Why everyone is so sick right now, as Covid-19 figures published weekly again by Scotland's health watchdog

Reports of illnesses sweeping workplaces and homes in Scotland are now frequent, but without mass testing, it is hard to tell whether symptoms are being caused by Covid-19.

Scotland’s health watchdog is once again publishing weekly Covid-19 statistics in response to a reported ‘summer wave’ of coronavirus.

Reports of illnesses sweeping workplaces and homes in Scotland are now frequent, but without mass testing, it is hard to tell whether symptoms are being caused by Covid-19.

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With large-scale testing now finished, Public Health Scotland (PHS) is relying on hospital admissions and wastewater detections to track Covid-19 outbreaks. Wastewater data analyses for Covid-19 are produced by PHS’s wastewater analysis group as part of Scotland’s monitoring programme, which is operated by the Scottish Government in partnership with Scottish Water and the Scottish Environment Protection Agency.

The amount of the Covid-19 virus circulating in Scotland has been increasing in wastewater detections for several weeks, increasing by ten times since April.  (Photo by Hannah McKay - Pool/Getty Images)The amount of the Covid-19 virus circulating in Scotland has been increasing in wastewater detections for several weeks, increasing by ten times since April.  (Photo by Hannah McKay - Pool/Getty Images)
The amount of the Covid-19 virus circulating in Scotland has been increasing in wastewater detections for several weeks, increasing by ten times since April. (Photo by Hannah McKay - Pool/Getty Images)

The amount of the Covid-19 virus circulating in Scotland has been increasing in wastewater detections for several weeks, increasing by ten times since April.

Although still below previous peaks, Covid hospital admissions in Scotland have increased by 36.4 per cent. Other seasonal infections, such as flu and respiratory syncytial virus (RSV), remain low, meaning if a person, their co-workers, or family and friends find themselves ill, it is likely Covid-19.

A spokesperson for PHS said: “Public Health Scotland has returned to weekly updates to the viral respiratory dashboard from June 27 in order to better track what is happening as close to real time as possible. Between April and October, PHS moves to four-weekly reporting of viral respiratory diseases as activity is usually lower during summer months.

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“Covid-19 and other respiratory infection levels continue to be monitored during this period and weekly reporting is being reinstated as a result of rising Covid-19 case numbers. The weekly dashboard updates will continue until Covid-19 activity shows signs of reducing.”

A spike in the middle of summer is not that unusual, in contrast to seasonal flu and cold viruses. Being ill in the summer is another indicator that current illnesses are caused by the Covid-19 virus.

Respiratory illnesses are associated with seasonal increases in the autumn and winter in Scotland, with seasonality patterns for both influenza viruses and non-influenza respiratory pathogens having been established through many years of surveillance data.

However, Covid-19 transmission has been occurring in waves throughout the seasons, as observed from PHS surveillance data since the start of the pandemic in 2020. The spokesperson for PHS said Covid-19 had yet to establish a seasonal pattern “so we can expect these sorts of increase in activity from time to time”.

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The good news is the level of severity of the virus is greatly reduced compared to the pandemic.

“The important thing to be aware of is that there is now a level of population immunity to Covid-19 as a result of natural infection and the vaccine programme,” the spokesperson said. “Therefore, it is highly unlikely that we will see the same level of infections and severity of illnesses that we did when the virus first emerged.”

Despite this, there has been an uptick in acute Covid-19 hospitalisations.

Using PHS’s hospitalisation data, the virus appears to be spreading throughout the entirety of Scotland at similar levels – as hospitalisation rates by area are broadly in keeping with population sizes.

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The NHS Greater Glasgow & Clyde and NHS Lothian areas, for example, have the highest hospitalisation numbers – 107 and 73 respectively – while health board areas such as NHS Fife and NHS Highland have much lower numbers.

At the end of June, there 410 people hospitalised with Covid-19 in Scotland, compared to 65 at the start of April.

Because there is no longer large-scale testing for Covid-19, PHS’s approach combines data from microbiological sampling and laboratory test results from community and hospital settings, with data from syndromic surveillance of NHS 24 calls, primary care consultations for respiratory symptoms, hospital, including intensive care, admissions and other settings.

The intelligence generated from surveillance of laboratory, syndromic and community settings “provide a comprehensive picture of current respiratory illness in Scotland”, with PHS estimating the virus is infecting one in 167 people in Scotland. However, PHS has said there was no one symptom that defines an infection as Covid-19.

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“Covid-19 will continue to be a source of coughs and colds,” a spokesperson said. “We are not aware of a symptom or set of symptoms that would be able to say someone’s infection was caused by this virus or by that one.

“It is really important at this time that if you have symptoms of a respiratory infection and feel unwell, or have a fever, you stay at home and avoid contact with other people until your fever has settled and you feel better.

“Proper hand and respiratory hygiene can help protect against Covid-19, as well as numerous other common viruses that may be circulating.”

The summer wave comes amidst the detection of a new strain of Covid-19 variants, known collectively as “FLiRT”. The unofficial nickname was inspired by the names of the mutations in the genetic code of the variants. They descend from JN.1, which had variant BA.2.86 as a parent.

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One of the FLiRT variants – KP.2 – caused around 25 per cent of new sequenced cases in the US over the final two weeks of April, according to the Centers for Disease Control and Prevention (CDC).

The UK Health Security Agency (UKHSA) said that as of April, the circulating variants in the UK were a mix of JN.1 sublinages, “several of which appear to be increasing in prevalence”.

“KP.2 is one of the variants identified in the UK - we will continue to monitor these variants as the situation evolves,” UKHSA guidance reads.

“UKHSA is continuing to monitor data relating to new variants both in the UK and internationally, assessing their severity and the ongoing effectiveness of vaccines. There is no change to the wider public health advice at this time.”

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