More and more COVID-19 cases continue to pour from outside NCR as more testing is being done. Photo by Jonathan Cellona, ABS-CBN News
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Mandaue, Lapu-Lapu, and other major cities in Cebu record more COVID-19 cases

More testing is being done in the provinces, which leads to the continuous upsurge of COVID-19 case counts. BY BENJAMIN CO MD
ANCX | May 04 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. 

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The rollercoaster ride with the data continues today. Two hundred sixty-two (262) new cases, 101 new recoveries, and 16 new deaths. 

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 by least 72 hours. However, the test results released from government facilities range from two to 10 days due to an overwhelming number of tests being conducted versus the private hospitals where there are fewer number of tests done. 

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 1,938 closed cases.

Instead of using a linear graph to determine if we are “bending” the curve, an exponential graph can best illustrate whether the mitigations we have put in place are actually bringing down the number of cases. The figure below shows that after more than 40 days since the confirmed cases reached 30 per day, we have not bent the curve at all.

Are we bending the curve? Data on the Philippines: X axis shows the number of days since confirmed cases first reached 30/day. Y axis is logarithmic scale. 

The case fatality is down at 6.58 percent (vs 7 percent world average) and the recovery rate up at 13.2 percent (vs 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. A linear scale is used in the data of the DoH with a median doubling time of 24 days based on the seven-day average daily growth rate of 2.88 percent. A logarithmic scale is the ideal graph to use. Figure 3 below shows that the doubling time in death rates is around 7.3 days.

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 3,474 and 14,552 suspect cases. The number of HCWs affected number 1,772 and comprise 19.2 percent of the confirmed cases. 

Posthumous results is up at 337. This is the number of people who have passed away before they were declared positive for SARS-CoV-2.

 

Are we testing enough?

Testing coverage and number of tests per confirmed case help us understand what we can know about the true spread of the virus from data on confirmed cases. The most helpful is the number of tests per confirmed case. This number accounts for the fact that a smaller outbreak requires less testing.

Testing is important because a country that performs very few tests for each case it confirms is not testing widely enough for the number of confirmed cases to reflect a reliable picture of the true spread of the virus. Hence, testing only people with the most severe symptoms may miss out the greater majority—the people with mild or no symptoms that were never tested. 

The figure below shows that a total of 126,164 tests have been done (averaging at least 5,182 tests daily in the last week) with 113,574 individuals tested. Of individuals tested, 11,917 tested positive (10.7 percent), and 101,416 (89.3 percent) tested negative. While there are only 9,485 confirmed cases, patients who in the past have tested positive undergo retesting. Some of them remain positive even after two to three retests done

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. 

The figure below shows the daily tests conducted based on data from the Department of Health. Vicente Sotto Memorial Medical Center is has exceeded its maximum daily capacity for testing. The case fatality rate in Cebu City is one of the lowest at 1 percent.

Comparison of some testing facilities and the number of daily tests conducted. 

 

New cases per day

The figure below shows the overall trend of new cases based on daily reports from the Department of Health.

Daily case reports

New cases based on region

Of the 262 new cases announced by the Department of Health, 260 had tagged residence information. The table below shows the breakdown: 153 cases from Luzon, 92 in Visayas, and 15 in Mindanao.

Cities with more than five new cases reported

Mandaue in Cebu had the most number of cases overnight with 54 confirmed. Cebu City is in second with 25 confirmed cases. Lapu-Lapu in Cebu had 8 cases. Cities in Metro Manila saw a surge of cases with Quezon City having 16, Taguig 13, Makati 11, Muntinlupa 11, Parañaque 9, and Pasay 5. Zamboanga registered 11 confirmed cases, followed by Lipa, Batangas with 9 cases. For a complete report on breakdown of new cases in the past 24 hours per city it can be found on COVID19stats.

The surge in cases in Central Visayas can be attributed to the increase in testing done at the Vicente Sotto Memorial Medical Center (see Figure above). 

Growth rate of confirmed case per region is highest in Region IX at 22.23 percent followed by Region VII (11.39 percent). Those with more than 2 percent growth rate include NCR (2.23 percent), Region XI (2.4 percent), Region VI (2.17 percent), Region X (3.24 percent).

Among the cities in Metro Manila with >2 percent growth rates and should be watched out for are: Parañaque (2.43 percent), Muntinlupa (2.57 percent), Las Piñas (2.55 percent), and Pasay City (2.53 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 8pm 03May 2020 (Sunday)

TOTAL CONFIRMED CASES: 3,581,879

TOTAL DEATHS: 248,558 (case fatality rate: 6.9 percent)

TOTAL RECOVERED: 1,159,553 (case recovery rate: 32.4 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 has passed 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 1,188,421 with a case fatality rate (CFR) of 5.77 percent with 68,602 total deaths recorded. The recovery rate for the US is stable at 15 percent. Among the states, New York leads almost 323,883 total confirmed cases and 24,648 total deaths with a CFR stable at 7.61 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 almost 7.2 million tests done to date (21,742 tests/M population). 

While the United States may have the highest number of cases and number of deaths in the world, Belgium (15.76 percent) and the UK (15.18 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 (0.48 percent).

The median average of case fatality rates worldwide is lower today at 6.9 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.