 viral testing results for PCR and LFD
samples taken on up to and including 30 April 2022.
As at late-August 2022, the COPS cohort included 189,912 pregnancies in 163,422
women in Scotland from the start of the COVID-19 pandemic on 1 March 2020 to end
of April 2022. Among these, we have identified a total of 18,564 confirmed cases of
COVID-19 in pregnancy with date of onset from 1 March 2020 up to 30 April 2022, in
18,315 pregnancies in 18,264 women.
The COPS pregnancy cohort will be incomplete for recent months; hence these
figures are provisional.
Detailed data is provided in a supporting Excel file that accompanies this
publication and is also available through the Scottish Health and Social Care Open
data platform.
The number of confirmed cases of COVID-19 in pregnancy has varied over time,
reflecting sequential waves of infection in the general population, and also increasing
access to testing (and hence increasingly complete ascertainment of cases). Small
numbers of confirmed cases of COVID-19 in pregnant women were seen in the first
wave of infection in March to May 2020. Subsequent peaks in case numbers have
been seen in October 2020 and January, July, and September 2021. Further peaks
(by far the highest to date) were seen in late December 2021-early January 2022 and
mid-March 2022, reflecting the spread of the Omicron viral variant.
40
Figure 16: Weekly number of confirmed cases of COVID-19 in
pregnancy, March 2020 to April 2022, Scotland
1,600
Number of confirmed cases of
1,400
1,200
1,000
800
600
COVID-19
400
200
0 15-Mar-20
12-Apr-20
10-May-20
07-Jun-20
05-Jul-20
02-Aug-20
30-Aug-20
27-Sep-20
25-Oct-20
22-Nov-20
20-Dec-20
17-Jan-21
14-Feb-21
14-Mar-21
11-Apr-21
09-May-21
06-Jun-21
04-Jul-21
01-Aug-21
29-Aug-21
26-Sep-21
24-Oct-21
21-Nov-21
19-Dec-21
16-Jan-22
13-Feb-22
13-Mar-22
10-Apr-22
Week ending
Of the 18,564 total confirmed cases of COVID-19 in pregnancy, 6,575 (35%)
occurred (i.e., had date of onset) in the first trimester of pregnancy (at 2 +0 to 13+6
weeks gestation); 6,840 (37%) occurred in the second trimester (at 14+0 to 27+6
weeks gestation); and 5,149 (28%) occurred in the third trimester (at 28+0 weeks
gestation or over).
Overall, 2,688 (14%) of the 18,564 total cases were associated with a hospital
admission, and 159 (1%) were associated with a critical care admission. Cases
occurring later in pregnancy were much more likely to be associated with a hospital
or critical care admission than cases occurring in early pregnancy. This reflects the
fact that admission is generally more common in later pregnancy (due to
complications of pregnancy unrelated to COVID-19 and/or for delivery), and also that
COVID-19 is more likely to cause severe maternal disease and/or pregnancy
complications in later pregnancy.
Of the 17,862 confirmed cases of COVID-19 in pregnancy occurring in December
2020 (the month the COVID-19 vaccination programme started in Scotland) to April
41
2022 inclusive, 6,694 (37%) have occurred in unvaccinated women, 1,479 (8%) in
women who have received one dose of vaccination, 5,160 (29%) in women who have
received two doses, and 4,529 (25%) in women who have received three doses or
more.
The proportion of confirmed cases of COVID-19 in pregnancy occurring in previously
vaccinated individuals has increased over time. This is an inevitable consequence of
the vaccination programme being rolled out and an increasing proportion of the
population being vaccinated. It is also likely that the current COVID-19 vaccines are
less effective at preventing asymptomatic or mild infection with the Omicron viral
variant than with previous variants. However, it should be emphasised that the
current COVID-19 vaccines remain highly effective at preventing severe COVID-19
disease.
Cases occurring in unvaccinated women are much more likely to be associated with
a hospital or critical care admission than cases occurring in partially or fully
vaccinated women. Among the 149 confirmed cases of COVID-19 in pregnancy
occurring in December 2020 to April 2022 inclusive that were associated with a
critical care admission, 129 (87%) occurred in unvaccinated women.
Rate of confirmed COVID-19 in pregnancy
Based on the late-August 2022 refresh of the COPS cohort, 36,416 women in
Scotland had an ongoing pregnancy at the start of April 2022 and 1,217 (3,342 per
100,000) women had confirmed COVID-19 in pregnancy during April 2022.
For the duration of the pandemic to date, the monthly rate of confirmed COVID-19
seen in pregnant women has been very similar to that seen in the general female
population of reproductive age (i.e., all women aged 18 to 44 years inclusive)
(comparator data available on request).
For the majority of the pandemic, the rate of confirmed COVID-19 in pregnancy was
generally higher in younger, compared to older, pregnant women, and in pregnant
women living in more, compared to less, deprived areas of Scotland. These patterns
have been less evident however from around December 2021 onwards, when
Omicron became the dominant variant in Scotland. For the majority of the pandemic
42
to date, there was no clear pattern in the rate of confirmed COVID-19 in pregnancy in
women from different ethnic groups. However, again since Omicron has been
dominant, more recently the infection rate has been higher in women with White
ethnicity, compared to women from South Asian; Black, Caribbean, or African; and
Other or mixed ethnic groups.
Babies’ outcomes following maternal confirmed COVID-19 in pregnancy
Based on the late-August 2022 refresh of the COPS cohort, a total of 12,778 babies
have been born to date following the mother having confirmed COVID-19 at any
stage during that pregnancy up to end April 2022. 12,738 of the babies were live
births (born at any gestation) and 40 were stillbirths (born at 24+0 weeks gestation or
over). 24 of the live born babies subsequently died in the neonatal period (within 28
days of birth). This gives an extended perinatal mortality rate for babies born
following maternal confirmed COVID-19 at any stage during pregnancy of 5/1,000
total births ([40+24]/12,778, 95% confidence interval [CI] 3.9 to 6.4/1,000).
1,982 of the 12,778 babies were born within 28 days of the date of onset of the
mother’s COVID-19 infection. 1,963 of these babies were live births (with 7
subsequent neonatal deaths) and 19 were stillbirths, giving an extended perinatal
mortality rate for babies born within 28 days of confirmed COVID-19 during
pregnancy of 13.1/1,000 total births (95% CI 8.8 to 19.5/1,000).
It cannot be assumed that stillbirths and neonatal deaths following confirmed COVID-
19 during pregnancy are related to the mother’s infection. Stillbirths and neonatal
deaths unfortunately occur for a wide range of reasons, and it is important to take the
background rate of mortality into account when considering the rates seen among
births following infection. For example, the overall extended perinatal mortality rate
seen among all births registered in 2020 was 6.3/1,000 total births ([198
stillbirths+100 neonatal deaths]/47,007 total births, 95% CI 5.7 to 7.1/1,000).
1,047 of the 12,738 live births following maternal confirmed COVID-19 at any stage
during pregnancy were delivered preterm, i.e., at <37+0 weeks gestation, giving a
preterm rate in this group of 8.2% (95% CI 7.8 to 8.7). 237 of the 1,963 live births
born with 28 days of maternal confirmed COVID-19 during pregnancy were delivered
43
preterm, giving a preterm rate in this group of 12.1% (95% CI 10.7 to 13.6).). For
comparison, the overall preterm rate seen among live births in financial year
2019/2020 was 8.4% (4,086/48,571 live births, 95% CI 8.2 to 8.7)
Public Health Scotland is conducting detailed analyses on the outcomes of women
and babies following COVID-19 in pregnancy through the COPS study. These
detailed analyses aim to provide accurate estimates of any excess risks associated
with infection. In the meantime, in line with what is known from the international
research evidence, the preliminary data presented above suggests that COVID-19
in pregnancy may be associated with an increased risk of perinatal mortality and
preterm birth, in particular among babies born shortly after the onset of maternal
infection.
How have we identified confirmed cases of COVID-19 in neonates for this
report?
The COVID-19 in Pregnancy in Scotland (COPS) study database includes a record
of all pregnancies in Scotland from 1 March 2020 (the start of the pandemic)
onwards. Records containing the woman’s CHI number (the unique patient identifier
used on all health records in Scotland) are included in analyses.
NHS live birth (LB) notification records are used to identify the subset of these
pregnancies that have ended in the birth of one or more live babies. NHS LB
notifications are sent from maternity services to NHS Board child health departments
on a daily basis. The child health departments use the notifications to create a record
for each baby on the national child health information system. This then enables
babies to receive invitations for child health reviews and routine immunisations. The
number of babies with an NHS LB notification record is very close to the total number
of live births registered by law with National Records of Scotland. A very small
number of babies who die very soon after birth (before that day’s notifications have
been sent) will not be notified.
This publication is based on the late-August 2022 update of the COPS database and
provides information on babies born up to end April 2022. By late-August 2022, NHS
LB notification records for babies born up to end April 2022 will be complete, and
44
hence we would expect this month's version of the COPS database to include almost
all live births occurring up to end April 2022.
All NHS LB notification records include the baby’s CHI number, and this is included in
the COPS study database. This means that subsequent health records relating to the
baby can then be linked to their (and by extension their mother’s) record within the
COPS study database.
To identify confirmed cases of COVID-19 in neonates, we have linked national
SARS-CoV-2 viral PCR and (for 6 January 2022 onwards) LFD testing data to
records for live births within the COPS study database. As for pregnant women, up to
5 January 2022, confirmed cases of COVID-19 in neonates have been identified by a
positive SARS-CoV-2 viral PCR test result. From 6 January 2022 onwards, confirmed
cases have been identified by a positive SARS-CoV-2 viral PCR test result or a
positive LFD test result (unless the positive LFD result was followed by a negative
viral PCR result within 48 hours).
For any baby, the date that their first positive test sample was collected has been
taken as the date of onset of their first episode of COVID-19. Confirmed cases in
neonates have been identified as those with date of onset within 28 days of birth (i.e.,
day 0 to day 27 inclusive, with day 0 being the baby’s date of birth). As subsequent
positive tests taken <90 days after a first positive test are discounted, each baby can
only have one confirmed episode of COVID-19 with onset in the neonatal period. The
proportion of all neonatal COVID-19 infections that have been detected as a
confirmed case will depend on the availability, take up, and accuracy of testing, and
(for 6 January 2022 onwards) the proportion of all positive LFD results that are
logged on the UK Gov website.
How have we identified the maternal vaccination status of neonates with
confirmed COVID-19?
Maternal COVID-19 vaccination may provide babies with some protection against
SARS-CoV-2 infection, as maternal antibodies made following vaccination cross the
placenta to the baby (and are therefore present in the baby’s blood after birth), and
are also present in breastmilk. We have used the linked records in the COPS study
45
database to determine the vaccination status of the mothers of neonates with
confirmed COVID-19. Vaccination status has been determined as at the date of
delivery (the baby’s date of birth). The same definitions of vaccination status have
been used as shown in the section on “How have we identified the vaccination status
of women with confirmed COVID-19 in pregnancy?” above. Maternal vaccinations
given during or prior to pregnancy have been included.
Confirmed COVID-19 in neonates
For this publication, we have used the COPS study database as updated in late-
August 2022 linked to records of SARS-CoV-2 viral testing results for PCR and LFD
samples taken on up to and including 30 April 2022.
As at late-August 2022, the COPS database included a total of 189,912 pregnancies
in 163,422 women in Scotland from the start of the COVID-19 pandemic on 1 March
2020 to end of April 2022. 153,835 of the pregnancies had completed, and 36,078
were ongoing at this date. 101,858 of the completed pregnancies had ended in a
delivery (delivery of one or more live or stillborn baby/babies), with 103,074 live
babies being born.
Among these live births, we have identified a total of 194 confirmed cases of COVID-
19 in neonates from 1 March 2020 up to 30 April 2022.
Using viral PCR and LFD testing data alone (i.e., all test records, not just records that
have linked to the COPS study database), shows that there has been an overall total
of 196 confirmed cases of COVID-19 in neonates between 1 March 2020 and 30
April 2022. There are various reasons why confirmed infections identified through
testing data only may not be identified through the COPS study database. For
example, if the date of birth is incorrect in the testing data, the infection may be
incorrectly assigned to the neonatal period, or if the baby's CHI number is not
available within the testing data, their record will not be linked to their COPS record.
Overall, however, this shows that the number of neonatal infections identified in the
COPS database is very close to the number identified through testing data alone.
46
Detailed data from the COPS study is provided in a supporting Excel file that
accompanies this publication, and is also available through the Scottish Health and
Social Care Open data platform.
The rate of COVID-19 in neonates is much lower than the rate seen among pregnant
women, however small peaks have been seen in the neonatal infection rate in line
with the sequential waves of infection seen in pregnant women and the general adult
population. The highest rate of COVID-19 in neonates seen to date was in January
2022, with similarly high levels in March 2022, reflecting the most recent waves of
infection associated with the Omicron viral variant.
Among the 194 confirmed cases of COVID-19 in neonates, 23 (12%) had date of
onset during the early neonatal period (day 0 to day 6 inclusive, with day 0 being the
baby’s date of birth) and 171 (88%) had date of onset during the late neonatal period
(day 7 to day 27 inclusive). It is not possible to definitively infer how a baby acquired
their SARS-CoV-2 infection from this. However, the fact that most infections had date
of onset in the late neonatal period is in line with other evidence that suggests that
most neonatal infections are acquired after birth, rather than before or at birth.
Among the 182 confirmed cases of COVID-19 in neonates that occurred between
December 2020 (the month the vaccination programme started in Scotland) and April
2022, 134 (74%) of the babies were born to a mother who was unvaccinated at the
time of delivery.
Data on COVID-19 infection in pregnant women and neonates from other UK
nations
No data on confirmed cases of COVID-19 in pregnant women or neonates is
routinely published for England, Wales, or Northern Ireland.
From the start of the pandemic, the UK Obstetric Surveillance System (UKOSS) has
been collecting data from hospitals across the UK on pregnant women with COVID-
19 who are admitted to hospital. Information is not routinely published by UKOSS,
however a number of research papers based on the collected data are publicly
available.
47
Similarly, the British Paediatric Surveillance Unit (BPSU) has been collecting data on
neonates with confirmed COVID-19 who are being cared for in hospital, and research
papers based on the collected data (for example see here) are publicly available.
48
COVID-19 Vaccination in Pregnancy
Data and commentary on COVID-19 vaccination in pregnancy have been included in
previous versions of this report published on 14 July 2021, 1 September 2021, 6
October 2021, 3 November 2021, 8 December 2021, 2 February 2022, 9 March
2022 and 11 May 2022. This report provides updated data on this topic, covering
vaccinations given in pregnancy up to the end of July 2022.
This report also includes a separate section on Confirmed cases of COVID-19 in
pregnant women and neonates.
These data are produced from the COVID-19 in Pregnancy in Scotland (COPS)
study which has undertaken surveillance and research on COVID-19 infection and
vaccination in pregnant women throughout the pandemic. The COPS study finishes
at the end of September 2022; hence this is the last planned publication on COVID-
19 infection and vaccination in pregnancy in this format. Plans are ongoing to monitor
the uptake of COVID-19 and flu vaccinations offered to pregnant women as part of
the autumn 2022 booster programme.
Advice for women on COVID-19 vaccination in pregnancy
COVID-19 vaccination is the safest and most effective way for women to protect
themselves and their babies against severe COVID-19. The Royal College of
Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives
recommend that pregnant women receive their COVID-19 vaccination. Information
for patients on COVID-19 vaccination in pregnancy is available on NHS inform and
from the RCOG.
Policy on COVID-19 vaccination in pregnancy
The Joint Committee on Vaccination and Immunisation (JCVI) advises the UK and
devolved governments on immunisation. Advice from the JCVI on COVID-19
vaccination for pregnant women has changed over time, as evidence has
accumulated on both the risks of COVID-19 disease in pregnancy, and the safety
and effectiveness of COVID-19 vaccinations in pregnancy.
49
Details have been provided in previous version of this report. In summary, when the
vaccination programme started in Scotland on 8 December 2020, the JCVI did not
recommend COVID-19 vaccination in pregnancy, due to the lack of evidence on
safety and effectiveness at that time. On 30 December 2020, the JCVI updated their
guidance to note that women in the highest risk groups that were being called for
vaccination at that point, and who happened to be pregnant, could be offered
vaccination during pregnancy. In practice this mainly affected pregnant health and
social care workers at high risk of occupational exposure to infection, and pregnant
women with underlying health conditions conferring clinical vulnerability to severe
COVID-19 disease. On 16 April 2021, the JCVI issued further guidance, confirming
that all women called for vaccination due to being in any priority group (including the
‘phase 2’ groups covering all adults aged 18-49 years) should be offered vaccination,
regardless of pregnancy status. In other words, from this time, pregnant women were
offered vaccination at the same time as non-pregnant women, based on their age
and clinical risk group.
More recently, on 16 December 2021, the JCVI added pregnant women to the list of
groups considered clinically vulnerable to COVID-19 disease, and hence prioritised
for vaccination (priority group 6). In response to this, the Chief Medical Officer for
Scotland asked NHS Boards to consider ways to further increase provision of
vaccination for pregnant women, for example by establishing dedicated antenatal
vaccination clinics.
In July 2022, the JCVI published guidance on the autumn 2022 COVID-19 vaccine
booster programme. This noted that pregnant women would be one of the priority
groups offered an autumn booster. The booster programme started in September
2022. As this report provides data on vaccinations given up to the end of July 2022,
it will not include any vaccines given through the autumn booster programme.
Up to date recommendations from the JCVI on COVID-19 vaccination are available
in Immunisation against Infectious Disease (the ‘Green Book’), published by the UK
Department of Health and Social Care.
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How have we identified COVID-19 vaccinations given to pregnant women for
this report?
To identify women vaccinated against COVID-19 in pregnancy, we have linked
national vaccination data to the COVID-19 in Pregnancy in Scotland (COPS) study
pregnancy cohort, which includes a record of all pregnancies in Scotland from 1
March 2020 (the start of the pandemic) onwards.
Detailed information on the data sources and methodology used has been provided
in previous versions of this report, and notes are also included in the Excel data
tables that accompany this report. Additional information on the COPS study is
available on the study website.
In brief, COVID-19 vaccinations have been identified as occurring in pregnancy if
they were given at any point from the date of conception (at 2 +0 weeks gestation) to
the date the pregnancy ends, inclusive. To minimise the chance that we have
identified a vaccination as occurring ‘in pregnancy’ when it actually occurred after a
pregnancy has ended, we have discounted any vaccinations that were showing as
delivered at 44+0 weeks gestation or over. It is very likely that these women have
completed their pregnancy, but the end of pregnancy record has not yet been
received by PHS.
Number of COVID-19 vaccinations given to pregnant women
For this publication, we have used the COPS database as updated in late-August
2022 linked to records of vaccinations delivered on up to and including 31 July 2022.
As at late-August 2022, the COPS database included a total of 201,892 pregnancies
among 171,431 women in Scotland from 1 March 2020 (the start of the pandemic)
onwards, and 148,443 pregnancies in 134,043 women from 1 December 2020 (the
month the COVID-19 vaccination programme started) onwards. Among these, we
have identified a total of 45,098 COVID-19 vaccinations given in 32,314 pregnancies
to 31,903 women from the start of the COVID-19 vaccination programme on 8
December 2020 up to 31 July 2022.
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The COPS pregnancy cohort will be incomplete for recent months; hence these
figures are provisional.
Detailed data is provided in a supporting Excel file that accompanies this
publication, and is also available through the Scottish Health and Social Care
Open data platform.
Of the 45,098 total vaccinations given in pregnancy, 13,893 (30.8%) were first doses,
15,058 (33.4%) were second doses, 15,990 (35.5%) were third doses, and 157
(0.3%) were fourth doses.
Small peaks in the number of first dose vaccinations given in pregnancy were seen in
January and March 2021, likely representing vaccination of health and care workers,
and clinically vulnerable women, respectively. A more substantial peak in first dose
vaccinations was then seen in early June 2021, reflecting the time when vaccination
was being offered to the general young adult population. As would be expected given
the recommended gap between first and second doses of vaccination, a substantial
peak in second dose vaccinations was then seen in early August 2021. Small
numbers of first and second dose vaccinations have continued to be given to
pregnant women up to the end of July 2022, reflecting the fact that vaccination
remains available to anyone who was not vaccinated when initially invited for
whatever reason.
Third primary doses of vaccination have been offered to immunosuppressed
individuals from September 2021. Booster doses have also been offered from
September 2021. Booster doses were offered 6 months following the end of the
primary immunisation course to individuals in the initial vaccination priority groups 1-9
(health and care workers, clinically extremely vulnerable and clinically vulnerable
individuals, and all adults aged 50 years or over) from September 2021, then to all
adults aged 40-49 years from 15 November 2021. In response to the emergence of
the Omicron variant, the offer of a booster dose was extended to all adults aged 18-
39 from 29 November 2021 and to young people aged 16-17 from 22 December
2011, with boosters for all groups (including previously eligible groups) available from
3 rather than 6 months following the end of the primary immunisation course from
this time. On 21 February 2022, the JCVI recommended that second boosters
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should be provided to immunosuppressed individuals (and older adults) from 6
months after their initial booster.
As would be expected from the above, a small number of third doses of vaccination
were given in pregnancy in September, October, and November 2021, with a
substantial peak in third dose vaccinations then seen in December 2021. A small
number of 4th doses are recorded from December 2021 onwards, representing
boosters following a third primary dose in the immunosuppressed group. No 5 th
doses (representing 2nd boosters for the immune supressed groups), have been
recorded in pregnancy as yet.
As noted above, from September 2022 the autumn COVID-19 vaccination booster
programme will be rolled out to clinically at-risk groups, including pregnant women.
However, the autumn booster programme had not begun in the timeframe covered
by this report.
Figure 17: Number of COVID-19 vaccines given in pregnancy by
dose, December 2020 to July 2022, Scotland
3,500
Number of vaccines
3,000
2,500
2,000
1,500
1,000
500
0 13-Dec-20
03-Jan-21
24-Jan-21
14-Feb-21
07-Mar-21
28-Mar-21
18-Apr-21
09-May-21
30-May-21
20-Jun-21
11-Jul-21
01-Aug-21
22-Aug-21
12-Sep-21
03-Oct-21
24-Oct-21
14-Nov-21
05-Dec-21
26-Dec-21
16-Jan-22
06-Feb-22
27-Feb-22
20-Mar-22
10-Apr-22
01-May-22
22-May-22
12-Jun-22
03-Jul-22
24-Jul-22
Week ending
First dose Second dose Third and subsequent dose
Of the 45,098 total vaccinations given in pregnancy, 17,218 (38%) vaccinations were
given in the first trimester of pregnancy (at 2+0 to 13+6 weeks gestation); 16,846
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(27%) were given in the second trimester (at 14+0 to 27+6 weeks gestation); and
11,034 (24%) were given in the third trimester (at 28+0 weeks gestation or over).
33,443 (74%) of the vaccinations given were Pfizer/BioNTech; 9,489 (21%) were
Moderna; and 2,166 (5%) were Oxford/AstraZeneca.
Uptake of COVID-19 vaccination among pregnant women
Based on the late-August 2022 refresh of the COPS database, 35,208 women in
Scotland had an ongoing pregnancy at the start of July 2022, and 97 (0.3%) women
received any COVID-19 vaccination during pregnancy in July 2022 (‘monthly uptake
of vaccination’).
For the duration of the pandemic to date, the monthly uptake of vaccination has
generally been higher in older, compared to younger, pregnant women. Monthly
uptake has generally been higher in pregnant women living in less, compared to
more, deprived areas of Scotland. Monthly uptake has also generally been lower
among pregnant women with Black, Caribbean, or African ethnicity compared to
pregnant women with White; South Asian; or Other or mixed ethnicity, although all of
these patterns have been less evident in recent months due to low numbers of
vaccination being delivered.
From the start of the vaccination programme in December 2020 until August 2021,
the monthly uptake of vaccination among pregnant women was considerably lower
than that seen in the general female population of reproductive age (i.e., all women
aged 18 to 44 years inclusive) (comparator data available on request). From
September 2021 to July 2022, monthly uptake in pregnant women and in the general
female population have been more similar, although uptake among pregnant women
remains consistently below that in the general female population.
Coverage of COVID-19 vaccination by the time of delivery
3,631 women delivered their baby (or babies in the case of a multiple pregnancy) in
July 2022. 2,842 (78%) of the women delivering in July 2022 had received at least
one dose of COVID-19 vaccination prior to delivery, with 2,636 (73%) of the women
having received at least two doses, 1,733 (48%) having received three or more
doses.
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As would be expected, the percentage of women delivering their baby in each month
who have been vaccinated before the date of delivery (‘coverage of vaccination by
delivery’) increased from the start of the vaccination programme in December 2020
until around April 2022. From April 2022 onwards, very little increase has been seen
in the percentage of women who have received any vaccination before delivery,
however small increases have continued to be seen in the percentage of women
have received two or more vaccines before delivery.
To date, the coverage of vaccination by delivery has been higher in women from
older, compared to younger, age groups. Coverage of vaccination by delivery has
been higher in women living in the least, compared to the most, deprived areas of
Scotland. Coverage of vaccination by delivery has also been lower in women with
Black, Caribbean, or African ethnicity compared to women with White; South Asian;
or Other or mixed ethnicity.
To date, vaccination coverage has been considerably lower among women delivering
their babies than among the general female population of reproductive age. By the
end of July 2022, 88% of all women aged 18 to 44 years inclusive had received at
least one dose of vaccination, with 83% having received at least two doses, and 67%
having received three doses (comparator data available on request). Coverage of
any vaccination in the general female population increased rapidly up to July 2021,
and subsequently increased very slowly from August 2021 onwards. By contrast,
coverage among women delivering their babies has continued to increase steadily up
to end April 2022, hence the gap in coverage between pregnant women and all
women of reproductive age is reducing over time.
Babies’ outcomes following maternal COVID-19 vaccination in pregnancy
Based on the late-August 2022 refresh of the COPS cohort, a total of 24,008 babies
have been born to date following the mother receiving COVID-19 vaccination at any
stage during that pregnancy up to end July 2022. 23,942 of the babies were live
births (born at any gestation) and 66 were stillbirths (born at 24+0 weeks gestation or
over). 41 of the live born babies subsequently died in the neonatal period (within 28
days of birth). This gives an extended perinatal mortality rate for babies born
55
following maternal COVID-19 vaccination at any stage during pregnancy of 4.5/1,000
total births ([66+41]/23,942, 95% confidence interval [CI] 3.7 to 5.4/1,000).
2,949 of the 24,008 babies were born within 28 days of the date of the mother’s
COVID-19 vaccination. 2,941 of these babies were live births (with 10 subsequent
neonatal deaths) and 8 were stillbirths, giving an extended perinatal mortality rate for
babies born within 28 days of COVID-19 vaccination during pregnancy of 6.1/1,000
total births (95% CI 3.7 to 9.8).
It cannot be assumed that stillbirths and neonatal deaths following COVID-19
vaccination during pregnancy are related to the mother’s vaccination. Stillbirths and
neonatal deaths unfortunately occur for a wide range of reasons, and it is important
to take the background rate of mortality into account when considering the rates seen
among births following vaccination. For example, the overall extended perinatal
mortality rate seen among births registered in 2020 was 6.3/1,000 total births ([198
stillbirths+100 neonatal deaths]/47,007 total births, 95% CI 5.7 to 7.1/1,000).
1,790 of the 23,942 live births following maternal COVID-19 vaccination at any stage
during pregnancy were delivered preterm, i.e., at <37+0 weeks gestation, giving a
preterm rate in this group of 7.5% (95% CI 7.1 to 7.8). 248 of the 2,941 live births
born with 28 days of maternal COVID-19 vaccination during pregnancy were
delivered preterm, giving a preterm rate in this group of 8.4% (95% CI 7.4 to 9.5). For
comparison, the overall preterm rate seen among live births in financial year
2019/2020 was 8.4% (4,086/48,571 live births, 95% CI 8.2 to 8.7).
Public Health Scotland is conducting detailed analyses on the safety of COVID-19
vaccination in pregnancy through the COPS study. In the meantime, in line with what
is known from the international research evidence, the preliminary data presented
above shows no increased risk of perinatal mortality or preterm birth following
COVID-19 vaccination in pregnancy. This finding contrasts to the relatively high rates
of perinatal mortality and preterm birth seen among babies born soon after COVID-
19 infection in pregnancy (see separate section in this report on Confirmed cases of
COVID-19 in pregnant women and neonates). Vaccination remains the safest and
most effective way for women to protect themselves and their babies against COVID-
19 infection.
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Data on COVID-19 vaccination in pregnancy from other UK nations
Data published by the UK Health Security Agency shows that among women in
England delivering their baby in May 2022, 73.2% had received at least one dose of
COVID-19 vaccination prior to delivery, and 66.9% had had at least 2 doses (see the
COVID-19 vaccine weekly surveillance report). The UKHSA report also provides
information on birth outcomes (preterm delivery, low birthweight, and stillbirth) among
vaccinated and unvaccinated women.
Data published by Public Health Wales shows that among women in Wales
delivering their baby in May 2022, 81% had received at least one dose of COVID-19
vaccination prior to delivery and 77% had received at least two doses. (See the latest
Monthly enhanced surveillance report available through the Vaccination tab on the
Public Health Wales Rapid COVID-19 surveillance dashboard).
These data for England and Wales are based on linkage of national maternity and
vaccination records.
For comparison, this report shows that 76.8% of women who delivered in Scotland in
May 2022 had received at least one dose of COVID-19 vaccination prior to delivery
and 70.0% had at least two doses.
No data on COVID-19 vaccination in pregnancy is currently available for Northern
Ireland.
57
Wider Impact of COVID-19
The COVID-19 pandemic has direct impacts on health as a result of illness,
hospitalisations and deaths due to COVID-19. However, the pandemic also has wider
impacts on health, healthcare, and health inequalities. Reasons for this may include:
• Individuals being reluctant to use health services because they do not want to
burden the NHS or are anxious about the risk of infection.
• The health service delaying preventative and non-urgent care such as some
screening services and planned surgery.
• Other indirect effects of interventions to control COVID-19, such as changes to
employment and income, changes in access to education, social isolation,
family violence and abuse, changes in the accessibility and use of food,
alcohol, drugs and gambling, or changes in physical activity and transport
patterns.
More detailed background information on these potential impacts is provided by the
Scottish Public Health Observatory in a section on Covid-19 wider impacts.
The surveillance work stream of the Public Health Scotland social and systems
recovery cell aims to provide information and intelligence on the wider impacts of
COVID-19 on health, healthcare, and health inequalities that are not directly due to
COVID-19. The wider impact dashboard can be viewed online and includes the
following topics:
• Hospital and unscheduled care; Accident and Emergency attendances; NHS
24 completed contacts; Out of hours cases; Scottish Ambulance Service;
Excess deaths and Outpatient appointments
• Healthcare for cardiovascular disease; Cancer and Injuries
• Healthcare for mental health
• Women booking antenatal care and Termination of pregnancy
• Healthcare for birth and babies and Child health
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• Substance use
These analyses are based on a selected range of data sources that are available to
describe changes in health service use in Scotland during the COVID-19 pandemic.
More detailed information is available at NHS Board and Health and Social Care
Partnership (HSCP) level.
59
Contact
Public Health Scotland
phs.covid19data&analytics@phs.scot
Further Information
COVID surveillance in Scotland
Scottish Government
Dashboard by Public Health Scotland
National Records Scotland
UK and international COVID reports
Public Health England
European Centre for Disease Prevention and Control
WHO
Weekly National Seasonal Respiratory Report:
Weekly national seasonal respiratory report - Week 37 2022 - Weekly national
seasonal respiratory report - Publications - Public Health Scotland
Next Release
The next release of this publication will be 05 October 2022.
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Open Data
Data from this publication is available to download from the Scottish Health and
Social Care Open Data Portal.
Rate this Publication
Let us know what you think about this publication via the link at the bottom of this
publication page on the PHS website.
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Appendices
Appendix 1: Testing Policy in 2022
Please note the following changes to testing policy in 2022:
• Prior to 05 January 2022, reported cases consisted only of positive
Polymerase Chain Reaction (PCR) tests
• From 05 January 2022, reported cases included both PCR and Lateral Flow
Device (LFD) positive tests. See here for more information
• From 01 March 2022, reported cases included episodes of reinfection at least
90 days after initial infection. Prior to this date, COVID-19 cases were based
on an individual’s first positive test only. More information is available on the
PHS website here
• From mid-April 2022, as part of the Scottish Government’s Test and Protect
transition plan, asymptomatic testing was no longer recommended
• Symptomatic PCR testing was still available, and LFD testing was still
encouraged for hospital and care home visitors, those who had been in close
contact with a case and to allow cases to finish their isolation after 7 days
• 01 May 2022 marks the beginning of updated testing policy. The purpose of
COVID-19 testing has now shifted from population-wide testing to reduce
transmission, to targeted testing. Therefore, reported cases will primarily
include clinical care settings, health and social care workforce, surveillance
and outbreak response
Appendix 2: Wastewater Analysis Notes
In May 2020, the Scottish Environment Protection Agency (SEPA) began exploratory
work to pinpoint fragments of coronavirus’ ribonucleic acid (RNA) in local wastewater
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samples. In contrast to COVID-19 case records, virus shedding into wastewater is a
biological process, meaning wastewater data is unaffected by factors that impact
whether testing is done. Sewage samples are taken by Scottish Water from 116
sample sites across Scotland from the sewage network (wastewater treatment
works). Composite samples are built up over a period of time. The amount of unique
fragments of viral DNA within known volumes of the sample is calculated, outputting
a number which can be used to calculate the number of COVID markers in each
sample which is reported as million gene copies per litre (Mgc/p/d). Site level
wastewater level can show substantial degree of variability, especially when
prevalence of COVID-19 is high. An average and standard deviation is taken for
three samples. Household drainage water is mixed with water from other urban
sources, meaning composite samples will contain rainwater which dilutes the sample.
Therefore, this variability is accounted for by controlling for rainfall.
Appendix 3: Notes
Case Definition
From 01 March 2022, PHS now include episodes of reinfection within COVID-19
reporting. Prior to this date COVID-19 cases were based on an individual’s first
positive test result only. The new daily calculation includes both new infections and
possible reinfections. Possible reinfections are defined as individuals who tests
positive, by PCR (polymerase chain reaction) or LFD (lateral flow device), 90 days or
more after their last positive test. This update to reporting will ensure that PHS’s
surveillance data reflects underlying transmission rates. More information is available
on the PHS website here.
RAPID (Rapid and Preliminary Inpatient Data)
Hospital admissions ‘with’ COVID-19 are defined as: A patient’s first positive PCR or
LFD test of the episode of infection (including reinfections at 90 days or more after
their last positive test) for COVID-19 up to 14 days prior to admission to hospital, on
the day of their admission or during their stay in hospital.
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The number reported does not take into account the reason for hospitalisation.
Therefore, people that were admitted for a non-COVID-19 related reason (and tested
positive upon admission) may be included.
RAPID is a weekly submission of people who have been admitted and discharged to
hospital. From 27 June 2022, RAPID submissions are made on a weekly basis. This
change has been made as the pandemic has moved away from the emergency
response to effective management of the virus, so Health Boards have returned to
pre-pandemic submission schedules.
Hospital admissions for the most recent week may be incomplete for some Boards
and should be treated as provisional and interpreted with caution. Where no data are
available at the time of publication, the number of admissions for the previous week
will be rolled forward for affected Boards. Missing data will either be due to a board
not submitting on time or there being zero COVID-19 admissions in the latest week.
These provisional data will be refreshed the following week.
Further, figures are subject to change as hospital records are updated. It can take on
average 6-8 weeks before a record is finalised, particularly discharge details.
These data include admissions to acute hospitals only and do not include psychiatric
or maternity/obstetrics specialties. In the data presented here, an admission is
defined as a period of stay in a single hospital. There may be multiple admissions for
a single patient if they have moved between locations during a continuous inpatient
stay (CIS), or if they have been admitted to hospital on separate occasions.
Hospital Inpatients
Number of patients in hospital with recently confirmed COVID-19, identified by their
first positive LFD test (from 5 January 2022) or PCR test. This measure (available
from 11 September 2020 and first published 15 September 2020) includes patients
who first tested positive in hospital or in the 14 days before admission. Patients stop
being included after 28 days in hospital (or 28 days after first testing positive if this is
after admission). Further background on this new approach is provided in this
Scottish Government blog.
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This is based on the number of patients in beds at 8am the day prior to reporting,
with the data extract taken at 8am on the day of reporting to allow 24 hours for test
results to become available. If boards have not submitted by 8am on Monday, the
most recent available data will be rolled over and used as a proxy for the missing
dates. Where a patient has not yet received a positive test result they will not be
included in this figure. Patients who have been in hospital for more than 28 days and
still being treated for COVID-19 will stop being included in this figure after 28 days.
All patients in hospital, including in intensive care, and community, mental health and
long stay hospitals are included in this figure.
ICU Admissions
COVID-19 related ICU admissions have been identified as the following: A patient
who has tested positive for COVID at any time in the 21 days prior to admission to
ICU, or who has tested positive from the date of admission up to and including the
date of ICU discharge.
ICU Occupancy
Clinical diagnosis of COVID-19 comprises patients admitted with a clinical diagnosis
of confirmed or suspected COVID-19 disease recorded in WardWatcher regardless
of SARS-CoV-2 PCR test status. The clinical diagnosis is the main reason that the
patient is admitted to ICU and is coded by ICU clinicians.
SARS-CoV-2 PCR +ve with non-COVID-19/unknown diagnosis comprises patients
with a positive SARS-CoV-2 PCR test who have been admitted with a non-COVID-19
clinical diagnosis or missing diagnosis recorded in WardWatcher at the time of data
extraction. Less than 5% of all patients in this group have an unknown diagnosis at
the time of data extraction, although this proportion is likely to be higher in the most
recent week.
Non-COVID-19 clinical diagnosis comprises patients with a negative SARS-CoV-2
PCR test and who have been admitted with a non-COVID-19 clinical diagnosis
recorded in WardWatcher.
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Unknown clinical diagnosis comprises patients with a negative SARS-CoV-2 PCR
test who are missing a clinical diagnosis recorded in WardWatcher at the time of data
extraction. Please see the most recent Scottish Intensive Care Society Audit
Group COVID-19 report for more information.
Appendix 4: Early Access Details
Pre-Release Access: Under terms of the “Pre-Release Access to Official Statistics
(Scotland) Order 2008”, PHS is obliged to publish information on those receiving Pre-
Release Access (“Pre-Release Access” refers to statistics in their final form prior to
publication). The standard maximum Pre-Release Access is five working days.
Shown below are details of those receiving standard Pre-Release Access.
Standard Pre-Release Access:
Scottish Government Health Department
NHS Board Chief Executives
NHS Board Communication Leads
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