Later today, the Government will announce the latest decision on tiers for England and, in advance, I said I would set out the latest position for residents to be able to review.
Back at the end of November, Derbyshire was placed in tier 3 based on high numbers of cases and a high number of people in hospital. At the time, both of those numbers were reducing but they hadn’t reduced quickly enough to get into tier 2.
There are five tests which the experts are using to make a decision on which tier to put an area in:
• Overall positive test rates in the entire community;
• Positive test rates specifically in the more ‘at risk’ section of the community;
• Proportion of people testing positive;
• Trend of increase / decrease in positive test rates, and;
• Impact on local health capacity
Note on data
Just a quick couple of points on the data I am going to refer to –
1) There are no absolute, published thresholds for where an area has to be in order to be in tier 1, tier 2 and tier 3. Instead, the experts look at all of the indicators and come to a decision.
2) It may also be that the Government is more or less cautious at different times based on what they think is coming up or where the overall situation is in the country. Christmas, and the increase in mixing (and, therefore, likely increase in coronavirus transmission) is a big factor in the considerations for the next couple of weeks – we are expecting rises everywhere for a time in January.
3) There is always a lag in terms of data being available. This means that I need to use data from around 11th December to give you an idea of the current position. When making comparisons with what was happening at the last tier review (on 25th November), I will compare with the data which was available at the time (so again a few days earlier – 21st November or thereabouts).
4) Some of the data isn’t published regularly so I can’t include it at this stage. I have a meeting later today (Thursday) where I expect to receive more and will publish it then.
Context: the current situation across England
At the last tiering decision, England had an overall positive test rate of around 200 and it was reducing each day. By the beginning of December, rates had dropped to around 150. In recent days, however, that has started to climb again quickly. It is now at 195 as of 11th December and rising.
There were 17,084 people in hospital with coronavirus on 25th November and the numbers were reducing by around 200 – 300 a day. As of yesterday, there were 18,038 people in hospital and rising. (Note: this is the number of people who are testing positive in hospital, not necessarily the number of people who are ill – but it is a useful indicator nonetheless). The number of people on mechanical ventilation was 1,480 on 25th November (and reducing) and is now 1,326 (15th December) (and rising).
In terms of death rates in England, 479 deaths were announced on the day prior to the last tiering decision. 612 deaths were announced yesterday.
Unit of assessment: Derbyshire vs North Derbyshire – does it matter?
At the last tiering decision, the whole county of Derbyshire was used as the unit for our area. As a consequence, Derbyshire entered tier 3 (along with Nottinghamshire and South Yorkshire nearby).
As many residents may know, since the return to tiering, I have argued that using a whole county approach is very blunt and I would prefer a smaller North Derbyshire unit to be used which better reflects natural boundaries. Individual district by district approaches (such as North East Derbyshire or Chesterfield) are too small as the rules get very confusing and lots of people cross the borders daily for work, leisure and life.
As it happened, at the last decision on tiering, the unit was pretty academic as any reasonable configuration of unit for all area – Derbyshire, North Derbyshire, Greater Chesterfield or the Sheffield City Region – all had rates which would have placed us in tier 3.
I have, and will continue, to make the case that a North Derbyshire unit should be used in the future.
So, what do the comparisons look like at the moment? Well, taking overall positive test rates, there still isn’t much of a difference between Derbyshire and North Derbyshire – and, in fact, a North Derbyshire unit is actually slightly higher than the county as a whole when looking at positive tests (whole county unit is 156 vs the average of Chesterfield / Bolsover / North East Derbyshire being 161). So, again, for the purposes of making a tier decision, the unit is going to be pretty academic. For ease of comparison, therefore, I will refer to Derbyshire as a whole to give you the data below.
Derbyshire: Positive test rates
At the last decision point, overall positive test rates in Derbyshire were around 220 and falling. They are now at 156 and rising.
Derbyshire: Positive test rates for more vulnerable communities
I am awaiting up-to-date figures on this (and expect to receive more later today) but the trends tend to follow the overall population, with a lag. I will update more on this later.
Derbyshire: proportion of people testing positive
The number of people testing positive will likely be rising based on the overall positive rates given that the amount of testing for those symptomatic remains pretty static and mass population testing in the county does not start until Monday. I will update more on this later.
Derbyshire: trend rates
There is a clear rise across Derbyshire in positive tests and, over the last seven days, county rates are up by 20%.
Underneath that number is quite a lot of variation. Looking at individual district-by-district rates:
District / Borough 11th Dec rate Change from 5th Dec (number) Change from 5th Dec (percentage)
Amber Valley 171 + 13 + 8%
Bolsover 231 + 66 + 40%
Chesterfield 134 + 1 No change
Derby 192 + 45 + 31%
Derbyshire Dales 73 – 6 – 7%
Erewash 121 – 6 – 5%
High Peak 136 + 41 + 43%
North East Derbyshire 118 + 11 + 10%
South Derbyshire 253 + 101 + 66%
Impact on the local health capacity
The number of patients in critical care in Chesterfield Royal tends to follow a similar trend line to the overall positive test rates, albeit several weeks behind.
A few weeks ago, there were around 13 – 18 people in critical care in the Royal at any one time. By the beginning of last week, when I had my last catch up with the Chief Executive, that had dropped to 9. This was positive although it remained the case that a substantial number of beds in critical care were being taken up at any one time by coronavirus patients.
Based on data issued two days ago, the number of patients in the Royal is now increasing again and is back up to 12.