A LEADING academic has questioned whether the Scottish Government is overcounting the number of people in hospital with Covid amid a bizarre statistical trend that has left Scotland recording patient rates nine times higher than England.
Professor Carl Heneghan, director of the Centre for Evidence-based Medicine (CEBM) at Oxford University, said there was a "potential substantial" issue with current data.
He noted that - according to official Government statistics as of August 28 - there were 255 patients in hospital in Scotland who had tested positive for Covid, compared to 430 in England.
Writing in a CEBM blog headlined 'Is Scotland Overcounting the Number of Patients in Hospital Beds', Prof Heneghan said: "The difference between countries is much starker when you analyse the number of patients in beds per population given England’s population is about ten times greater than Scotland's (55.98 million versus 5.45 million).
"In England 7.7 per million of the population are occupying a hospital bed.
"However, in Scotland 46.8 per million are in a hospital bed with Covid – a rate that is nearly nine times higher."
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Prof Heneghan previously triggered an investigation into how Public Health England was measuring virus deaths after noticing that deaths in England were counted as 'Covid deaths' even if the individual had tested positive months earlier and was killed by a bus.
He added that the "reason for the disparity in the Scottish data is not clear".
It comes as clinicians and public health experts in Scotland told the Herald they too were puzzled by recent patterns in hospital admission data.
The number of people in hospital with Covid in the UK peaked on April 12, when there were 17,172 patients in England and 1,487 in Scotland - roughly in line with the differences in population.
In both countries these were confirmed - not suspected - cases.
Between June 1 and August 1, the number of Covid patients in Scotland fell steadily from 736 to 260 - a drop of 65 per cent.
In England, the decline was a steeper 85% - from 5358 to 809.
However, from August the nations diverged.
While England saw a continued decrease of 42% in the number of Covid patients in hospital between August 1 to September 1, from 809 to 472, the decline stalled in Scotland.
As of September 1, there were actually more Covid patients in Scotland - 264 - although that had dropped back to 258 by yesterday.
The actual number of new hospital admissions - as opposed to people counted in hospital - remains comparatively low compared to the peak in April, however, when 200 patients arrived in a single day.
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In the whole of July, according to Public Health Scotland, there were just 23 new Covid admissions in Scotland, rising to 40 in August up to August 26 - the last date for which statistics are available.
One possibility is that the discharge rate has slowed.
Dr David Chung, vice-president of the Royal College of Emergency Medicine in Scotland and an A&E consultant in Ayrshire, said: "We're not seeing huge amounts - if any - Covid admissions.
"There's very few people in the hospital with Covid full stop.
"Most places have gone down to not having completely separate Covid areas anymore and they're having separate side rooms instead.
"There are still people who are taking a long time to recover though, so I think that's what the majority of people in with Covid are now - rather than new admissions."
The Scottish Government website also notes that those counted as confirmed Covid cases in hospital "may include people who are in hospital for other reasons but have previously tested positive for Covid-19".
Prof Heneghan suggests that this might have resulted in overcounting if it includes patients who had tested positive at any time, as opposed to during their time in hospital or in the 14 days immediately prior to admission.
He notes, for example, that between July 31 and August 4, the number of people in hospital with Covid in Scotland rose by 15 yet the number of new Covid admissions - defined by positive test on admission or 14 days prior - rose by just four.
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Prof Heneghan writes: "This is similar to the problem with the PHE issue with deaths in England, which meant previously that everyone who has ever had Covid at any time must die with Covid too.
"The reason for the disparity in the Scottish data is not clear.
"The problem matches the pattern of poor quality data whereby Covid analyses have overestimated the true extent of the problems.
"It is, therefore, essential that we have data that we can trust, data that is verifiable and reported in the same way across the devolved nations to permit comparisons."
However, it is unclear whether the way NHS England counts patients is any different, and this does not appear to explain why the two countries diverged so obviously in August.
There have also been recent anomalies in the data for England, such as the number of people in hospital with Covid plunging from 430 to 280 between Friday August 28 and Saturday 29, before returning to 472 by Tuesday.
NHS England was asked by the Herald if this was an error and to clarify how they counted Covid patients in hospital, but has not yet responded.
Professor Linda Bauld, an expert in public health at Edinburgh University, said it was "crystal clear" that the figures between Scotland and England were not comparable, but not why they were so different.
"We need a much clearer explanation of the methodology in each country and what can and cannot be compared."
Commenting on the Scottish figures in particular, Prof Bauld added: "The trend is consistent throughout August, it's really consistent - we've got largely the same number of people in hospital.
"These are obviously the same people, because daily admissions have not risen very significantly.
"I wouldn't be particularly concerned though.
"I don't think it says that we're not providing good enough care in Scotland therefore people are staying longer.
"But it is strange that discharges appear to have slowed."
A Scottish Government spokeswoman said: “We are aware that our hospitalisation figures include people who may remain in hospital for other reasons, but may no longer be suffering from Covid.
"Work is underway to better delineate the nature of the care being provided to people who are in hospital as a consequence of Covid-19 and to identify the most meaningful public measure at this point in the pandemic.”
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