Coronavirus (COVID-19) weekly insights: latest health indicators in England, 29 January 2021

• Infection rates remain high, with 1 in 55 (1.87%) of the population estimated to have the coronavirus (COVID-19) in the week ending 23 January 2021 (Coronavirus (COVID-19) Infection Survey (CIS)).
• Cases compatible with the new variant have increased in the East Midlands, but remained relatively stable or declined in all other regions (week ending 23 January, CIS).
• The rate of confirmed COVID-19 patients admitted to hospital decreased slightly but remained high at 33.5 per 100,000 people in the week ending 24 January 2021, more than twice the rate seen in the week ending 6 December 2020 (13.3 per 100,000 people).
• In the week ending 15 January 2021, the number of registered deaths involving COVID-19 in England increased by 20.9%.
• Deaths involving COVID-19 represented 40.2% of all deaths in England compared with 33.9% in the previous week (ending 8 January 2021).
• Of those who had not already received or been offered the vaccine, the proportion who said they would be likely to have the vaccine if offered increased with age, from 80% of those aged 16 to 29 years, to 98% of those aged 70 years and over (Opinions and Lifestyle Survey, Great Britain, 20 to 24 January).

In this weekly summary, we present the main findings from the latest coronavirus (COVID-19) data for England. This article is a collaboration between the Office for National Statistics (ONS), Joint Biosecurity Centre (JBC) and Public Health England (PHE).

In England, infections, hospitalisations and deaths started increasing in December 2020. Infection and hospital admission rates remain high and the number of deaths involving COVID-19 has increased in the most recent week. Cases compatible with the new variant of COVID-19 have decreased but continue to account for the majority of positive cases in England. Despite recent increases most people do not have antibodies to COVID-19, suggesting most of the population is still vulnerable to infection.

This release is going to be replaced by the Coronavirus (COVID-19) latest insights interactive tool on 12 February. The article content will be available in the interactive tool.

The coronavirus (COVID-19) infections and hospital admissions started increasing in December 2020. Infection rates remain high in the week ending 23 January 2021. The hospital admission rate decreased slightly but remains high in the week ending 24 January. The number of registered deaths involving COVID-19 increased in the most recent week (ending 15 January).

There is a period of time between a person becoming infected with COVID-19 and being admitted to hospital or dying because of it. Therefore, we expect to see a delay between a change in infection levels and corresponding changes in the numbers of hospital admissions and deaths.

Figure 1: Infection rates and hospital admissions remain high, deaths involving COVID-19 have increased

Estimated COVID-19 positivity rates, hospital admissions and number of deaths, England, 1 August 2020 to 24 January 2021

Notes:

1. All figures are provisional and subject to revision.
2. Infection statistics refer to infections reported in the community, by which we mean residential households. These figures exclude infections reported in hospitals, care homes and/or other institutional settings.
3. Figures exclude deaths of non-residents.
4. Based on date a death was registered rather than occurred.
5. The International Classification of Diseases, 10th edition (ICD-10) definitions are as follows: coronavirus (COVID-19) (U07.1 and U07.2).
6. We use the term “involving COVID-19” when referring to deaths that had COVID-19 mentioned anywhere on the death certificate, whether as an underlying cause or not.

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The Coronavirus (COVID-19) Infection Survey (CIS) estimated that 1,018,700 people in England had COVID-19 between 17 and 23 January 2021. This is equal to about 1 in 55 people or 1.87% of the population. The percentage of people testing positive (positivity rate) remains high and is similar to last week’s estimate (ending 16 January). Over the past two weeks the number of people testing positive has decreased, however, the positivity rate remains more than twice as high as in the first week of December (ending 5 December 2020), when 0.88% of the population tested positive.

The Real-time Assessment of Community Transmission (REACT) study estimated 1.57% of the population to be infected between 6 and 22 January 2021. Both REACT and CIS show similar trends over time, with positivity rates currently much higher than in the beginning of December.

CIS and REACT both estimate how many infections there are in the community, although they use different methods. For more information see Data sources and quality.

Figure 2: Coronavirus (COVID-19) Infection Survey (CIS) and Real-time Assessment of Community Transmission (REACT) study show similar trends over time

Estimated percentage of community population testing positive for COVID-19, 3 May 2020 to 23 January 2021, England

Notes:

1. All results are provisional and subject to revision.
2. These statistics refer to infections reported in the community, by which we mean private households. These figures exclude infections reported in hospitals, care homes and/or other institutional settings.
3. CIS estimates until 5 July are fortnightly weighted estimated and after that date they are weekly modelled estimates.
4. REACT data from the period 6 January to 22 January includes some swab tests from 30 December onwards.

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In the week ending 24 January 2021, confirmed COVID-19 hospital admission rates decreased slightly but remained high, at 33.5 per 100,000 people compared with 35.6 in the previous week (ending 17 January). This is more than twice the rate seen in the week ending 6 December 2020 (13.3 admissions per 100,000 people). The number of COVID-19 patients being admitted to intensive care units (ICU) and high-dependency units (HDU) also remained high in the latest week, at 2.4 per 100,000 people compared with 2.5 per 100,000 people in the previous week.

Proportion of deaths involving COVID-19 in England increased from the previous week

The number of deaths involving COVID-19 in England increased by 20.9% to 6,767 in the week ending 15 January 2021. Deaths involving COVID-19 represented 40.2% of all deaths in England compared with 33.9% in the previous week (ending 8 January). This is the highest proportion of deaths involving COVID-19 since the start of the pandemic.

The percentage of people testing positive for the coronavirus (COVID-19) decreased in London, the North East, West Midlands and the South East in the most recent week (Coronavirus (COVID-19) Infection Survey (CIS), 17 to 23 January 2021).

Despite the decrease, London still has the highest positivity rate among English regions (2.71%), followed by the North West (2.28%). The South West (1.42%) and Yorkshire and The Humber (1.20%) have the lowest proportions of people testing positive.

The Real-time Assessment of Community Transmission (REACT) study also reported the highest positivity rates to be in London (2.83%) between 6 and 22 January. Similar to CIS, the regions with the lowest proportions of positives were the South West (0.87%) and Yorkshire and The Humber (0.80%).

Differences in regional patterns might be because of methodology and different testing periods.

Figure 3: London and the North West have the highest positivity rates

Estimated percentage of the population testing positive for the coronavirus (COVID-19) on nose and throat swabs, by region, on 20 January 2021, England

Notes:

1. All results are provisional and subject to revision.
2. These statistics refer to infections reported in the community, by which we mean private households. These figures exclude infections reported in hospitals, care homes and/or other institutional settings.

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Hospital admission rates decreased in most English regions

In the week ending 24 January 2021, confirmed COVID-19 hospital admission rates decreased in most regions in England, except for the East Midlands, West Midlands and Yorkshire and The Humber, where rates increased.

The highest hospital admission rate in the week ending 24 January was in the West Midlands (49.5 per 100,000 people), while the North West recorded the lowest rate (23.8 per 100,000 people). London saw the largest decrease in admission rates, falling to 36.5 from 45.7 per 100,000 people in the previous week (ending 17 January).

Figure 4: Hospital admissions and deaths involving COVID-19 by region

Change in hospital admission rates and numbers of deaths involving COVID-19 from previous week, England, weeks ending 24 and 15 January 2021

Notes:

1. All figures are provisional and subject to revision.
2. Figures exclude deaths of non-residents.
3. Based on date a death was registered rather than occurred.
4. The International Classification of Diseases, 10th edition (ICD-10) definitions are as follows: coronavirus (COVID-19) (U07.1 and U07.2).
5. We use the term “involving COVID-19” when referring to deaths that had COVID-19 mentioned anywhere on the death certificate, whether as an underlying cause or not.

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The South East had the highest number of deaths involving COVID-19

Deaths involving COVID-19 increased in eight out of nine English regions in the week ending 15 January 2021. A decrease was seen only in Yorkshire and The Humber. The East of England recorded the largest increase. The South East had the highest number of deaths involving COVID-19 (1,411 deaths). Both the East of England and South East registered the highest number of weekly deaths involving COVID-19 since the pandemic began.

The percentage of people testing positive has decreased in all age groups, except in children age 2 years to school Year 6 where there are early signs of levelling off. Positivity rates in secondary school children have decreased substantially in the latest week (ending 23 January 2021, Coronavirus (COVID-19) Infection Survey (CIS)). The percentage of positive tests was highest in young adults (school Year 12 to age 24 years) at 2.01% and lowest in adults aged 70 years and over at 0.86%.

Hospital admission rates have decreased for most age groups

Even though more young people have been infected, hospital admissions and deaths involving the coronavirus are highest among those aged over 65 years. Of more than 88,900 deaths involving COVID-19 in England to date, almost 90% were among people aged 65 years and over.

Hospital admissions decreased among most age groups in the week ending 24 January 2021. The largest fall in admission rates was seen among those aged 85 years and over, where 281.1 per 100,000 people were admitted to hospital, down from 300 in the previous week (ending 17 January). This is almost 30 times the rate among those aged 15 to 44 years. Rates have been the highest among those aged 85 years and over throughout the pandemic. The hospital admission rate is lowest among children aged between 5 and 14 years, at 1.1 per 100,000 people.

In the week ending 15 January, the number of deaths involving COVID-19 in England increased in all age groups 15 years and over compared with the previous week (ending 8 January). The biggest increase was seen in those aged 85 years and over, with 452 more deaths than the previous week.

Figure 5: COVID-19 infections, hospital admissions and deaths by age

Estimated percentage of the population testing positive for COVID-19 in the week ending 23 January, hospital admission rates in the week ending 24 January and deaths registered in the week ending 15 January 2021, by age, England

Notes:

1. All figures are provisional and subject to revision.
2. Infection statistics refer to infections reported in the community, by which we mean residential households. These figures exclude infections reported in hospitals, care homes and/or other institutional settings.
3. Infection statistics are based on statistical modelling conducted by CIS research partners at the University of Oxford.
4. Infection estimates are given for the reference date: 13 January 2021.
5. Figures exclude deaths of non-residents.
6. Based on date a death was registered rather than occurred.
7. The International Classification of Diseases, 10th edition (ICD-10) definitions are as follows: coronavirus (COVID-19) (U07.1 and U07.2).
8. We use the term “involving COVID-19” when referring to deaths that had COVID-19 mentioned anywhere on the death certificate, whether as an underlying cause or not.

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A new genetic variant of the coronavirus (COVID-19) was identified in the UK in December 2020. Positivity rates for cases compatible with the new variant increased sharply in December. At the national level in England, rates of new variant compatible positives have decreased in the most recent week (Coronavirus Infection Survey (CIS), 17 to 23 January 2021). Positivity rates for cases clearly not compatible with the new variant have also decreased.

Meanwhile, positives where the virus was too low for the variant to be identifiable have increased in recent weeks. Cases that are classified as not identifiable are usually those where individuals have had the virus for a longer period of time. This means that increases in this group are consistent with an increase in infections acquired a longer time ago. This is consistent with overall decrease of new coronavirus infections. For more information on the new variant, including recent changes to our classification of variants, see Glossary and our new blog entry.

Figure 6: Positivity rates for cases compatible with the new variant and not compatible with the new variant have decreased in England

Positivity rates for cases compatible with the new variant of COVID-19, not compatible with the new variant and where the virus was too low for the variant to be identifiable, on nose and throat swabs, daily, since 13 December 2020, England

Notes:

1. All results are provisional and subject to revision.
2. These statistics refer to infections reported in the community, by which we mean private households. These figures exclude infections reported in hospitals, care homes and/or other institutional settings.
3. Data should be treated with caution. There are further uncertainties given that not all cases that are positive on the ORF1ab- and N-genes will be the new variant.
4. New variant compatible positives are identified as those that are positive on the N-gene and ORF1ab-gene, but not the S-gene. Positives that are not compatible with the new variant are defined as those that are positive on the S-gene, N-gene and ORF1ab-gene. Positives where the virus is too low for the variant to be identifiable are defined as those that are positive with all other gene patterns. These definitions are regardless of the cycle threshold (Ct) value.

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Cases that are compatible with the new variant are increasing in the East Midlands. Rates are relatively stable or declining in all other regions.

Figure 7: Cases compatible with the new variant have increased in the East Midlands

Positivity rates for cases compatible with the new variant of COVID-19, not compatible with the new variant and where the virus was too low for the variant to be identifiable, on nose and throat swabs, daily, by region, since 13 December 2020, England

Notes:

1. All results are provisional and subject to revision.
2. These statistics refer to infections reported in the community, by which we mean private households. These figures exclude infections reported in hospitals, care homes and/or other institutional settings.
3. Data should be treated with caution. There are small numbers of positives detected leading to considerable uncertainty surrounding these estimates. There are further uncertainties given that not all cases that are positive on the ORF1ab- and N-genes will be the new variant.
4. New variant compatible positives are identified as those that are positive on the N-gene and ORF1ab-gene, but not the S-gene. Positives that are not compatible with the new variant are defined as those that are positive on the S-gene, N-gene and ORF1ab-gene. Positives where the virus is too low for the variant to be identifiable are defined as those that are positive with all other gene patterns. These definitions are regardless of the cycle threshold (Ct) value.

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Despite recent increases, most people do not have COVID-19 antibodies

The presence of coronavirus (COVID-19) antibodies suggests that a person previously had the infection. The Coronavirus (COVID-19) Infection Survey (CIS) reported an increase in the proportion of people with antibodies to 12.1% (around one in eight people) in December 2020. This is more than double the percentage seen in September (5.7%).

The percentage of people with antibodies among NHS blood donors also increased in recent weeks, to 10.1% (30 December 2020 to 15 January 2021), from 7.3% in the previous month (23 November to 20 December 2020). Despite the increase, the results suggest that most of the population is still vulnerable to infection.

The proportion of people following preventative measures to help slow the spread of the coronavirus (COVID-19) remained high in the latest week (Opinions and Lifestyle Survey, Great Britain, 20 to 24 January 2021). The majority of people reported that in the last seven days, they always or often washed their hands after returning home (90%), used a face covering (95%), avoided physical contact when outside their home (94%) and maintained social distance (90%).

The proportion of adults in Great Britain reporting staying at home or only leaving for work, exercise, essential shopping or medical needs in the past seven days fell slightly (62%, 20 to 24 January) compared with the previous week (65%, 13 to 17 January). Despite the decrease, this is twice as high as the mid-December level, when only 31% adults reported that (10 to 13 December 2020).

Of those who had not already received or been offered the vaccine, the proportion who said that they would be very or fairly likely to have the vaccine if offered increased with age. This was from 80% of those aged between 16 and 29 years to 98% of those aged 70 years and over.

Figure 9: The proportion of adults who said they would be likely to have the COVID-19 vaccine increased with age

Great Britain, 20 to 24 January 2021

Notes:

1. Question: "If a vaccine for the coronavirus (COVID-19) was offered to you, how likely or unlikely would you be to have the vaccine?".
2. Base population for percentage: Adults who reported they had not yet received or been offered COVID-19 vaccination.
3. Response for the category "Prefer not to say" has been removed from the chart due to having a reported proportion amongst all adults of 1% or less.
4. Response for the categories "Neither likely or unlikely", "Very unlikely", or "Don’t know" for adults aged 70 years and above have been suppressed due to having either a small sample size or the estimate being less than 1%.
5. Confidence intervals are provided in the datasets associated with this bulletin. As a general rule, if the confidence interval around one estimate overlaps with the interval around another, we cannot say with certainty that there is more than a chance difference between the two estimates.
6. Totals may not sum to 100% due to rounding and removal of the response category "Prefer not to say".

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Following a decline in well-being in early January 2021, this week well-being scores for life satisfaction (6.5), happiness (6.4) and feeling that things done in life are worthwhile (7.0) remained at some of the lowest levels recorded since the survey began in March 2020 (Opinions and Lifestyle Survey, Great Britain, 20 to 24 January 2021). However, the anxiety score shows a slight improvement (4.3) compared with early January 2021 (4.6), when the highest score since April 2020 was reported.

Figure 10: Well-being scores remained low this week with happiness at its lowest level since March 2020

Average well-being scores, March 2020 to January 2021, Great Britain

Notes:

1. Questions: "Overall, how satisfied are you with your life nowadays?", "Overall, to what extent do you feel that the things you do in your life are worthwhile?", "Overall, how happy did you feel yesterday?" and "Overall, how anxious did you feel yesterday?".
2. This question is answered on a scale of 0 to 10, where 0 is “not at all” and 10 is “completely”.
3. Base: all adults.

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This report was prepared by the Office for National Statistics (ONS) in collaboration with our partners at the Joint Biosecurity Centre (JBC) and Public Health England (PHE).

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Positivity rate

In this article we refer to the positivity rate as the proportion of people that have tested positive for the coronavirus (COVID-19) using nose and throat swab tests. The Coronavirus COVID-19 Infection Survey (CIS) estimates positivity in the community population. CIS positivity rates refer to everybody that had the infection within a given week. This is different to the incidence rate, which refers to the proportion of “new” positive COVID-19 cases.

Please note that the NHS Test and Trace records infections among people experiencing symptoms or referred for testing (for example, by their employer). It only includes new COVID-19 cases when computing the positivity rates (incidence of the disease).

New variant

Swabs are tested for three genes present in the coronavirus: N protein, S protein and ORF1ab. Each swab can have any one, any two or all three genes detected. Positives are those where one or more of these genes is detected in the swab other than tests that are only positive on the S-gene which is not considered a reliable indicator of the virus if found on its own.

The new variant of COVID-19 has genetic changes in the S-gene. This means the S-gene is no longer detected in the current test, and cases that would have previously been positive on all three genes are now positive only on the ORF1ab and the N-gene (not the S-gene).

There are also other reasons why a swab may be positive for only these two genes, including lower viral load in the sample, which is why we have always seen a small percentage of this type of positive result. Absence of the S-gene appears to have become a reliable indicator of the new variation in COVID-19 from mid-November, based on the higher levels of virus in these type of positives after this date. Prior to that, the data should not be read as being an indicator of the variant.

Cases positive for the N-gene and ORF1ab-gene, but not the S-gene are classed as compatible with the new variant. Positives that are not compatible with the new variant are defined as those that are positive on all three genes (S-, N- and ORF1ab-genes). All other gene patterns are classed as positives where the virus is too low for the variant to be identifiable. These definitions are regardless of cycle threshold (Ct) value.

Antibodies

Evidence of a previous infection and a degree of immunity to the virus. You can read more about antibody testing in the Department of Health and Social Care guidance.

Coronavirus (COVID-19) Infection Survey

The Office for National Statistics (ONS) Coronavirus (COVID-19) Infection Survey (CIS) estimates the number of infections in the community population in England, Wales, Northern Ireland and Scotland.

People tested are from randomly selected residential households and may or may not have any coronavirus (COVID-19) symptoms. Nose and throat swabs are taken from all household members aged two years and over. It excludes those in hospitals, care homes or other institutional settings. Positivity rates are calculated for seven-day periods and adjusted to represent the population. Results are published in a weekly bulletin, with a release on the characteristics of people testing positive published monthly. The survey is delivered in partnership with University of Oxford, University of Manchester, Public Health England and Wellcome Trust.

Real-time Assessment of Community Transmission (REACT) Study

The REACT Study also estimates the number of infections in the community population. The study tests randomly selected individuals (rather than households) over the age of five years. Results are calculated for time periods ranging from 18 to 32 days for each testing round.

Differences between REACT and CIS include data collection procedures and modelling approaches. Unlike CIS, REACT does not carry out follow-up visits with subjects. Because of this, the incidence rate cannot be calculated for REACT studies. REACT-2 additionally tracks COVID-19 antibody prevalence using finger-prick blood tests. REACT is commissioned by the Department of Health and Social Care (DHSC) and carried out by Imperial College in partnership with Ipsos MORI.

Hospital admissions

Data on hospital admissions is provided by Public Health England and comes from the Severe Acute Respiratory Infection (SARI) Watch surveillance system. SARI Watch monitors the number of patients with confirmed flu and COVID-19 admitted to hospital and critical care units (ICU and HDU). Admission rates are recorded by age and region. These data are provisional and subject to revision, and previous estimates may be updated in subsequent weeks.

Deaths

Figures for deaths involving COVID-19 included in this publication are from the ONS’s weekly provisional counts of the number of deaths registered in England and Wales. This includes deaths with COVID-19 mentioned on the death certificate. Figures are based on the date the death was registered, not when it occurred. There is usually a delay of at least five days between occurrence and registration. More information on this issue can be found in the Impact of registration delays release.

Preventative measures, social contact and well-being

This publication includes indicators from the Opinions and Lifestyle Survey collected to understand the impact of the coronavirus pandemic on people, households and communities in Great Britain.

Strengths and limitations of data sources

This publication collates data from a range of sources reporting on the coronavirus pandemic. Each of these sources has their own strengths and limitations.

The Coronavirus (COVID-19) Infection Survey and REACT data both track COVID-19 infections in the community, by testing samples of the population. Their estimates of positivity rates contain uncertainty. There is uncertainty in the estimates, swab tests results and in the quality of data collected in the questionnaire. Death figures in this article are based on the date the death was registered, not when it occurred. There is usually a delay of at least five days between occurrence and registration. More information on this issue can be found in our Impact of registration delays release.