With more tests being done every day, Philippine COVID-19 numbers continue to get better

Infectious diseases and clinical pharmacology expert Dr. Benjamin Co has been thankfully breaking down coronavirus numbers in his personal blog since the outbreak started. The perspective he provides is informative, and comforting for those who are craving for a clear picture of how we are faring against the virus. Starting today, Dr. Co will be sharing daily updates with ANCX.

Refer to the link DOH.gov.ph or up-to-date data or to COVID19.gov.ph. (The latter is not a secure site.) The new site for the Department of Health is user friendly, provides more information but is still direly lacking in what the relevant information should be. I advise the readers to look through their official site.

On April 1, the official report of cases was 2,311. The total number of cases to date is 6,459. This approximates an average of around 215 cases per day. But the fluidity of events including how effective the ECQ (enhanced community quarantine), additional testing capabilities are factors that will affect the numbers in the subsequent weeks.

The figure below shows the DAILY new cases (blue), new deaths (red) and new recoveries (green) since the start of the first case reported in the country. Notice the increase in new cases after the initial Metro Manila quarantine followed a day later by the Luzon-wide ECQ (enhanced community quarantine). When mass testing had begun in some sectors, the number of new cases started to decline. The green line shows the slow and gradual increase in daily recoveries.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 7 — FIGURE 5

Note that the recoveries in green have been higher than the deaths in red for the past three days.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 8 — FIGURE 6

An important data is the doubling time. The doubling time tells us how many days it takes for confirmed cases to double, based on the seven-day average daily growth rate. In short, the shorter the doubling time, the steeper the slope, the larger the number of cases within that span of time. The doubling time in the US for example is around four days. Which means that if the doubling time does not lengthen in the US, they would see an increase of 100,000 cases every three days. The doubling time in the Philippines started around four, but now averages at least two weeks (14 days). The latest doubling time is now almost 18 days! Remember: The longer the doubling time, the earlier we can flatten the curve. In addition, the growth rate in cases at 5.25 percent last week has now decreased to its lowest at 3.93 percent.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 9 — FIGURE 7

A case is considered closed when patients either recover or die.

The table above shows the number of closed cases in the South East Asian region. The Philippines has 1041 closed cases. This means that of the 6,259 cases to date, 1041 have had outcomes—with 59 percent recoveries (613 cases) and 41 percent (428) resulting in death.

On the Department of Health website, there are 2,219 patients that are still for “validation.” These 2219 patients are confirmed positive cases but their outcomes are undetermined. If they are positive, asymptomatic, and home quarantined, what is the current status of these cases that are for “validation” and how are the various local government city health offices assisting the Department of Health in having these patients retested?

With more tests being done every day, Philippine COVID-19 numbers continue to get better 10 — FIGURE 8

Are we testing enough?

The figure below shows the overall summary of SARS-CoV-2 testing in the country as of April 18, 2020. On the average, more than 86 percent of patients tested (with symptoms or asymptomatic or those who came in contact with positive patients) would test negative.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 11 — FIGURE 9

SARS-CoV-2 Testing in the Philippines

The figure below that shows the tests conducted, number of people tested, and those who turn out positive or negative. The trend is simple to follow. At least 14 percent of patients tested turned out positive while 86 percent turned out negative. This was consistently seen in the past week. The less we test, the less the positives reported.

Testing is a vital instrument in identifying patients who are both asymptomatic and those who have the disease. While testing is not perfect, when done correctly and timely, it helps in identifying patients that are positive, asymptomatic and have the potential for infecting other people. By knowing this subgroup of population, early intervention by segregation from the community or family breaks the transmission of the virus. Breaking the transmissibility of an infection is vital in containing an outbreak, especially for one as invisible and invincible as SARSCoV2 where there is currently no recommended treatment or vaccine available.

In short, testing is our window into how this pandemic is spreading in the country. It is a tool that provides information on how we’re doing in our fight versus COVID19 and whether our efforts are reducing the spread and impact of the virus are working. In short, it helps allocate medical resources and staff more efficiently because we are able to isolate those infected, trace and quarantine all contacts. It helps allocate scarce medical resources and staff more efficiently. The generation of accurate epidemiological data is important in making critical decisions for exit plans after a lockdown.

A closer scrutiny shows us that the number of tests conducted provides more information on the status of infection in the country. The more the patients tested, the more accurate the information on the incidence of COVID-19 in the Philippines in general, and each locality in particular.

As a strategic measure in the lifting of a lockdown, testing allows us to properly assess interventions that should be implemented including the most costly ones called social distancing and the paralysis of various business, industries and regions. The economic cost of testing is nothing compared to economic losses of not understanding the pandemic and the risk it poses.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 12 — FIGURE 10

SARS-CoV-2 testing. Note that the more the tests conducted, the clearer the picture on the actual incidence of the disease is in the country.

The trend of recoveries is expected to rise this week as we see the patients who were positive, admitted and discharged come home this week.

It is imperative that reports come in on time. Based on the data from the DoH, note the reporting latency below for recoveries and for deaths. Based on the data drop information provided, 225 cases were considered posthumous results or the number of people who died before they were declared positive. With 17 accredited testing centers now available, the capacity of the Department of Health to double the tests per day (from the current 4,000 tests) should be achievable. Hopefully, the turnaround time is also shortened and that all patients who test positive but are on home quarantine should be tested as well. Otherwise, we defeat the purpose in testing for recoveries as well.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 13 — FIGURE 11

With more tests being done every day, Philippine COVID-19 numbers continue to get better 14 — FIGURE 12

With more tests being done every day, Philippine COVID-19 numbers continue to get better 15 — FIGURE 13

Only a little more than 30 percent of recoveries are recorded within three days. The majority are reported after 8 days or longer with an average of almost 1 week before a recovery is announced publicly. With respect to reporting of deaths, almost half are announced within the first three days of demise while about 25 percent are reported after eight days. It take almost five days after the demise of a patient before a death is announced publicly. This provides inaccurate picture of the ongoing outbreak in the country and may impact on exit strategies for the government. The delayed reporting (backlogs from testing centers) and missing follow-up recoveries may account for our lower than the regional and global average of recovery and fatality rates.

By demographics (as of April 19, 2020)

Majority of the cases are more than 25 years old. The pediatric age group makes up only 2.3 percent of the total cases while the senior citizens make up almost 40 percent of the total. Recovery rates are better in those less than 54 years old with a mortality rate of almost 45 percent for the senior citizens.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 16 — FIGURE 14

With more tests being done every day, Philippine COVID-19 numbers continue to get better 17 — FIGURE 15

With more tests being done every day, Philippine COVID-19 numbers continue to get better 18 — FIGURE 16

By location (as of April 19, 2020): Most vs Least COVID cases

While Quezon City may have the most number of cases, the top 10 cities with the most COVID-19 cases per million residents is in the table below. San Juan has only 199 cases but because it has only 122,200 officially registered residents, it has approximately 1630 cases per million residents. Only ONE city is outside of the National Capital Region. That is Balanga, Bataan which is in number 8 with 291.48 cases per million residents.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 19 — FIGURE 17

The Department of Health hotline is (02)8-6517800 loc 1149-1150. People who present with fever and/or respiratory symptoms are encouraged to get in touch with the DoH.

Global statistics

Update as of 6pm 20 April 2020 (Monday)

Total cases: 2,414,617 (yesterday: 2,341,958)

The total number of cases worldwide has passed the 2,400,000 mark with a bit more than 70,000 cases overnight compared to the previous day of a over 80,000 cases. Note that the average case fatality rate for COVID-19 is now at 6.84 percent.

Total deaths: 165,174

Total recovered: 629,441

Cumulative case fatality rate: 6.84 percent (yesterday: 6.89 percent)

Recovery rate: 26.07 percent (yesterday: 25.68 percent) This recovery rate is up today with less than the average cases overnight and fewer deaths. In the last 23 days alone, we saw almost 2.27M new cases, accounting for almost 94 percent of the total cases to date.

Active Cases vs. Closed Cases

Of the total 2,414,617 cases (as of this writing), more than 1.6M are active (currently infected cases). The remaining 794,615 already had an outcome – either recovered or died.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 20 — FIGURE 18

With more tests being done every day, Philippine COVID-19 numbers continue to get better 21 — FIGURE 19

Total cases worldwide

The total cases is now past the 2,400,000 mark. On March 6, the 100,000 cases was reached (102,050). It took a little less than 1 month to reach the 1,000,000th case. This was breached on April 2, 2020 (1,016,948 cases). The average trend today approximates 75,000 cases per day. If this rate does not decline, the world will close in on 3,000,000 cases on or before the end of April 30. Majority of the world cases are from the United States, Europe and the United Kingdom. This is roughly an average of 1,000,000 cases approximately every four weeks.

The next two graphs will show the cumulative number of cases (by number of days since 10,000 cases were reached) and the cumulative number of cases (by number of days since 100 deaths were reached) from the top 7 countries that contribute to the pool of cases in the world. The United States of America contributes to almost 1/3 of the total cases in the world.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 22 — FIGURE 20

The United States has the steepest climb averaging 30,000 cases daily the past week as they passed the 750,000 total cases. China and Iran have plateaued. The other countries in the top 7 are still seeing slight increase in cases at a significantly
lower rate compared to the past 2 weeks.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 23 — FIGURE 21

The number of deaths due to COVID-19 in the United States now far exceeds that of Italy, as they approach the 40,000 mark. Deaths continue to increase significantly for France, Italy, and Spain. Germany, Iran and China on the other hand are seeing a plateau in the death rates.

The United States of America leads globally in the number of total cases at 759,766 with a case fatality rate (CFR) steady at 5.35 percent with more than 40,000 total deaths recorded. The recovery rate for the US is up at 9.3 percent in spite of the large number of new cases overnight. New York has 247,215 cases with 18,298 deaths or a CFR of 7.4 percent.

While the United States may have the highest number of cases, the Bahamas has the highest case fatality rate (15 percent) in the world while Vietnam, Cambodia, Uganda, Rwanda, Maldives, Madagascar, Guinea-Bissau have no fatality reported to date.

China has the highest recovery rates at 93.16 percent, while the United Kingdom has the lowest recovery rate at 0.36 percent followed by Norway at 0.45 percent, Ireland at 0.50 percent and the Netherlands at 0.98 percent.

With more tests being done every day, Philippine COVID-19 numbers continue to get better 24 — FIGURE 22

Top 20 Countries in the World with COVID-19 Cases

Total cases, recoveries, and deaths of top 20 countries with COVID-19.

The median average of case fatality rates is now at 6.87 percent and is predicted to climb to ~7 percent