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 more than three years and also update some of the remaining indicators.
The World Health Organization (WHO) declared in May 2023 that Covid-19 was no longer a global health emergency, but said it did not mean the danger was over.
In Wales, while some hospital and mortality data is still being published, other surveillance measures have been scaled back or discontinued.
We will next update this feature in December/January
What are indicators showing now?
We can see a fall in people testing positive for Covid in hospitals in recent weeks, with the latest total similar to what we were seeing over the summer.
Mortality figures at the start of November involving Covid are lower than this time last year, averaging 20 a week over the last three months.
Deaths from all causes have been below normal levels in recent weeks although the trend this year has been above average most weeks.
Numbers of in-patients with Covid by 3 November had fallen for five weeks and were similar to totals seen in August.
Positive tests for Covid appear to follow a more cyclical pattern than flu or other winter viruses, which show a seasonal peak.
There were 312 in-patients testing positive for Covid, including four patients in critical care.
We might expect to see more elderly people in hospital and nearly half of those testing positive for Covid were over 80 and 88% were over 60.
We no longer know how many of these patients are being treated primarily for Covid or happen to be incidentally testing positive while in hospital for other things.
When analysis was possible last year it was found that there were far fewer patients being primarily treated for Covid.
Digital Health and Care Wales has now stopped its weekly Covid snapshot figures, although Public Health Wales (PHW) is still publishing some hospital data.
Numbers of acute hospital patients testing positive for Covid by 12 July 2023 had fallen to the lowest levels for nearly two years (65), with only three (5%) being primarily treated for the virus.
When patients with suspected Covid and those recovering were included, there were 206 people in hospital beds for these last set of figures.
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.
The waves of the pandemic saw dozens of patients in critical care with Covid.
This reached 164 patients at the first wave peak in April 2020, while the second wave peak in January peaked at 150 patients.
As the vaccination programme kicked in, there were only 40 patients at the winter peak of 2021-22 and then 24 patients with Covid in critical care at the peak of winter 2022-23.
For the final Digital Health and Care Wales figures, there were five patients in critical care with Covid on 12 July 2023, with one of those recovering from Covid.
A long-running study of more than 500 Welsh critical care patients with Covid gave insights into the virus.
https://www.icnarc.org/Our-Audit/Audits/Cmp/Reports
The mortality rate 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 were 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.
At its peaks, there were between 120 and 140 admissions a day on average to hospitals for patients with Covid.
There were five admissions of people testing positive for Covid on 12 July, with numbers in single figures for the previous 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.
How many Covid hospital cases were directly due to the virus?
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 or primarily treated for it.
There were some differences between health boards over definitions so care needs to be taken in how we interpret this.
But 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 - and where they are likely to have acquired it.
There were 118 positive tests for Covid in hospitals in the week ending 12 November.
Public Health Wales figures showed "probably" or "definitely" hospital-acquired infections in patients made up more than half 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 66.
There have been around 22,000 hospital-acquired infections recorded since the start of the pandemic.
The issue of patients catching Covid while in hospital was a particularly acute feature during the early days of the pandemic, when there was no vaccine.
Figures showing the pattern of acute respiratory infections last winter and into this coming winter show seasonal peaks for flu and respiratory syncytial virus (RSV).
Covid hospitalisations show more of an undulating pattern over the course of the year.
RSV has started to rise amongst mostly young children.
NHS bed occupancy hit a high of 96%
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%.
Over the course of 2022-23 bed occupancy was 85.5% on average.
It had fallen to 69% in 2020-21, during the height of the pandemic - the lowest recorded. Early in the pandemic there was a fear hospitals would not be able to cope with a surge in cases and many planned treatments were cancelled.
Covid in the winter
Health officials will continue to keep a close eye on Covid over the winter period, in case it adds to pressures on the NHS with more seasonal viruses.
This winter, there is a realistic worst scenario of just under 1,200 Covid patients in late December and a "most likely" of 620 patients in the updated modelling from Welsh government scientists.
Currently, the figures are close to the "most likely" scenario although it is at the early part of the winter.
Modelling 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.
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.
What do other indicators tell us?
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 had been analysing samples of waste water, although this due to be brought back for the winter of 2023/24 after the monitoring programme was stopped after three years in the summer of 2023.
Surveillance involving testing for infection of blood donors was also stopped at the same time.
Wales was not re-joining a scaled-down relaunch of the long-running ONS swab survey, which had been discontinued in early 2023.
How many people have died from Covid-19?
The number of people who have died with Covid a contributory factor had reached 12,258 in Wales by 3 November 2023.
In the most recent week, 21 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 13 of Wales' 22 local authorities, including in three in Cardiff and Swansea.
Sixteen of the deaths (76%) were due to Covid, when it was the underlying cause of death.
Sixteen of the latest registrations also involved people over the age of 75.
When counted by day occurring - not day registered - there were 10 deaths involving Covid in the week ending 3 November.
However, the most recent weekly figures are usually an underestimate, due to delays in registrations catching up.
Up to 3 November, there have been 10,063 deaths due to Covid, with the virus the underlying cause of death.
There have been just over half the number of Covid deaths so far in 2023 compared to the same period in 2022.
Covid was the ninth leading cause of death in 2023 up to the end of July.
The ONS counts deaths in people's homes, hospices and other settings, as well as hospitals and care homes.
The first death in Wales from Covid occurred on 15 March 2020 in a 68-year-old Wrexham hospital patient
The first wave peaked with 73 deaths on a single day in April 2020
Covid's second wave in the winter of 2020-21 brought 83 deaths on 11 January 2021 alone - the worst single day during the pandemic in Wales
The pattern for deaths remained fairly low in 2022, although the summer heatwave brought a peak of 27 deaths between 18-19 July 2022
Winter 2022-23 brought a peak of 17 deaths on 10 January 2023, the most occurring in a single day for a year
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 10,309 more deaths than we might have expected to see.
There have been 1,632 deaths from all causes above the non-pandemic average so far in 2023 and 2,224 in the last 12 months.
So far in 2023, there have been 5.6% more deaths than average and deaths in people under 44 are 10% higher.
Deaths in the week ending 3 November were 4.2% below the five-year pre-pandemic average.
There were 642 deaths from all causes - 28 fewer than we might expect to see.
This was the third successive week deaths had been below average, although most weeks have been above average this year so far.
Covid accounted for 3.3% of all deaths in Wales in the latest week, more than the proportion in England (3%), where deaths were above normal by 4.1%.
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 (17.3%) of all Covid deaths registered have occurred in care homes.
There has been 18 deaths involving Covid among care home residents registered over the last three months. There were two deaths in the latest week out of 106 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. The same occurred in 2022.
Covid was the second leading cause of death in care home residents after dementia in 2021, accounting for 12.9% of male resident deaths and 11.1% of female resident deaths.
In 2022, Covid dropped to being the fifth leading cause of death in care home residents in 2022, accounting for 4.5% of deaths.
How do deaths from Covid-19 compare with other causes, like flu?
There have been nearly twice as many deaths due to flu and pneumonia in Wales than due to Covid so far in 2023.
There have been more Covid than flu deaths in only three weeks.
Covid-19 was the 32nd leading cause of death in Wales in July 2023, after being the 19th leading cause in June.
This was the lowest ranking as cause of death for two years and the third lowest since the pandemic began. It was behind accidental poisoning and appendicitis.
Monthly mortality analysis - which was also discontinued at the end of July - showed there were 21 deaths due to Covid in July - 0.8% of all registered deaths.
This was fewer than in June when there were 35 deaths.
Looking at when Covid was a contributory factor, there were 29 deaths involving Covid in Wales - or 1.1% of all deaths registered in July.
So far in 2023, up to the end of July, ill-defined conditions - which include old age and frailty - was the leading cause of excess deaths, nearly 41% above normal levels.
Heart disease was again the leading cause of death in July 2023 in Wales.
Flu and pneumonia again ranked sixth but below normal levels.
Up to the end of July 2023, heart disease was the leading cause of death - although still below average - and Covid was 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. It was the leading cause of death at the height of the pandemic in 2020.
More than three quarters of deaths involving Covid in 2023 have been in the over 75s, according to the ONS.
The median age of a person to die due to Covid during the pandemic has been 82.
Three children aged one to 14 have died where Covid has been a factor.
A baby girl is so far the only child under one to have died where Covid was a factor, in the week ending 18 November 2022.
The median age of death due to Covid in June 2023 was 83.
There has been one death in Wales, in October 2022, where Covid vaccination has been a factor, according to death registrations. It involved a person in their 50s.
Analysis of mortality from the start of the pandemic until the end of July 2023 shows the age-standardised mortality rate for deaths involving Covid is slightly higher in Wales (102.2 deaths per 100,000), than England on 101.5 deaths per 100,000.
Scotland (9.56) and Northern Ireland (93.2) are both lower in the 41 months to the end of July.
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.
Are deaths really 'due to' Covid-19?
Covid was the underlying cause of death - not just a contributory factor - in 71% of Covid deaths mentioned by doctors on death certificate in Wales in 2023 up until the end of October.
It has been as high as 94% and on average since the start of the pandemic, 82.1% of deaths with Covid on death certificates can be said to be due to Covid.
So, there were 10,063 deaths due to Covid by 3 November 2023 in Wales.
Covid has been "suspected" by doctors in around 4% of cases.
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.
Which areas have been hit hardest?
Rhondda Cynon Taf (RCT) and Merthyr Tydfil have the highest mortality rates over the course of the pandemic in Wales.
By 3 November, RCT had reached a total of 1,233 deaths, with the highest crude mortality rate - 518.7 deaths per 100,000.
This was the eighth 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 302 deaths (513.6 deaths per 100,000) was the 11th highest. Bridgend was 14th (502.4 deaths per 100,000) in England and Wales.
Cardiff (1,221) 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 Bridgend.
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 127 deaths per 100,000 due to Covid in the three years of the pandemic up to the end of July 2023.
This is the highest in Wales, the lowest being 55.5 deaths per 100,000 due to Covid in the Powys health board area, set against a Welsh average of 84.3.
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.
How does Wales compare with other countries?
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.
Autumn vaccine programme reaches half of over 65s
The 2023 autumn booster programme had by early November reached more than 461,500 people.
That included more than half of over 65s and 81% of care home residents.
Numbers of NHS staff who took up offers of a vaccine booster was down on earlier stages of the programme.
Just over a third of all those eligible across different groups had taken up the offer by early November, perhaps reflecting numbers who felt they had immunity from having had the virus more than once.
More than 9.6m doses of Covid vaccine have been administered in Wales since December 2020.
Analysis of vaccine uptake has consistently found gaps between people living in deprived areas and also people from black, Asian and mixed groups.
The offers of the primary course of vaccine to anyone over five, available since December 2020, ended in June 2023.
What about variants?
The dominant variant in Wales has been Omicron for more than a year and 680 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 46% of those analysed in the week have been the EG.5.1 sub-variant.
Infections survey paused after two and a half years
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.
By this measure, infections were estimated to have peaked in Wales in April 2022 with 232,000 (around 8%) estimated to be affected.
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.
But the Welsh government decided not to re-join a scaled-down version of the survey, which was relaunched in winter 2023.
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 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.
Around 94,000 reported long Covid symptoms
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.
Two thirds in Wales reporting long Covid said they had symptoms of weakness and tiredness and more than half a shortness of breath.
Nearly half had muscle ache.
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.
What case rates told us about Covid in Wales
After the end of mass testing at the end of March 2022, there was no longer a reliable case rate based on PCR test results
Up to 1 April 2022, there were 827,225 positive cases across Wales, but this only measured people who were tested. It did not include many people not offered a test in the first wave, those who chose not to be tested, as well as thousands testing positive with lateral flow tests in 2022
Over the course of the mass testing period in the pandemic, Merthyr Tydfil had the highest cases per 100,000 of Wales' local authorities.
Only around 33,730 positive PCR tests recorded in the year after mass testing ended. Only around 130 positive PCR tests were being recorded weekly in November 2023.
When we look at infections at a community level, there has generally a split between rural and more urban areas.
This is noticeable when we look at a map of community case rates for the whole pandemic, taking into account population sizes.
Pontardawe in Neath Port Talbot - of similar-sized smaller communities - had the highest number of positive Covid tests, 3,796
Tonypandy West and Clydach Vale in Rhondda Cynon Taf had the highest case rate of these smaller communities
The lowest case rate was in Cilgerran and Crymych in Pembrokeshire
Abersoch in Gwynedd is the community with the smallest number of positive tests, 839.
At the peak of the Omicron wave at the end of 2021, the positivity rate - the number of positive results from all PCR tests taken - reached 51.6%.
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.
A younger profile for much of the third wave
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.
What do the figures on testing tell us?
More than 8.8 million Covid-19 tests have been carried out since the start of 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 is still taking place in hospitals and also for some vulnerable people and those with symptoms in care homes.
There are around 2,400 PCR tests currently taking place each week, about half in the over 60s. This compares to around 200,000 a week at the pandemic's peak.
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.
Testing that was processed privately - at so-called Lighthouse labs - is no longer taking place.
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.
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.
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.
R-number no longer being used to measure infections
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.
How much has Covid cost?
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.
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