Secretary Carlito G. Galvez, Jr. visited Zamboanga City to inspect 3 proposed testing laboratories. The city has had a surge of new cases in the past week. Photo by ABS-CBN News
Culture Spotlight

In the past week, Zamboanga City’s COVID cases had the highest growth rate among Phil cities

With almost 100 new cases, the Region IX city has a 10 percent growth rate. Thankfully, it has kept its fatality rate low. BY BENJAMIN CO MD
ANCX | May 15 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. 

One useful site is COVID19stats, where one can see most of the DoH data in graph format.

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The DoH reported 215 new cases, 123 new recoveries and 16 new deaths. Compared to the global confirmed cases, the Philippines contributes to 0.27 percent of the cases and 0.26 percent of the deaths from COVID-19 in the world.

Two things to remember with the daily data analytics: 

(1) These three parameters (new confirmed cases, new recoveries, new deaths) are not real-time data. The data provided by the Department of Health is the date of public announcement. In reality it’s very, very late. 

(2) Depending on where testing is done, RT-PCR test results take an average of one to two days to process. Barring any delays, all tests done should ideally be released by at least 48 hours (the earlier the better). However, the test results released from government facilities range from three to 14 days, probably due to an overwhelming number of tests being conducted when compared to private hospitals where fewer number of tests done.

The announced new cases, recoveries and deaths are the tally of reported cases of the day.

Comparison of daily new daily cases, deaths and recoveries. There are now 3,266 closed cases. 

Case fatality rate is up at 6.67 percent (vs 6.69 percent global average vs. 2.44 percent ASEAN average) and recovery rate is slightly up at 20.34 percent (vs. 37.7 percent world average vs. 30.1 percent ASEAN average) for the day. 

The case fatality rate of the Philippines closes in on the world average fatality rate. (Note that a few weeks ago the CFR of the world was at 7.75 percent. With more global testing and tracing, there are now less deaths and more asymptomatic cases recorded. Even within the ASEAN region, the average death rate is lower compared to ours and the average recovery rate is higher than the Philippines.) Which means one of two things: we are not doing enough testing and tracing and/or our healthcare system has many gaps.

The figure below shows the trajectory of death rates in the country since the start of the pandemic (date of recording of the first 5th death).

Are we bending the curve? Trajectory of deaths in the Philippines. 

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 logarithmic scale is the ideal graph to use. The doubling time in death rates is around 8.3 days. The growth rate of cases is around 2 percent (based on the seven-day average).

 

DOH Reporting

More than half (438 cases) are posthumous results. This is the number of people who have passed away before they were declared positive for SARS-CoV-2.

 

New cases per day

Of the 215 new cases announced today, all had tagged with their residence information. One hundred forty-four (67 percent) were from the NCR, only 2 (1 percent) from Region VII and 69 (32 percent) from other areas in the country. Region-level data is accurate, but cases by city are reported only for those that could be verified. There were quite a handful still for validation as of this report. 

In the NCR, the breakdown is as follows: Quezon City (17), Makati (10); Manila, Taguig and Malabon (6 each); Parañaque, Mandaluyong, Pasay, Muntinlupa (3 each); Pasig and Caloocan (2 each); then 1 apiece for Valenzuela, Marikina and Las Piñas, and 80 for validation. 

Region VII reported 1 case in Cebu City and one for validation. 

Other areas with reports include: Rizal (4), Laguna (6), Cavite (1), Batangas (7), Quezon (3), Bulacan (2), Pampanga (3), Angeles City (1), Davao City (12), Negros Occidental (1), Camarines Sur (1), Zamboanga City (15), Zamboanga del Sur (1), Samar (4), while the remaining unaccounted for are still for validation. 

Among the localities that are alarming is Zamboanga City that has seen a dramatic surge in cases in the past few days (96 confirmed cases to date). Its overall seven day average growth rate is now almost 10 percent, the highest among all the cities in the Philippines. The death rate in Zamboanga City is 2.08 percent (2 deaths in 96 cases). 

Davao City has also had a few surges the past days with 12 cases reported today making a total of 171 confirmed cases and a case fatality rate of 13 percent (22 deaths). 

While Cebu City has been reporting more cases in the past days, its seven day average growth rate has decreased to ~3 percent. In spite having 1,544 confirmed cases, it has one of the lowest admission numbers (9 admissions) and only 15 deaths (0.97 percent death rate).

New daily cases, death and recoveries

The DoH website update shows a bar graph (above) for daily cases, active cases, daily deaths and daily recoveries. The current trend shows that based on the average number of patients in the last seven days we should be testing the threshold of 250 cases a day, for the next seven days, to see if we’re bending the curve. 

However, this will depend on the testing capacity of the country. Compared to the global data our daily deaths (as publicly reported) are less than 50/ day. Nevertheless, most of the data coming in are quite late. 

 

Making sense of data

Over the past week, we’ve been noticing so much disparity in data from the Department of Health. It is understandably a gargantuan task to contain a pandemic, and we understand that it’s trying its best on all fronts.

Vital to the public, and for useful information purposes regarding the pandemic, are reports that are encoded accurately and validated well.

Encoding too much information that will serve no use to the public is not helpful. A suggestion is to keep the data minimal. What are useful data endpoints that would help us in deciding if this pandemic is under control or that mitigation measures are working or not?

Death rate is the most important parameter. It is a finite measurement and deals with the most fearful outcome. How we decrease the death rate is our win against this seemingly invincible outbreak.

Confirmed cases provides us the information on exactly how many test positive for the virus. Low confirmed cases in the advent of high death rates tell us that we’re not testing enough and that we’re missing out on the asymptomatic, pre-symptomatic, and super-spreaders. 

Tests done. The ability to test is paramount in this pandemic. While we may, in some way or another, be limited with testing because of resources and expenses, we need to take into consideration that this is the only investment we can make short of waiting for a vaccine or any form of treatment to come out of the magic box. Testing helps identify positive patients particularly in community transmission settings where the likelihood of someone getting infected with the virus is much higher because of issues on social distancing in the homes and in communities.

Breaking down data per region and per city based on growth rate of the infection in that city assists the local government in where their gaps are. 

While information on recoveries may find some use, I find that the recovery rate reports coming in are too slow. That’s probably because only those who are hospitalized and have recovered (tested with two negative swabs) are recorded. Those that are in isolation or quarantine in their homes may not be followed up by the local governments on time, accounting for the poor information on recoveries. Besides, most of the patients who are not clinically ill will eventually recover. Recovery rate is not a critical parameter for outcomes in a pandemic of this proportion.

I am not sure if the public is even interested in finding out the inventory of PPEs, ventilators, hospital beds, etc. These are information for internal operational purposes and should be encoded by a separate team. Having a handful of people encoding 10,000 line items compared to the same handful of people encoding 100 line items will result in a lot of error for the former compared to the latter.

But these are just suggestions on how to create a more efficient way of informing the public on the variables that are important in policy and decision making. We need to clean up the background noise by clearing the information that is cluttering the people behind data entry.

How the government agency takes these suggestions is up to them. But they are meant to help improve at making the information that is churned from their data bureau more realistic, accurate and useful for policy making purposes. 

The Department of Health makes a disclaimer that there are no newly submitted report as of yesterday May 14, 2020 and that the latest testing available is from May 13, 2020.

To get in touch with the Department of Health, the COVID hotline is (02)894-COVID loc 1555.

Global statistics

Update as of 9PM 15 May 2020 (Friday)

TOTAL CONFIRMED CASES: 4,541,148

TOTAL DEATHS: 303,636 (case fatality rate: 6.69 percent)

TOTAL RECOVERED: 1,711,878 (case recovery rate: 37.7 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 confirmed cases has passed the 4.5 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 growth rate, at least one million new confirmed cases may be registered every 10 days. This means there is a high probability that the five million mark will be reached on or before May 19, 2020. 

Total number of recoveries has passed the 1.7 million mark with significantly greater recoveries than deaths. 

The United States of America continue to lead globally in the number of total confirmed cases at 1,457,593 with a case fatality rate (CFR) of 5.96 percent with 86,912 total deaths recorded. The recovery rate for the US is up at 21.82 percent. Among the states, New York leads almost 353,096 total confirmed cases and 27,426 total deaths with a CFR lower at 7.77 percent. The growth rate of new cases and deaths has slowed down significantly in New York. More than 10.6M tests have been done as of yesterday (32,166/million population). 

Spain is still at number 2 with 272,646 total confirmed cases and 27,321 deaths (10 percent case fatality rate). Russia is now a close third with 262,843 cases and 2,418 deaths (0.9 percent CFR).

The median average of case fatality rates worldwide is lower at 6.69 percent. From the current data for the past two to three months, around 80 to 90 percent of patients are either asymptomatic or recover unremarkably. Almost 98 percent of the currently infected (active or positive) cases are mild or asymptomatic. 

Based on current data, of the 2,015,514 closed cases (cases which had an outcome), 85 percent (1,711,878) had recovered or discharged while 15 percent (303,636) died. 

Recoveries far outnumber the deaths with a ratio of approximately 6:1.