Cebu City now has a total of 684 confirmed COVID-19 cases. Photo from Mayor Edgardo Labella's Facebook account
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As Cebu ramps up testing this week, its new COVID-19 cases outnumber NCR

Cebu City is now only behind Quezon City in terms of total COVID-19 cases reported. BY BENJAMIN CO MD
ANCX | May 02 2020

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 will share daily updates and analysis of the Department of Health reported numbers with ANCX. 

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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 where a COVID19 tracker is seen. Readers can check their official site where Data Drop for raw data can be found. 

Comparison of daily new daily cases, deaths and recoveries. There are now 1,663 closed cases.

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There are 3 parameters in Figure 1. New confirmed cases today are 156. 40 new recoveries and 24 new deaths.  This brings the case fatality rate up at 6.75 percent (vs 7.02 percent world average) and the recovery rate up at 12.6 percent (vs 31.8 percent world average) for the day.

Doubling time lets us know the number of days it takes for the confirmed cases (or death rates) to double and can be determined linearly or exponentially. The linear scale is used in this report which shows that the median doubling time is 24 days based on the 7 day average daily growth rate of 2.88 percent. (This is approximately 7 days on a logarithmic scale). The lower the growth rate, the longer the doubling time. 

Logarithmic scale of fatality rate in the Philippines. Y axis is the exponential growth since the first 5th death (March 14, 2020) and the X axis shows the number of days since the first fifth case. The doubling time using logarithmic scale is ~7.2 days. 

Provided as added information in real-time is the number of probable cases at 3227 and 14,420 suspect cases. The number of HCWs affected number 1,723 and comprise 19.6 percent of the confirmed cases. 

Posthumous results is up at 331. This is the number of people who have passed away before they were declared positive for SARS-CoV-2.

 

Are we testing enough?

The figure below shows that a total of 115,012 tests have been done (averaging at least 4800 tests daily in the last week) with 103,417 individuals tested. Of the individuals tested, 11,063 tested positive (11 percent), and 92,134 (89 percent) tested negative. While there are only 8,928 confirmed cases, patients who in the past have tested positive undergo retesting. Some of them remain positive even after two to three retests done. 

More than 6,000 tests were conducted yesterday with 5,912 individuals tested. Of these, only 363 tested positive while 5,485 were negative. Even with more tests available, if the output will create backlogs, it defeats the purpose of having more tests done if results will not be released in real time.

SARS-CoV-2 Testing in the Philippines

Number of tests conducted and number of individuals tested

The figures above show the tests conducted, and number of people tested. For now, at least 11 percent of patients tested turned out positive while the remaining 89 percent were negative. It is possible that the increase in new confirmed cases may be due to more testing in the past days. The usual turnaround time for RT-PCR averages two to four days. 

The snapshot below from the website of the DoH  shows the testing capacity of the accredited testing centers in the Philippines. In the last column, note that it says “remaining available tests.” Would this mean that these are the remaining test kits in the inventory for these testing centers? Or does it mean that these are the remaining tests that need to get done in these testing facilities? If these are the remaining testing kits at the site, then RITM and Baguio General Hospital will need to have kits replenished in their facilities to ramp up testing.

These testing centers supposedly have a maximum facility capacity. The Philippine Red Cross (PRC) and the Research Institute for Tropical Medicine (RITM) for example can, at best, supposedly do 1,500 tests a day each site. Yet the former does significantly less tests than the latter. The efficiency of each center needs to get maximized, otherwise the other testing centers can eventually become overwhelmed.

 

New cases per day

Flattening of the curve is based on continuous daily data. If there is a long latency time in reporting new cases, new recoveries and new deaths, poor data quality becomes an unreliable source in determining how effective an intervention (in this case the ECQ) is at lowering the cases in the community. The figure below shows the overall trend of new cases in the Philippines. 

When testing is ramped up, we expect to see some of the cases go up. In order to see if we’ve managed to control the outbreak in the Philippines, we will need to see a decline in the fatality rates.

Are we flattening the curve?

New cases based on region

Of the 156 new cases announced by the Department of Health, 155 had tagged residence information. Sixty-two cases were reported in Luzon (49 in NCR, 12 in Calabarzon and one in the Bicol Region). Central Visayas had 93 cases with most of them coming from Cebu City. No cases came from Mindanao.

Cities with more than 3 new cases reported

Cebu City had the most number of cases overnight with 74 cases. This can be correlated with the fact that Vicente Sotto Memorial Medical Center in Cebu had been ramping up testing this week and has even exceeded its testing capacity. Other cities in Cebu that reported new cases were: Mandaue (6), Lapu-Lapu (3), Talisay (2), Consolacion (2), Minglanilla (1), Davao (1), Lilian (1), and Daanbantayan (1).

In cases by city, Quezon City still ranks first with 1,258 cases (428 cases/million) followed by Cebu City with 684 total cases. In spite of the number of cases of Cebu, the CFR remains low with five deaths (0.7 percent CFR). Davao City remains to have the highest CFR at 16 percent (18 deaths in 113 cases) among the highly urbanized cities.

The reports on demography and by location in general will now be provided every SUNDAY so that the whole week summary is provided. 

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

TOTAL CONFIRMED CASES: 3,414,027

TOTAL DEATHS: 239,777 (case fatality rate: 7.02 percent)

TOTAL RECOVERED: 1,086,883 (case recovery rate: 31.8 percent)

 

Total cases worldwide 

Note that every reference has its own cut-off time for reporting. For the global data, WorldOMeters is used as its reference.

The total cases is closely approaching the 3.5 million mark. The average trend in the past week has averaged ~100,000 new confirmed cases daily with more testing being done worldwide. At the current exponential at least one million new confirmed cases will be registered on an average of 10 days if the growth rate is not curbed. This means that we may breach the four million mark before May 9, 2020. 

The total number of recoveries has passed the one million mark with significantly greater recoveries than deaths. 

The United States of America leads globally in the number of total confirmed cases as they cross the million mark at 1,131,492  with a case fatality rate (CFR) of 5.8 percent with 65,776 total deaths recorded. The recovery rate for the US is slightly higher at 14.28 percent. Among the states, New York leads almost 315,222 total confirmed cases and 24,069 total deaths with a CFR stable at 7.64 percent. While the new cases in the USA continue to increase with 36,000 recorded overnight, this can be attributed to the massive testing being done with close to 6.7M tests done to date (20,242 tests/M population). 

While the United States may have the highest number of cases and number of deaths in the world, Belgium (15.71 percent) and the UK (15.56 percent) have the highest case fatality rate. 8 countries with more than > 50 cases AND zero (0) fatalities reported from COVID-19 are: Vietnam, Cambodia, Uganda, Rwanda, Madagascar, Mozambique, Central African Republic and Nepal.

Cambodia has the highest recovery rate at 97.54 percent (119 of 122 cases) and no deaths reported since their first case of COVID-19. Note that Cambodia has had no new case since April 13, 2020. The following countries have the lowest recovery rates: Netherlands (0.32 percent), Norway (0.41 percent), and the United Kingdom (0.50 percent).

The median average of case fatality rates worldwide is now up at 7.11 percent but is predicted to hover at 7 percent. With more recoveries over the whole pandemic cycle, probably the fatality rates should go down to depict the true mortality rate after the pandemic.