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 214 new cases, 101 new recoveries, and 11 new deaths. Compared to the global confirmed cases, the Philippines contributes to 0.26 percent of the cases and 0.26 percent of the deaths from COVID-19 in the world.
Some take home messages from the data:
(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. Even global data will vary in time of reporting, depending on the capacity of that country. To date, the latency period of the Department of Health on reporting recoveries averages 9 days (with more than 50 percent reported after 8 days and more) and deaths averaging more than 9 days (with around 45 percent being reported after 8 days or more).
(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 3,378 closed cases.
Case fatality rate is up at 6.64 percent (vs 6.65 percent global average vs. 2.34 percent ASEAN average) and recovery rate is slightly up at 20.82 percent (vs. 38.1 percent world average vs. 37 percent ASEAN average) for the day.
While case fatality rate in the country is slightly lower, it now approaches the global average which has gone down, and we’re doing poorly in terms of death rates with Indonesia being lower at 6.4 percent. We have the highest case fatality rate now in in the ASEAN region. In terms of recovery rate, while we have improved a bit, we are still below the world average. We also have the poorest recovery rate in the ASEAN region.
On the assumption that majority of the patients who are confirmed cases are either asymptomatic or pre-symptomatic, an important observation is that the recoveries are not being tracked and tested on time. Let us use the duration April 15 to April 30 as an illustrative example. There were 3,287 new confirmed cases. I use the latter half month data in April because that is one full month to look back from today. The average duration of the clinical disease is around 14 days. That would have been enough time to see these 3,287 cases closed by now, either as recoveries or as deaths. For the same duration, a total of 233 deaths were recorded while 748 were considered recovered. That’s a total of 981 cases with outcomes from April 15 to April 30. That leaves us with 2,306 patients still without outcomes for the same duration. Even if we were to presume that severe and critically ill patients take an additional 10 to 14 days more in the hospital, this group of patients reflect <5 percent of the patients with confirmed cases. In short, those recoveries should have been added on to the total recoveries we’ve had today.
We’re really not testing enough.
This information is disturbing because we follow a World Health Organization (WHO) definition where in order to classify a person as recovered, one needs to have two consecutive negative tests after testing positive. With testing kits being limited and expensive, a suggestion is to look back at this definition of “recovery”—especially when patients are already asymptomatic and are retested past the third week of infection where the RT-PCR will most likely be negative.
Asymptomatic patients, or those who had mild symptoms and isolated/quarantined for 15 days and remained well, can probably have only one confirmed negative test to classify them as recoveries. Retesting over and over until these asymptomatic patients test negative past the period of the sensitivity of the RT-PCR becomes futile, and a waste of limited resources just to fulfill a definition criteria.
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).
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). It is compared with South Korea to illustrate that while South Korea may have more confirmed cases, they have bent the curve. The Philippines has maintained a plateau with our reports on deaths.
Are we bending the curve? Trajectory of deaths in the Philippines. (compared to South Korea data for illustrative purposes)
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 nine days. The growth rate of cases is around 2.15 percent (based on the seven-day average).
DOH Reporting
More than half (445 cases) are posthumous results. This is the number of people who died before they were declared positive for SARS-CoV-2.
New cases per day
Of the 214 new cases announced today, all had tagged with their residence information. One hundred forty-seven (69 percent) were from the NCR and 67(31 percent) are 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.
All 17 cities in the NCR had reported cases today: Quezon City (27); Manila (13); Caloocan (10); Parañaque, Taguig and Muntinlupa (6 each); Pasig (5); Pasay, Mandaluyong, Las Piñas, Valenzuela and Makati (2 each); and one apiece for San Juan, Marikina, Malabon, Navotas and Pateros! Fifty five cases were for validation as of this publication.
There are no reports from Region VII today.
Other areas with reports include: Rizal (5), Laguna (13), Cavite (3), Batangas (3), Bulacan (2), Nueva Ecija (1), Tarlac (1), Davao City (6), Davao del Norte (2), Zamboanga City (25), Cotabato City (1), and the rest are for validation.
Among the localities that are alarming is Zamboanga City that has seen a dramatic surge in cases in the past few days (121 confirmed cases to date). Its overall seven-day average growth rate is now almost 13 percent, the highest among all the cities in the Philippines. The death rate in Zamboanga City is 1.65 percent (2 deaths in 121 cases).
Davao City has also had a few surges the past days with 12 cases reported today making a total of 177 confirmed cases and a case fatality rate of 12.4 percent (22 deaths).
New daily cases, death and recoveries
The DoH website update shows the bar graph 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.
As of today, there is no information provided on testing as the DoH is improving its mechanisms and systems. According to their READ ME FIRST information sheet, the DoH assumes no liability for any errors, omissions or inaccuracies in the data and its interpretations as information may change at any time without notice.
To get in touch with the Department of Health, the COVID hotline is (02)894-COVID loc 1555.
Global statistics
Update as of 9PM 16 May 2020 (Saturday)
TOTAL CONFIRMED CASES: 4,641,376
TOTAL DEATHS: 308,845 (case fatality rate: 6.65 percent)
TOTAL RECOVERED: 1,767,389 (case recovery rate: 38.1 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 confirmed cases has passed the 4.6M 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 1M 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 worldwide closed in on the 1.8M mark with significantly greater recoveries than deaths.
The United States of America continue to lead globally in the number of total confirmed cases at 1,484,285 with a case fatality rate (CFR) of 5.96 percent with 88,507 total deaths recorded. The recovery rate for the US is up at 22 percent. Among the states, New York leads almost 356,016 total confirmed cases and 27,574 total deaths with a CFR lower at 7.74 percent. The growth rate of new cases and deaths has significantly declined in New York in the past week with less than 150 deaths seen overnight compared to the 982 deaths seen on April 11. More than 11 million tests have been done as of yesterday (33,532/million population).
Spain is still at number 2 with 274,376 total confirmed cases and 27,459 deaths (10 percent case fatality rate). Russia is now a close third with 272,043 cases and 2,537 deaths (0.93 percent CFR).
The median average of case fatality rates worldwide is lower at 6.65 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.
As of this writing, of the 2,080,003 closed cases (cases which had an outcome), 85 percent (1,771,002) had recovered or discharged while 15 percent (309,001) died.
Recoveries far outnumber the deaths with a ratio of approximately 6:1.
Photo by Basilio H. Sepe, ABS-CBN News