Covid in Wales: What do the stats tell us?

What can statistics tell us about coronavirus in Wales?

Here we assess some of the figures showing the pandemic over the past three years and also update some of the remaining measures.

The World Health Organization (WHO) declared in May 2023 that Covid-19 is no longer a global health emergency, but said it did not mean the danger was over.

We are still officially at a "Covid stable" stage, and while some hospital and mortality data is still being published weekly or monthly, other surveillance measures have been scaled back or paused.

Numbers of acute hospital patients testing positive for Covid by 12 July 2023 had fallen to the lowest levels for nearly two years.

Only three patients - in Cardiff and Vale and Swansea Bay - were being "actively" treated for Covid, the lowest under this indicator.

Digital Health and Care Wales has now stopped its weekly Covid figures, although Public Health Wales (PHW) is still publishing some hospital data.

Numbers of in-patients with Covid on 23 July, had risen slightly over the week to 93, according to figures from PHW.

These include three patients in critical care.

But the trend has generally shown a decline over the past three months.

The final "snapshot" figure from Digital Health Wales on 12 July had shown the number of patients testing positive for Covid in all hospital beds in Wales was 65.

The vast majority were "incidental" patients who happened to test positive in hospital.

Only three (5%) confirmed Covid patients in acute beds on 12 July were being primarily treated for the virus, with 62 patients in hospital being treated for other conditions.

When patients with suspected Covid and those recovering were included, there were 206 people in hospital beds for the last set of figures, 12 July.

These included 138 patients recovering, so they were no longer testing positive for Covid but were waiting for discharge or for a care package to become available.

The number of people in hospital with Covid has held a similar pattern for the past year.

There were five patients in critical care with Covid on 12 July, with one of those recovering from Covid.

Only three Covid patients in critical care were being primarily treated for it, and there were 35 times more non-Covid patients in critical care than patients with the virus.

PHW figures suggested three critical care patients with Covid on 23 July, similar figures being seen for three months.

There were 24 patients with Covid in critical care at the peak of winter 2022-23, compared with 40 the previous year, while in the second wave in January 2021 it peaked at 150.

The mortality rate of critical care Covid patients, in a long-running study of 513 Welsh patients after January 2022, was about 34%, including those who died later on a general ward.

About 63% had been discharged from hospital. The study also showed patients admitted in the past year who survived are spending less time in critical care - an average of seven days - than early in the pandemic.

Around 60% of patients had been admitted to critical care with Covid the primary reason for treatment.

The average age of those admitted in 2022-23 was 58, and just over half were men. Half were from more deprived parts of Wales. About 26% were under 50.

There were five admissions of people testing positive for Covid on 12 July, with numbers in single figures for three months.

Figures had been low and, for the first time since the pandemic began, no Covid admissions were recorded on 24 January 2023. The previous low had been just one admission on two days in May and June 2022.

Scientific advice suggested Covid should continue to plateau in the coming weeks, with hospital admissions continuing to be low, although projections were uncertain.

Over 18 months from the start of 2022, hospitals in Wales were asked to track how many of their patients testing positively for Covid were actually being primarily treated for it.

Over this period, 13% of patients on average with Covid were being actively treated for it.

Digital Health and Care Wales indicated the data had no standard definition for "actively being treated for Covid", meaning there were some differences between health boards in how they arrived at the figure so care needs to be taken how we interpret this.

Certainly since the autumn of 2022, the proportion of "active" Covid cases was usually in single figures.

The Icnarc intensive care study has found a far smaller proportion of critical care patients with Covid were being primarily treated for the virus during 2022 (41%), compared with the period before (nearly 86%).

The mortality rate was 31% for those with "primary" Covid, compared with 25% for those with incidental Covid.

Public Health Wales is still publishing weekly data on patients who test positive for Covid in hospitals.

There were 69 positive tests for Covid in hospitals in the week ending 23 July.

Public Health Wales figures showed "probably" or "definitely" hospital-acquired infections in patients made up 61% of those with Covid in beds, compared to those patients who came with Covid or the origin can't be determined.

Hospital-acquired infections stood at 42.

There have been around 20,380 hospital-acquired infections recorded since the start of the pandemic.

Latest PHW hospital figures show a slight rise in the number of in-patients testing positive for Covid in week of 23 July 2023.

There were 93 in-patients testing positive for Covid, with very few (five) testing for other respiratory conditions.

Modelling from Welsh government scientists for the winter of 2022-23 had suggested in a "worst case" scenario that Covid, flu and other respiratory conditions could account for 2,750 hospital beds - or 28% of total capacity at the peak.

The "most likely" scenario had been for 1,390 patients with Covid, flu and other respiratory conditions on 9 December 2022, including 668 with confirmed positive tests for Covid.

The peak when it came in early January reached around 1,760 patients.

Routine testing has now been paused for health and social care workers and care home residents with symptoms, while the Covid alert level system has also been suspended.

An indication of pressure on the NHS in the aftermath of Covid was overall bed occupancy in acute hospitals, which hit a new high of 96.2% on 1 March 2023.

This broke the previous record set two weeks before and an earlier high at the end of October 2022.

The final weekly snapshot showed bed occupancy at 94.8%.

Modelling for Covid alone peaked at more than 1,800 patients with the virus in a "worst case scenario" in December 2022.

The actual curve for patients with Covid positive tests by the end of the modelling period in March was tracking with the "most likely" scenario after following a more undulating pattern, which had taken it closer to the "optimistic" scenario at one point.

Scientific advisers suggested the most recent medium-term projections show a continued plateau in the coming weeks. However, there was a large amount of uncertainty in this, particularly in June.

Another measure of pressure on the health service is NHS staff absence, although this data set has now been stopped

A total of 0.1% of staff - about 121 - were absent due to Covid-related sickness in the week to 19 June, according to the final Welsh government figures. This does not include NHS Wales staff absent for other reasons.

Total absence stood at 4.8%, roughly the same as the usual pre-pandemic figure.

The quarterly average to September 2022 was 6.6%, about the same as the three months to March 2022 and the fourth highest rate on record.

The rate at which GPs are consulted about Covid-19 is also another indicator, which peaked in the first week of January 2022 at 98 consultations per 100,000 and has now fallen back to extremely low levels, under one or two per 100,000.

Another measure has been analysing samples of waste water, which had been showing a decreasing trend for viral load but that is now unstable.

The latest week showed the signal increasing in 11 regions, falling in two regions, and level in one region.

Other surveillance indicators, including the long-running ONS swab survey estimating infection levels, which also analysed levels of antibodies, have been discontinued.

The number of people who have died with Covid a contributory factor has reached 11,972 in Wales since March 2020.

In the most recent week, up to 14 July, four people in Wales had a death registered which involved Covid-19 and saw it mentioned on their death certificate, according to the ONS.

There were deaths in only four of Wales' 22 local authorities: Ceredigion, Carmarthenshire, Newport and Swansea, all in hospital.

There were four also the previous week, the lowest weekly totals for two years.

Three of the four deaths (75%) were due to Covid, when it was the underlying cause of death.

Two of the latest registrations involved people over the age of 85 and two aged 45 to 64.

When counted by day occurring - not day registered - there were three deaths involving Covid in the past week registered so far, the same as in the previous week.

However, the most recent weekly figures are usually an underestimate, due to delays in registrations catching up.

Up to the end of June there have been 9,870 deaths due to Covid, with the virus the underlying cause of death.

There have around half the number of Covid deaths so far in 2023 compared to the same period in 2022.

The ONS counts deaths in people's homes, hospices and other settings, as well as hospitals and care homes.

ONS also records so-called "excess deaths". This looks at average deaths from all causes overall, compared with five non-pandemic years.

So since March 2020, there have been 10,088 more deaths than we might have expected to see.

There have been 2,904 deaths from all causes above the non-pandemic average in the last 12 months.

So far in 2023, there have been 7.2% more deaths than average and deaths in people under 44 are 4% higher.

Deaths in the week ending 14 July were 11.8% above the five-year pre-pandemic average.

There were 653 deaths from all causes - this is 69 more deaths than we might expect to see.

Covid accounted for 0.6% of all deaths in Wales in the latest week, about the same proportion as in England (0.8%), where deaths were above normal by 3.7%.

Analysis by ONS found excess deaths - when deaths due to Covid were excluded - were 103 (-0.1%) below average over the whole pandemic period to the end of December 2022.

But non-Covid excess deaths were running above average for eight successive months at the end of 2022, totalling 1,653.

At a local level, Monmouthshire (15%) and Caerphilly (13%) had the highest proportion of excess deaths.

Monmouthshire saw the 12th highest proportion of excess deaths across England and Wales in 2022.

Both Rhondda Cynon Taf, Vale of Glamorgan and Bridgend saw deaths below average.

Nearly a fifth (17.6%) of all Covid deaths registered have occurred in care homes.

There has been one death involving Covid among care home residents registered over the last seven weeks. There were no deaths again in the latest week out of 83 deaths from all causes.

Care Inspectorate Wales reported that deaths peaked in May 2020 and before it stopped publishing data it was notified of 2,339 care home resident deaths with suspected or confirmed Covid up to the end of June 2023.

There were 726 deaths above the five-year average in care homes in Wales in April 2020, at the height of the first wave of the pandemic.

There were also high numbers of excess deaths in the winter of 2020-21, when the vaccination programme was only just starting.

Altogether, in the three-year period from January 2020 there were nearly 1,500 excess deaths in care homes in Wales.

ONS analysis of deaths in care homes in 2021 found mortality rates lower in Wales in male residents than in England or any English region.

Covid was the second highest cause of death in care home residents after dementia, accounting for 12.9% of male resident deaths and 11.1% of female resident deaths.

There have been nearly twice as many deaths due to flu and pneumonia in Wales than due to Covid so far in 2023.

Covid-19 was the 19th leading cause of death in Wales in June 2023, after being the 10th leading cause in May.

Because it was also the 19th leading cause of death in June 2022, ONS has indicated a possible seasonal effect of Covid deaths.

Mortality analysis showed there were 35 deaths due to Covid over the month - 1.2% of all registered deaths.

This was fewer than in May when there were 57 deaths.

Looking at when Covid was a contributory factor, there were 51 deaths involving Covid in Wales - or 1.8% of all deaths registered in June.

So far in 2023, up to the end of June, ill-defined conditions - which include old age and frailty - was the leading cause of excess deaths, more than 46% above normal levels.

Heart disease was again the leading cause of death in June 2023 in Wales.

Flu and pneumonia again ranked sixth, ahead of Covid's mortality rate again but 10% below normal levels. It is the fifth leading cause in 2023 up to the end of June.

So far in 2023, heart disease is the leading cause of death and Covid is the ninth leading cause.

Heart disease ranked as the leading cause of death for 2022 as a whole.

Covid was the seventh leading cause of death in 2022, with a mortality rate of 38.5 deaths per 100,000, after being the second leading cause of death in Wales after heart disease in 2021 and the leading cause of death at the height of the pandemic in 2020.

The ONS, which takes into account population and age structure, found the mortality rate for deaths due to Covid in Wales in June was 11.8 deaths per 100,000 - down on May's figure.

From the start of the pandemic, the age-standardised mortality rate for deaths involving Covid is slightly higher in Wales (104.6 deaths per 100,000), than England on 104 deaths per 100,000, with Scotland (97.9) and Northern Ireland (95.5) both lower in the 40 months to the end of June.

The age-standardised mortality rate due to Covid - with Covid the underlying cause of death - is slightly higher in England than in Wales.

It is also higher in all English regions apart from south west, south east and east England.

When a crude mortality rate, not adjusting for the age or population profile, is used, deaths are higher in Wales.

Covid was the underlying cause of death - not just a contributory factor - in 68.6% of Covid deaths mentioned by doctors on death certificate in Wales in May.

It has been as high as 94% and on average since the start of the pandemic, 82.5% of deaths with Covid on death certificates can be said to be due to Covid.

So, there were 9,870 deaths due to Covid by the end of June 2023 in Wales.

In about 3.7% of these deaths, the doctor had written that Covid was "suspected".

A doctor's duties include certifying deaths, and this can include any cause in a chain of events leading up to them, including pre-existing conditions and whatever medically makes a contribution.

Rhondda Cynon Taf (RCT) and Merthyr Tydfil have the highest mortality rates over the course of the pandemic in Wales.

By 14 July, RCT had reached a total of 1,203 deaths, with the highest crude mortality rate - 506.1 deaths per 100,000.

This was the 10th highest crude mortality rate of all local authorities across England and Wales.

Deaths involving Covid can also be shown to be hitting people living in deprived areas, usually associated with poorer health, harder than in the least deprived areas of Wales.

Merthyr with 295 deaths (501.7 deaths per 100,000) was the 11th highest. Bridgend was 15th (493.5 deaths per 100,000) in England and Wales.

Cardiff (1,192) has the second highest number of deaths in Wales, although because of its population size, its mortality rate is one of the lowest in Wales.

So far in 2023, Conwy and Powys have the highest Covid mortality rates in Wales, based on the sizes of their populations.

They are followed by Swansea and Denbighshire.

Six of RCT's communities were in the highest 20 within Wales during the first and second waves, when the death rates can be broken down further.

At a health board level, the age-standardised mortality rate for Cwm Taf Morgannwg, which covers RCT, Merthyr and Bridgend, was 132.4 deaths per 100,000 due to Covid in the three years of the pandemic up to the end of May 2023.

This is the highest in Wales, the lowest being 58 deaths due to Covid in the Powys health board area, set against a Welsh average of 88.3.

The community with the highest number of Covid deaths across 2020 and 2021, including in the first two waves of the pandemic, was Tonyrefail West in Rhondda Cynon Taf, with a total of 63 deaths due to Covid.

This was followed by Sandfields in Neath Port Talbot and Porth East and Ynyshir in RCT (55 deaths each), by the end of 2021.

When translated into mortality rates, based on population size, Gwersyllt West and Summerhill in Wrexham was the highest at 742.6 deaths per 100,000 - or 44 deaths over the two years.

This was followed by Tonyrefail West, Port Talbot East and Llanelli Bigyn in Carmarthenshire.

All communities of Wales have now had at least two deaths during the pandemic.

The lowest number of deaths at a community level were in Aberystwyth North and Aberystwyth South, Bangor City and Llandudno Junction South and Llansanffraid Glan Conwy.

At a local authority level, in the second wave of the pandemic, Bridgend was the worst-hit area in Wales.

In 2021, Bridgend had the highest Covid mortality rate - 271 deaths or 183.2 deaths per 100,000; this was the 24th highest area across England and Wales.

There are figures to compare relative excess deaths in different European countries.

Bulgaria has the highest relative cumulative age-standardised mortality rate - 18.2% higher than normal - and Norway the lowest, 4.1% below average.

Wales was 3.7% above average in June 2021 and then 2.1% above average in July 2022 - ranked 21st out of 33 nations.

For those aged under 65, Wales was 4.8% above average (ranked 12th) and 1.5% above average (joint 24th) in the over-65s.

Wales also saw excess mortality in more than half of weeks over the period.

The 2023 lspring booster programme reached 286,032 people - which was more than two thirds of those eligible in Wales.

But that varied across Wales, with fewest reached in the Hywel Dda health board area (55.3%) from the last published figures in July.

The spring programme covered 78.3% of care home residents in Wales and 73.7% of the over 75s.

More than 1.1m autumn boosters were given out in 2022-23, reaching 89% of care home residents and more than 82% of over 65s.

More than 9.1m doses of Covid vaccine have been administered in Wales since December 2020.

Analysis of the spring booster programme showed "significant differences" in take-up between different population groups.

There was a gap in reaching fewer people from deprived areas - a difference of more than 17% between the most deprived and least deprived areas.

There was also a gap of 28 percentage points involving eligible black, Asian, mixed and people. The widest was in the black population; just 39.4% had a booster compared to 75% of white over 75s by July 2023.

The offers of the primary course of vaccine to anyone over five, available since December 2020, ended in June 2023. Higher risk groups are expected to be offered another booster in the autumn of 2023.

The dominant variant in Wales has been Omicron for more than a year and 194 new cases have been sequenced in the last month.

Because of the ending of mass testing in April 2022, we should not expect to see the same numbers of results going off for sequencing any more.

Around 40% of those analysed in the last month have been the XBB.1.16 type.

One in 40 people - 74,500 or 2.41% of the population - were estimated to have had Covid up to 14 March 2023, according to the final infections survey by the Office for National Statistics (ONS).

This was slightly up on the previous week (68,200) but about 60% of the estimated number of infections we were seeing at this same point last year.

From summer 2020, the ONS organised a weekly nose and throat swab survey involving thousands of households across Wales, which latterly saw people being sent test kits by post.

It became the most important tool to measure the level of infections, with the end of mass testing in March 2022.

However, the survey was "paused" at the end of March 2023, as the UK Health Security Agency (UKHSA) worked to confirm a surveillance approach which was "proportionate and cost effective" to living with Covid.

The health minister expressed her "deep disappointment and concern" about the "loss of this important source of surveillance". and the break in data gathering at a time infections were still being recorded in Wales.

In the final survey, infections were estimated to be increasing in England and uncertain in Wales, Scotland and Northern Ireland.

The estimates were that one in 40 people in England and Scotland and one in 70 in Northern Ireland had the virus.

Highest daily estimates in Wales were in the over 70s and 80s.

Data from the infection survey, before it was wound up, also suggested 94.6% of adults in Wales have some protection from antibodies - through vaccination or immunity following infection.

The estimate was 91% of 16 to 24-year-olds in Wales would have tested positive for antibodies in February 2023.

At the higher threshold, 79.5% of adults in Wales are at or above 800 nanograms per millilitre and nearly three quarters in those aged 16 to 24 and 92.3% of the 75-79 age group.

A more recent test of blood donors in Wales found more than 80% prevalence of the N antibody, indicating a natural infection from having Covid, and a 99.9% prevalence of the S antibody from either infection or having had the Covid vaccine.

The number of people who were reporting they had long Covid symptoms in Wales a year after being infected in early March 2023 was estimated to be around 57,000.

This was just under 2% of the population who are estimated to still be suffering symptoms 12 months or more since having Covid.

A total of 94,000 people were estimated to have long Covid at any duration. Of these, 24% said it had "a lot" of impact on their daily lives and 52% said it had little impact.

An estimated 3.14% of people in Wales reported having long Covid - this was slightly less than in Scotland and the West Midlands and north west and north east of England.

Just under 2% reported long Covid after a year - fewer than England and most of its regions and Scotland.

Across the UK, prevalence was greatest in the 35 to 69 age group, in women, and in people living in deprived areas.

This data set has now been curtailed, with the end of the ONS infection survey.

A separate survey of more than 1,600 people with long Covid in Wales referred to the Adferiad recovery programme found around 70% were female and half were aged over 50.

Of those needing follow-up, around a quarter had hospital treatment. Average stays were around two weeks.

Fatigue, "brain fog" and shortness of breath were the most common symptoms.

Scientific advisers for the Welsh government estimate that potentially up to a quarter of people who have Covid may develop long Covid.

In January 2022, this would have included far higher proportions of Covid cases involving people aged between 50 and 70 - an estimated 43% of those with Covid.

But even if 6% of young people under 25 with Covid developed long-term symptoms, this could still mean more than 2,200 young people with long Covid in Wales.

This analysis was used to develop a "social cost" estimate for Covid, which looked at the cost to the NHS of treating Covid at different stages of the pandemic.

With the effects of the vaccine, and less patient time in hospital and intensive care, it meant this estimated cost had fallen from £21,000 per case in the second wave of the pandemic to £5,769 per case by January 2022.

Of this, more than £4,800 per case would be the cost of long Covid.

When we look at infections in communities, broken down into middle-layer super output areas, with populations averaging 5,000, there has generally a split between rural and more urban areas.

This is still noticeable when we look at a map of community case rates for the whole pandemic, taking into account population sizes.

The Wales positivity rate was around 18% by the end of 2022 but there were far fewer PCR tests after the end of mass testing in April 2022.

At the peak of the Omicron wave at the end of 2021, the positivity rate reached 51.6% of all tests carried out.

Locally, Neath Port Talbot over the course of the whole pandemic had the highest positivity rate (18.8%) and Ceredigion the lowest.

Earlier in the pandemic, a 5% positivity threshold was suggested by the World Health Organisation as an indicator that infections were too high.

There was a much younger profile to cases in the third wave in the latter half of 2021.

Between January and March 2022 there was a rise in proportions of those aged 20 to 40 testing positive.

In terms of PCR tests, the 20 to 40 age group made up more than 41% of positive results in winter 2021-22.

The so-called R-number - the reproduction number - had been a tool to express the infection rate of Covid.

However, it is has now been phased out as a measure.

Expressed within a range, if it was above 1, this indicated that infections were growing.

The range for the last estimate in December 2022 was between 0.9 and 1.2, suggesting infections were rising. So, for every 10 people with Covid in Wales, between another nine and 12 people would be infected.

More than 8.7 million Covid-19 tests have been carried out during the pandemic, with the first positive result recorded in Swansea on 27 February 2020.

For most of the first wave, testing was confined to hospitals and some care homes but mass testing became available in the spring of 2020.

This ended at the start of April 2022, although it will remain in place for hospital patients and there will be some for vulnerable people and those with symptoms in care homes.

There are around 3,500 PCR tests currently taking place each week, compared to around 200,000 a week at the pandemic's peak.

Testing that's processed privately - at so-called Lighthouse labs - is no longer taking place.

Up to the end of routine testing in April 2022, about 17,000 PCR tests routinely took place in hospitals each week and up to 30,000 weekly in care homes.

There have also now been changes to guidance for Covid testing in hospitals, although patients will still be tested before admission or ahead of surgery or chemotherapy.

By July 2023, only about 1,200 PCR tests were being carried out each week, about 47% of them in hospitals.

Altogether, around 32,500 positive results were recorded in care homes over the course of the routine testing programme from autumn 2020.

Care home staff no longer need to take a weekly PCR test, while free lateral flow tests will only be provided in limited circumstances.

Care Inspectorate Wales figures also show only three care homes in Wales have notified one or more confirmed cases of Covid in the latest week.

School absences for Covid-related reasons are no longer being recorded.

We saw over the 2021-22 academic year, 69.1% of pupils missed at least half a day's schooling because of Covid.

Meanwhile, absence in general was much higher than in previous years - running at an average of 11% in primary-aged pupils and 16.3% in secondary-aged children during the 2021-22 academic year.

This was more than twice the absence rate in pre-pandemic years.

Analysis of these figures showed 10% were persistently absent - and this rose to 21% of those from poorer backgrounds.

In the financial year ending in March 2021, the first year of the pandemic, spending on infectious diseases in the NHS in Wales jumped by £373 million.

That worked out at £156 per person in Wales, or just under 6% of all NHS Wales spending.

The costing of treating patients with Covid and managing the virus was put at £628m. Spending also included field hospitals and operating the track and trace system.