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 in those who are craving for a clear picture of how we are faring against the virus. Dr. Co shares his daily updates with ANCX.

Additional notes from Dr. Co today: “There are less tests yesterday and today because the Research Institute for Topical Medicine (RITM) is closed for disinfection. Nevertheless we’re testing almost 2500 a day which isn’t so bad. Overall general trend shows that on the average out of every 1,000 people tested, 13 percent were positive while 87 percent were negative. The good news remains that we have almost 10 percent recoveries with a much longer (20 days) doubling time and a growth rate down to 3.4 percent. Encouraging news indeed.”

--

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. 

You may also like:

• One concern about Covid 19—should we be swimming in swimming pools?
• More employers and workers embrace flexible work arrangements in the time of COVID-19
• The government owes our seafarers a safe passage home
• With more tests being done every day, Philippine COVID-19 numbers continue to get better

COVID19stats.ph is a new site which gives you a very good summary of the Philippines data. (summary of those that are unable to access this site is seen below)

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/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.

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

One important data is the doubling time. The doubling time tells us how many days it takes for confirmed cases to double, based on the 7-day average daily growth rate. Hence, the shorter the doubling time, the steeper the slope, the more the number of cases within that span of time. The doubling time in the US for example is around 2-3 days. Which means that if the doubling time does not lengthen in the US, they would see an increase of 100,000 cases every 3 days. The doubling time in the Philippines started around 4, but now averages more than 14 days. The latest doubling time is now almost over 20 days! The longer the doubling time, the earlier we can flatten the curve. In addition, the growth rate in confirmed cases was at 5.25 percent last week. Yesterday it was 3.93 percent. Today it is at 3.40 percent.

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 1,091 closed cases. This means that of the 6,599 cases to date, 1091 have had outcomes – with 60 percent recoveries (654 cases) and 40 percent (437) resulting in death. 

On the Department of Health website, there are 2,307 patients that are still for “validation”. These 2,307 patients are confirmed positive cases with many who may have already had outcomes (most likely recovered) but remain undocumented. 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 and reported? 

There were only eight new admissions to various hospitals as a possible, suspect or documented case of COVID-19 in the past 24 hours.

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.

SARS-CoV-2 Testing in the Philippines

The figure below shows the tests conducted, number of people tested, and those who turn out positive or negative. The trend is simple to follow. At least 13 percent of patients tested turned out positive while the remaining 87 percent were negative. This was consistently seen in the past week. The other day, the DoH issued a statement regarding the closure of RITM for a few days for disinfection which explains the fewer number of tests conducted. The number of tests conducted yesterday was only 2,370 (or almost 1500 short of the daily tests done) yielding 135 positive tests and 2017 negative in 2154 individuals tested.

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. 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 of testing on shows us that the number of tests conducted provides more information on the status of infection in the country. The more 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.

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. 

Data on testing is needed. Without data on COVID-19, we cannot understand how the pandemic is progressing. We cannot respond to the threat – individually or as a society. We cannot know if our countermeasures are working. Finally, the reliability of data on testing is necessary to assess the reliability of data that informs us about the spread of the pandemic: the data on confirmed cases and deaths. 

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.

By demographics (as of April 20, 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 more than 45 percent for the senior citizens. 

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 200 cases but because it has only 122,200 officially registered residents, it has approximately 1,636 cases per million residents. Only one city is outside of the National Capital Region. That is Balanga, Bataan which is in number 9 with 291.48 cases per million residents.

For the first time, a city outside of the National Capital Region is in the top ten of confirmed cases of COVID-19. Cebu is in number 10 with 169 confirmed cases but has a low case fatality rate with five deaths (3 percent).

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 7pm 21 April 2020 (Tuesday)

Total confirmed cases: 2,495,374 (yesterday: 2,414,617) 

The total number of confirmed cases worldwide is closing on the 2,500,000 mark with a bit more than 80,000 cases overnight compared to the previous day of a over 70,000 cases. Note that the average case fatality rate for COVID-19 is now at 6.86 percent. 

Total deaths: 171,065

Total recovered: 655,664

Cumulative case fatality rate: 6.86 percent (yesterday: 6.84 percent)

Recovery rate: 26.28 percent (yesterday: 26.07 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 2.35M new cases, accounting for around 94 percent of the total cases to date. 

Active Cases vs. Closed Cases

Of the total 2,495,374 cases (as of this writing), almost 1.7M are active (currently infected cases). The remaining 826,729 already had an outcome – either recovered or died.  

Total cases worldwide

The total cases now approach the 2,500,000 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 4 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.

The United States has the steepest climb averaging 30,000 cases daily the past week as they close in on 800,000 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.

The number of deaths due to COVID-19 in the United States now far exceeds that of Italy, as they pass the 42,000 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 792,938 with a case fatality rate (CFR) steady at 5.36 percent with more than 42,000 total deaths recorded. The recovery rate for the US is down at 9.13 percent due to the large number of new cases overnight. Among the states, New York leads with 252,094 cases with 18,929 deaths with a CFR of 7.51 percent much lower than the previous day of >9 percent. 

While the United States may have the highest number of cases it also has the most number of deaths in the world at 42,364 (which is just 5.36 percent of the total cases). On the other hand, the Bahamas has the highest case fatality rate (15 percent) in the world (with 9 deaths in 60 cases). The following countries that have more than 50 cases have had no deaths reported so far: Vietnam, Uganda, Rwanda, Maldives, Madagascar, Guinea-Bissau, Equatorial Guinea and Cambodia. 

Germany has the highest number of recoveries with 95,200 recoveries from 147,065 cases (64.7 percent recovery rate). China has the highest recovery rates at 93.17 percent, while the following countries have the poorest recovery rates: Haiti (57 cases and no recoveries, 0 percent), Netherlands (33,588 cases and 74 recoveries, 0.22 percent), United Kingdom (125,856 cases and 446 recoveries, 0.35 percent), Norway (7,156 cases and 32 recoveries, 0.45 percent) and Ireland (15,652 cases and 77 recoveries, 0.49 percent).

Top Twenty 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 6.86 percent and is predicted to climb to ~7 percent