21 June 2021 Lineage Designation Status Alpha B.1.1.7 VOC-20DEC-01 VOC Beta BMonitoring SARS-CoV-2 variants of concern and variants under investigation 6 World Health Organization nomenclature as of 21 June 2021 Lineage Designation Status B.1.1.7 with S494P Monitoring A.27 Monitoring Iota B.1.526 Monitoring B.1.1.7 with Q677H Monitoring B.1.620 Monitoring B.1.214.2 Monitoring R.1 Monitoring B.1.621 Monitoring B.1 with 214insQAS Monitoring AT.1 Monitoring Lineage A with R346K, T478R and E484K Monitoring Delta like variant with E484A Monitoring P.1 + N501T and E484Q Monitoring *VOC-21FEB-02 (B.1.1.7 with E484K). This specific clade of B.1.1.7 with E484K has not been detected in England since 1 March 2021. There is apparent transmission outside the UK based on international sequence data. It is no longer included in the data update but monitoring of international data continues. ^Designated as Variant of Interest by WHO, 14 June 2021 and as a variant under investigation by Public Health England on the 23 June 2021. SARS-CoV-2 variants of concern and variants under investigation 7 Sequencing coverage Figure 1. Coverage of sequencing: percentage of SARS-CoV-2 cases sequenced over time as of 21 June 2021 (including genotyping data). (Find accessible data used in this graph in underlying data) SARS-CoV-2 variants of concern and variants under investigation 8 VOC and VUI case numbers, proportion, deaths and case fatality rate Table 2 shows the number of cases and deaths associated with each variant of concern and variant under investigation, and the proportion of total sequenced cases accounted for by each variant. Table 3 and 4 show the number of cases known to be infected with variants of concern or variants under investigation who visited an NHS Emergency Department, the number who were admitted, and the number who died in any setting (note data is shown from 1 February 2021 onwards to enable comparison). Figure 2 shows the cumulative number of cases per variant indexed by days since first report. Table 2. Number of confirmed (sequencing) and probable (genotyping) cases by variant as of 21 June 2021 Variant Confirmed (sequencing) case number Probable (genotyping) case number* Total case number Case proportion* Deaths Case fatality Cases with 28 day follow up Deaths among those with (sequencing) case number Probable (genotyping) case number* Total case number Case proportion* Deaths Case fatality Genotyping is used to identify variants Alpha, Beta, Delta and Gamma; targets were updated in mid-May 2021 to prioritise accurate identification of Delta over Alpha. SARS-CoV-2 variants of concern and variants under investigation 10 Table 3. Attendance to emergency care and deaths among all (sequencing and genotyping) COVID-19 cases in England, 1 February 2021 to 21 June 2021 Variant Age group (years) Cases Since 1 Feb Cases with specimen date in past 28 days Cases with an A&E visit§ (excluding cases with the same specimen and attendance dates)‡ Cases with an A&E visit§ (including cases with the same specimen and attendance dates) Cases where presentation to A&E resulted in overnight inpatient admission§ (excluding cases with the same specimen and admission dates)‡ Cases where presentation to A&E resulted in overnight inpatient admission§ (including cases with the same specimen and admission dates) Deaths n % n % n % n % n % n % Alpha <50 117,263 4,224 3.6 4,888 4.2 5,731 4.9 1,224 1.0 1,676 1.4 66 0.1 ≥50 32,289 453 1.4 3,127 9.7 4,592 14.2 1,721 5.3 2,792 8.6 1,551 4.8 Beta ><50 575 45 7.8 21 3.7 23 4.0 5 0.9 8 1.4 1 0.2 ≥50 165 11 6.7 17 10.3 25 15.2 7 4.2 15 9.1 7 4.2 Delta ><50 82,458 71,311 86.5 2,013 2.4 2,728 3.3 564 0.7 902 1.1 8 0.0 ≥50 9,571 8,025 83.8 393 4.1 732 7.6 181 1.9 418 4.4 109 1.1 Eta ><50 272 6 2.2 11 4.0 13 4.8 5 1.8 6 2.2 0 0.0 ≥50 116 - 0.0 4 3.4 7 6.0 1 0.9 3 2.6 6 5.2 Gamma ><50 207 58 28.0 7 3.4 7 3.4 1 0.5 1 0.5 0 0.0 ≥50 18 3 16.7 1 5.6 1 5.6 - 0.0 - 0.0 0 0.0 Kappa ><50 377 9 2.4 10 2.7 11 2.9 1 0.3 2 0.5 0 0.0 SARS-CoV-2 variants of concern and variants under investigation 11 Variant Age group (years) Cases Since 1 Feb Cases with specimen date in past 28 days Cases with an A&E visit§ (excluding cases with the same specimen and attendance dates)‡ Cases with an A&E visit§ (including cases with the same specimen and attendance dates) Cases where presentation to A&E resulted in overnight inpatient admission§ (excluding cases with the same specimen and admission dates)‡ Cases where presentation to A&E resulted in overnight inpatient admission§ (including cases with the same specimen and admission dates) Deaths n % n % n % n % n % n % ≥50 62 4 6.5 5 8.1 5 8.1 2 3.2 2 3.2 1 1.6 Theta ><50 4 - 0.0 1 25.0 1 25.0 - 0.0 - 0.0 0 0.0 ≥50 3 - 0.0 - 0.0 - 0.0 - 0.0 - 0.0 0 0.0 VUI21APR-03 ><50 11 - 0.0 - 0.0 - 0.0 - 0.0 - 0.0 0 0.0 ≥50 2 - 0.0 - 0.0 - 0.0 - 0.0 - 0.0 0 0.0 VUI21FEB-04 ><50 221 27 12.2 6 2.7 9 4.1 1 0.5 2 0.9 0 0.0 ≥50 51 2 3.9 1 2.0 2 3.9 - 0.0 1 2.0 1 2.0 VUI21MAY-01 ><50 154 34 22.1 1 0.6 2 1.3 - 0.0 1 0.6 0 0.0 ≥50 23 6 26.1 - 0.0 - 0.0 - 0.0 - 0.0 1 4.3 VUI21MAY-02 ><50 102 12 11.8 8 7.8 9 8.8 2 2.0 3 2.9 0 0.0 ≥50 31 1 3.2 - 0.0 - 0.0 - 0.0 - 0.0 0 0.0 Zeta ><50 16 - 0.0 - 0.0 - 0.0 - 0.0 - 0.0 0 0.0 ≥50 8 - 0.0 1 12.5 1 12.5 1 12.5 1 12.5 0 0.0 SARS-CoV-2 variants of concern and variants under investigation 12 Data sources: Emergency care attendance and admissions from Emergency Care Dataset (ECDS), deaths from PHE daily death data series (deaths within 28 days). NHS trusts are required to submit emergency care attendances by the 21st of each month. As a result, the number of cases with attendances may show substantial increases in technical briefs prepared after the monthly cut-off, compared with other briefs from the same month. ¥ Cases without specimen dates and unlinked sequences (sequenced samples that could not be matched to individuals) are excluded from this table. * Cases are assessed for any Emergency Care attendance within 28 days of their positive specimen date. Cases still undergoing within 28-day period may have an emergency care attendance reported at a later date. § At least 1 attendance or admission within 28 days of positive specimen date ‡ Cases where specimen date is the same as date of Emergency Care visit are excluded to help remove cases picked up via routine testing in healthcare settings whose primary cause of attendance is not COVID-19. This underestimates the number of individuals in hospital with COVID-19 but only includes those who tested positive prior to the day of their Emergency Care visit. Some of the cases detected on the day of admission may have attended for a diagnosis unrelated to COVID19. ^ Total deaths in any setting (regardless of hospitalisation status) within 28 days of positive specimen date. SARS-CoV-2 variants of concern and variants under investigation 13 Table 4. Attendance to emergency care and deaths by vaccination status among Delta confirmed cases (sequencing and genotyping) including all confirmed Delta cases in England, 1 February 2021 to 21 June 2021 Age group (years) Total Cases with specimen date in past 28 days Unlinked >< Cases where presentation to emergency care resulted in overnight inpatient admission§ (including cases All cases 1,320 N/A 22 88 189 190 831 <50 902 N/A 16 79 85 27 695 >50 418 N/A 6 9 104 163 136 SARS-CoV-2 variants of concern and variants under investigation 14 Age group (years) Total Cases with specimen date in past 28 days Unlinked <21 days post dose 1 ≥21 days post dose 1 Received 2 doses Unvaccinated with the same specimen and attendance dates) Deaths within 28 days of positive specimen date Total 117 N/A 3 1 19 50 44 ><50 8 N/A - - 2 - 6 >50 109 N/A 3 1 17 50 38 Data sources: Emergency care attendance and admissions from Emergency Care Dataset (ECDS), deaths from PHE daily death data series (deaths within 28 days) ¥ Cases without specimen dates and unlinked sequences (sequenced samples that could not be matched to individuals) are excluded from this table. * Cases are assessed for any Emergency Care attendance within 28 days of their positive specimen date. Cases still undergoing within 28-day period may have an emergency care attendance reported at a later date. § At least 1 attendance or admission within 28 days of positive specimen date ‡ Cases where specimen date is the same as date of Emergency Care visit are excluded to help remove cases picked up via routine testing in healthcare settings whose primary cause of attendance is not COVID-19. This underestimates the number of individuals in hospital with COVID-19 but only includes those who tested positive prior to the day of their Emergency