Recovery JSNA: COVID-19
Coronavirus disease (COVID-19) is an infectious disease caused by a variant of coronavirus first discovered in 2019. This chapter provides an overview of the disease, its symptoms, how it is transmitted, as well as data and information outlining how the disease has impacted the population of Wiltshire in terms of cases, mortalities, hospitalisations. This chapter also explores the groups at higher risk of severe coronavirus symptoms.
This chapter will cover the following topics:
The main symptoms of Coronavirus (COVID-19) are:
- · A high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
- · A new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
- · A loss or change to your sense of smell or taste – this means you've noticed that you cannot smell or taste anything, or things may smell or taste different to normal
Most people with coronavirus have at least 1 of these symptoms.
Source: Extracted from the NHS.uk on 12/03/2021
Non-specific symptoms include shortness of breath, fatigue, loss of appetite, myalgia, sore throat, headache, nasal congestion, diarrhoea, nausea and vomiting.
Atypical symptoms such as delirium and reduced mobility, can present in older and immunocompromised people, often in the absence of a fever.
Of people who develop symptoms, current data indicate that:
- · 40% have mild symptoms without hypoxia (problems with the level of oxygen in the blood) or pneumonia
- · 40% have moderate symptoms and non-severe pneumonia
- · 15% have significant disease including severe pneumonia
- · 5% experience critical disease with life-threatening complications
Critical disease includes acute respiratory distress syndrome (ARDS), sepsis, septic shock, cardiac disease, thromboembolic events, such as pulmonary embolism and multi-organ failure.
Source: Extracted from gov.uk on 12/03/2021.
The main route of transmission is from cough and sneeze droplets. These droplets fall on people in their vicinity and can be directly inhaled or picked up on the hands and transferred when someone touches their face.
How long any respiratory virus survives will depend on a number of factors, for example:
- · What surface the virus is on
- · Whether it is exposed to sunlight
- · Differences in temperature and humidity
- · Exposure to cleaning products
Under most circumstances, the amount of infectious virus on any contaminated surfaces is likely to have decreased significantly by 24 hours, and even more so by 48 hours.
Source: Extracted from gov.uk on 12/03/021 .
Tests in the UK are carried out through a number of different routes:
- · Pillar 1: swab testing in Public Health England (PHE) labs and NHS hospitals for those with a clinical need, or who are health and care workers
- · Pillar 2: swab testing for the wider population, as set out in government guidance
- · Pillar 3: serology testing to show if people have antibodies from having had COVID-19
- · Pillar 4: blood and swab testing for national surveillance supported by PHE, the Office for National Statistics (ONS), and research, academic, and scientific partners to learn more about the prevalence and spread of the virus and for other testing research purposes, such as the accuracy and ease of use of home testing
See the government’s national testing strategy for more information on the different pillars.
These different routes are administered in different ways and that has an influence on how they are reported.
Source: Extracted from gov.uk on 12/03/2021
Care home testing
There are 2 types of test kits delivered to care homes:
- · polymerase chain reaction (PCR) test kits known as Kingfisher kits
- · lateral flow device (LFD) test kits
All of these kits are throat and nose swab tests and will tell a person whether they had coronavirus at the time the test took place. They cannot tell a person if they have had coronavirus in the past.
See the guidance for testing in adult care homes:
- · For ‘On-site testing for adult social care services’ go to Coronavirus (COVID-19) testing for adult social care settings.
- · For ‘Testing for professionals visiting care homes’ go to Coronavirus (COVID-19) testing in adult care homes.
Source: Extracted from Coronavirus (COVID-19): getting tested - GOV.UK (www.gov.uk) on 12/03/2021
PCR testing capacity continues to meet demand, and the average number of tests undertaken in Wiltshire within a seven day period for each month are:
- May 2021 - 7,840
- April 2021 - 6,186
- March 2021 - 6,295
- February 2021 - 7,748
- January 2021 - 16,858
- December 2020 - 13,061
- November 2020 - 12,290
- October 2020 - 10,686
- September 2020 - 9,839
Rapid lateral flow testing started in Wiltshire in November 2020 and in May 2021 was averaging around 8,600 tests per day during the week and 6,700 per day at the weekend.
Source: Extracted from gov.uk on 30/06/2021 .
A case is a person who has tested positive for COVID-19 through a Pillar 1 or 2 test.
The true number of those currently infected is not the same as the number of cases. It is thought a large minority of people are asymptomatic or experience the disease in such a mild form that they may not notice and so may not get a test.
Up to date information on cases in Wiltshire can be found here.
Case information is presented in these views:
ONS Covid-19 infection survey
The COVID-19 Infection Survey (Pilot) measures:
- · How many people in the community across England & Wales (results given separately) test positive for COVID-19 infection at a given point in time, regardless of whether they report to experiencing symptoms?
- · The average number of new infections per week over the course of the study
- · The number of people who test positive for antibodies, to indicate how many people are ever likely to have had the infection
The survey looks at infections in a community setting (not hospital or care home). The methodology is pragmatic in nature and lacks the normal rigour that would occur outside of a pandemic.
For further detail please visit the ONS website.
R and Growth rates
R represents the rate of onward infection or the number of people an infected person is likely to infect.
Growth rates represent the likely growth rate of infected individuals.
Please see gov.uk for the latest R and growth rates. .
Hospital Acquired COVID-19 Infections
In October the Healthcare Safety Investigation Branch (HSIB) issued a report on the factors behind hospital acquired covid-19 infections in England last spring. We now have better access to testing and personal protective equipment (PPE).
A Health Service Journal analysis of NHS England data found that around one in four COVID-19 cases was probably caught by hospital inpatients initially admitted for other reasons. Using this approach the chart shows the percentage of cases that may have been acquired in hospital for 1st August 2020 to 31st March 2021.
Information on the burden of Coronavirus in hospitals is publicly available at the national, regional and NHS Trust level but not at the local authority level.
Figures for the main hospitals that support Wiltshire can be found via these links:
There are two measures of mortality related to Coronavirus.
- · Registered Deaths: The ONS publishes mortality figures every Tuesday and the publication is a week behind the registration of deaths. The details provided can be broken down by local authority and broad setting.
- · Deaths within 28 days of a positive COVID-19 test – PHE publishes, daily, the number of deaths of patients who have died and had a positive COVID tests in the 28 days prior.
The ONS measure is considered the more robust as it involves a doctor certifying that the death was either due to COVID-19 or that it was an underlying factor in the death of the person.
The PHE measure being more timely does not have the same robust verification, but allows an understanding of the likely impact of COVID-19 infections and hospitalisations on the population. It is possible that at times of high infection that this measure may be more accurate.
ONS mortality 2020: Weekly in Wiltshire
The ONS data for 2020 shows a total of 5,303 deaths registered in Wiltshire, compared to a 5-year average of around 4,668. This means there were around 635 deaths in excess of the average.
474 mortalities included a mention of COVID-19 on the death certificate.
ONS mortality 2020: Place of death in Wiltshire
In 2020, a similar number of deaths took place in hospitals and in hospices as the 5-year average. Overall, there were 5 fewer deaths in 2020 than the 5-year average.
The number of deaths in care homes was 219 more than the 5-year average
The number of deaths at home were 430 more than the 5-year average.
ONS Covid-19 mortality 2020: Place of death in England and Wiltshire
Around half of COVID-19 deaths in Wiltshire were in care homes, while in England it was only around a quarter. The hospital deaths in England account for two-thirds of COVID-19, whereas the deaths in Wiltshire were just under half.
Long term effects of COVID-19 infection
For some people, coronavirus (COVID-19) can cause symptoms that last weeks or months after the infection has gone. This is sometimes called post-COVID-19 syndrome or "long COVID".
Many people feel better in a few days or weeks and most will make a full recovery within 12 weeks. For some people, symptoms can last longer.
People who had mild symptoms can still have long-term problems.
Symptoms of long COVID can include:
- · extreme tiredness (fatigue)
- · shortness of breath
- · chest pain or tightness
- · problems with memory and concentration ("brain fog")
- · difficulty sleeping (insomnia)
- · heart palpitations
- · dizziness
- · pins and needles
- · joint pain
- · depression and anxiety
- · tinnitus, earaches
- · feeling sick, diarrhoea, stomach aches, loss of appetite
- · a high temperature, cough, headaches, sore throat, changes to sense of smell or taste
- · rashes
Long COVID: Prevalence
The ONS has estimated, based on the data collected as part of the COVID-19 infection survey that:
- · 20% of respondents who had tested positive for COVID-19 exhibited symptoms for a period of 5 weeks or longer
- · 10% of respondents who had tested positive for COVID-19 exhibited symptoms for a period of 12 weeks or longer
Based on the data around the number of infections the ONS estimated that in the week of 22nd November there were around 186,000 people suffering with COVID symptoms that had persisted for between 5 and 12 weeks.
The Zoe Study run by Kings College London estimated slightly lower proportions of people likely to suffer persistent COVID symptoms but also found:
- · Persistent COVID symptoms were greater in the older population, 10% of 18-49 year olds and 22% of those aged over 70.
- · In the younger age group it was women who were more likely to suffer persistent COVID symptoms (14.5% vs 9.5%)
Long COVID: NICE guidelines
The NICE Rapid Guidelines for managing the long term effects of COVID-19 defines 3 phases following an infection:
- · Acute COVID-19 – Signs and symptoms of COVID-19 for up to 4 weeks
- · Ongoing Symptomatic COVID-19 – Signs and symptoms of COVID-19 from 4-12 weeks
- · Post COVID-19 Syndrome (PCS) – Signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.
Management of people with ongoing COVID-19 and PCS
- · Self Management and Supported Self Management
- · Self management guidance, setting realistic goals & social prescribing
- · Accessing support from other agencies
- · Multidisciplinary Rehabilitation
- · Initial referral
- · Structured rehabilitation/reablement programme
Source: Extracted from NICE Guidelines on 19/01/2021
Long COVID: Wiltshire
There have been around 17,500 COVID-19 cases in Wiltshire since the beginning of the pandemic, to the end of May 2021. This suggests that around:
- · 3,500 people are potentially suffering with ongoing symptomatic COVID-19
- · 1,750 people are likely to go on to suffer from PCS
GP practices have been asked by NHS England to maintain a register of Long COVID patients.
BSW CCG is currently developing services to support these patients in accordance with the NHS Guidance. .
Vulnerable groups in Wiltshire
The national evidence has highlighted a number of groups that could be at greater risk of COVID-19. These were:
- · Those in urban areas-Source: ons.gov.uk
- · Males- Source: gov.uk and ons.gov.uk
- · Older Age groups- Source: gov.uk
- · BAME groups- Source: gov.uk
- · Deprivation- Source: gov.uk
- · Those with obesity- Source: gov.uk
- · Diabetics- Source: ons.gov.uk
- · Those with Ischaemic heart disease- Source: ons.gov.uk
- · Those with Chronic lower respiratory diseases - Source: ons.gov.uk
- · Those with Dementia and Alzheimer disease - Source: ons.gov.uk
Wiltshire consists mainly of rural areas. The few areas defined as ‘urban city and town’ by ONS include parts of:
- · Amesbury
- · Calne
- · Chippenham
- · Corsham
- · Devizes
- · Melksham
- · Royal Wootton Bassett
- · Salisbury
- · Trowbridge
- · Warminster
- · Westbury
Wiltshire has a similar population pyramid to England. However, Wiltshire has a lower proportion of young adults than England.
Percentage of the population 65 and over by community area
Ethnicity and age
The most recent reliable ethnicity data available at local authority level is the 2011 census. NOMIS offers the ability to cross tabulate a number of items from the 2011 census including ethnicity and age.
Overweight and obese
A number of figures are provided through the Fingertips dashboard published by PHE.
The image below provides an overview of these indicators.
Compared to England, Wiltshire generally has a lower rate of excess weight in children, and a similar percentage of overweight and obese adults.
Childhood excess weight by Community Area
Adult excess weight data is not available below local authority level at this time.
Source: Extracted from the Wiltshire Intelligence website on 05/08/2021
Number of people in Wiltshire with health conditions related to COVID-19
These figures try to give an understanding to the size of the vulnerable groups. However, the registers are not exact matches to the conditions mentioned in the national evidence and an individual can be on multiple registers. Furthermore, some conditions are more closely correlated with COVID-19 outcomes than others.
Dementia and Alzheimer
4,836 adults in Wiltshire were reportedly part of the Dementia register in 2019/20.
Ischaemic heart disease
11,027 adults in Wiltshire were reportedly part of the Stroke and Transient Ischaemic Attack register in 2019/20.
Chronic lower respiratory disease
9,335 adults in Wiltshire were reportedly part of the COPD register in 2019/20.
77,985 adults in Wiltshire were reportedly part of the Hypertension register in 2019/20.
35,837 adults in Wiltshire were reportedly part of the Asthma register in 2019/20.
28,513 adults in Wiltshire were reportedly part of the Diabetes Mellitus register in 2019/20.
The registered figures and proportions for each practice are below.
The registers have been ranked in order of the sum. As stated above, some individuals will be on multiple registers. However, this is still a good method to identify practices that might have a higher proportion of patients with higher risks.