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.
The rollercoaster ride with the data continues today. Two hundred ninety-five (295) new cases, 90 new recoveries and four new deaths.
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Two things should be considered here:
(1) These three parameters are not real time data. On the average, deaths and recoveries take an average of a week before they are publicly announced. For recoveries, almost 50 percent are announced after eight days or more. For deaths, almost 40 percent are announced after eight days or more as well.
(2) RT-PCR test results take an average of two to three days to process. Barring any delays, all tests done should be released in at least 72 hours. However, the test results released from government facilities range from two to 10 days due to the overwhelming number of tests being conducted there versus the private hospitals where the number of tests done in the latter are fewer. In the meantime, the announced new cases, recoveries and deaths will be simply be the tally of reported cases of the day.
Comparison of daily new daily cases, deaths and recoveries. There are now 1,663 closed cases.
If and when testing is ramped up, we will see an increase in the number of new cases daily. And will change the actual inflection (peak) of the cases of COVID-19 in the the Philippines.
It is important to remember that it is not only the number of tests that is important, but the ability of the testing facility to release the results in a timely manner for it to be useful that matters. It will end up an exercise in futility if we do mass testing of 30,000 a day yet there will be a long backlog in the results.
The case fatality is down at 6.58 percent (versus 7 percent world average) and the recovery rate up at 13.2 percent (versus 32.2 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 seven 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 3369 and 14,469 suspect cases. The number of HCWs affected number 1758 and comprise 19.7 percent of the confirmed cases.
Posthumous results is up at 334. This is the number of people who have passed away before they were declared positive for SARS-CoV-2.
Are we testing enough?
(As of the publication of this blog, there is no update on the testing done the previous day May 2, 2020 on the Department of Health website and in the Data Drop).
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 figure above shows 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.
Snapshot of the daily tests conducted as per Department of Health shows Vicente Sotto Memorial Medical Center doing more tests daily in the past week. This accounts for their being able to identify more patients who are positive for SARS-CoV-2. Their fatality rate is one of the lowest at 0.55 percent.
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 295 new cases announced by the Department of Health, 294 had tagged residence information. The table above shows the breakdown: 135 cases from Luzon (117 in NCR), 124 in Visayas (114 from Cebu City) and 35 in Mindanao (12 from the Davao Region).
Cities with more than three new cases reported
Cebu City had the most number of cases overnight with 114 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.
Zamboanga City saw a steep leap with 22 new cases, Parañaque had the most number of cases in the National Capital Region with 13 new cases, Davao City had 11 new cases and Quezon, Quezon saw a surge of 9 new cases reported. A complete report on breakdown of new cases in the past 24 hours per city can be found on COVID19stats.
Data based on Location
(To be reported every Sunday)
Top 10 cities with most number of cases.
Quezon City still has the most number of cases per city, but is closely followed now by Cebu City which has 893 cases with a very low case fatality rate of 0.55 percent.
Top 10 cases by Region
The NCR which is the most densely populated region has the most number of cases followed by Region IV-A and Region VII. The highest case fatality rate per region is Region I with 12 deaths in 62 cases (19 percent) followed by Region XI (14 percent) with 20 deaths in 143 cases.
(To be reported every Sunday)
Cases by age and sex
Recovery and fatality rates by age group
The pediatric age group comprises only 4.2 percent of the total cases of COVID19. The majority of patients affected are between 20 to 59 years old. Senior citizens (> 60 years old) comprise 25 percent of the total cases. Recovery rates are better in younger age groups. The fatality rate is highest among senior citizens (> 60 years old) with 65 percent of deaths belonging to this age group.
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 8pm 03May 2020 (Sunday)
TOTAL CONFIRMED CASES: 3,497,047
TOTAL DEATHS: 244,876 (case fatality rate: 7 percent)
TOTAL RECOVERED: 1,126,291 (case recovery rate: 32.2 percent)
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 1M 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 1,160,838 with a case fatality rate (CFR) of 5.81 percent with 67,448 total deaths recorded. The recovery rate for the US is slightly higher at 15 percent. Among the states, New York leads almost 319,213 total confirmed cases and 24,368 total deaths with a CFR stable at 7.63 percent. While the new cases in the USA continue to increase with 30,000 recorded overnight, this can be attributed to the massive testing being done with over 6.9M tests done to date (20,940 tests/M population).
While the United States may have the highest number of cases and number of deaths in the world, Belgium (15.68 percent) and the UK (15.37 percent) have the highest case fatality rates. 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 for more than two weeks.
Cambodia has the highest recovery rate at 98.36 percent (120 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 (0.34 percent), Norway (0.41 percent), and the United Kingdom (0.49 percent).
The median average of case fatality rates worldwide is steady at 7 percent. With more recoveries over the whole pandemic cycle, the fatality rates is expected to be lower to depict the true mortality rate after the pandemic.