While Dr. Co believes that having limited resources is challenging, he knows there is no other recourse but to continue to test, trace, and isolate. George Calvelo, ABS-CBN News
Culture Spotlight

Build more testing and quarantine centers before numbers become alarming, says this infectious diseases expert

While we are still well below the threshold that would place our healthcare system into jeopardy, we need to start controlling our COVID numbers now. BY BENJAMIN CO MD 
ANCX | May 19 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.

The DoH reported 224 new cases, 114 new recoveries, and 6 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.

Disclaimers on 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 nine days (with more than 50 percent reported after eight days and more) and deaths averaging more than nine days (with around 45 percent being reported after eight days or more). 

(2) Depending on where testing is done, RT-PCR test results take an average of one to two days to process. All tests done should ideally be released within 48 hours (the earlier the better). However, the test results released from government facilities take around three to 14 days, probably due to an overwhelming number of tests being conducted as compared to private hospitals.

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

Figure 1. Comparison of daily new daily cases, deaths and recoveries. There are now 3,680 closed cases. 

Case fatality rate is down at 6.47 percent (vs 6.53 percent global average, vs. 2.44 percent ASEAN average) and recovery rate is slightly up at 22 percent (vs. 39.06 percent world average, vs. 40.3 percent ASEAN average) for the day. 

The case fatality rate of the Philippines has considerably lowered with less deaths being reported the past several days.

Table 1. Outcomes of resolved cases

Table 1 shows that in terms of resolved cases, the Philippines ranks 132 out of 146 countries in terms of recoveries-to-closed cases ratio. In the ASEAN region, while we have 3,680 closed cases, 77 percent are considered recovered while 23 percent had died. 

Globally, the Philippines remains 25th in death rate (6.47 percent CFR), but has gone down to 134th spot in recovery rate in spite of our slight gain in recoveries (21.97 percent).

Table 2. The first column shows the case fatality rate while the last column shows the recovery rate of these countries. We are 25th in terms of death rates while 134th in terms of recovery rates. 

Figures 2 and 3 below show the trajectory of death rates in the country since the start of the pandemic (date of recording of the first 5th death). Currently the doubling time for deaths on the logarithmic curve is approximately every nine days. The Philippines has maintained a plateau with our reports on deaths.

Figure 2. Trajectory of cases of deaths in the Philippines.

Figure 3. 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. The seven-day average daily growth rate is down to at 1.9 percent. 

Using a seven-day rolling average provides more useful information on what is happening with the pandemic. It smoothens the curve and corrects some errors in data or latent reporting systems. Because we already have data for more than two months, we can actually track how well we’re doing at “bending the curve” of daily cases and total confirmed deaths from COVID-19. Figure 4 below shows three countries: the Philippines, South Korea, and Thailand. The Y axis represent daily confirmed cases while the X axis represent the total confirmed deaths. 

The current data shows an actual slowing down in the number of daily confirmed cases and a plateau in the reported deaths for the Philippines. South Korea and Thailand are countries that have not only slowed down the daily confirmed cases and total deaths, they have bent the curve.

Figure 4. Daily cases vs deaths due to COVID-19

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DOH Reporting

More than half (453 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 224 new cases announced today, all were tagged with residence information. One hundred seventy-four (78 percent) were from the NCR, 33 (15 percent) from other areas in the country, and 17 (7 percent) from Region VII. 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. 

As of this writing, 53 of the 174 cases in the NCR are for validation. The remaining 121 cases are from: Quezon City (40); Valenzuela (17); Taguig City (12); Makati (11); Manila and Caloocan City (10 each); Pasay (7); Malabon (5); Marikina, Pasig and Muntinlupa (2 each); and one apiece for Pateros, Navotas, and ParaƱaque. 

Region VII has 7 cases from Cebu City, 1 from Mandaue, and 9 from Cebu Province. 

Other areas with reports include: Rizal (4), Laguna (2), Bulacan (4), Pampanga (1), Aurora (1), Sorsogon (1), Cotabato (2), South Cotabato (1), Sarangani (1), while the remaining cases in the provinces are for validation.

Figure 5. New daily cases, death and recoveries

The DoH website update shows a bar graph (Figure 4) for daily cases, active cases, daily deaths, and daily recoveries. Based on the average number of patients in the last seven days, we should be testing the threshold of 225 new confirmed cases daily next week to see if we’re bending the curve. (This is based on a 10 percent decrease in the average cases for this week.)

 

Testing Capacity

While it is understandable that there are issues hounding the capacity of testing in the country, this problem is not ours alone. Several countries are struggling with having tests conducted and contact tracing methods as well. We are no exception. But I believe we can do better—we must. We just need to get a better foothold on which patients we need to prioritize for the testing and how aggressively we will need to do contact tracing. 

I also know how difficult and costly testing may be for a country that has limited resources. However, there is no other recourse but to continue capacitating various regions with testing centers and building isolation and quarantine facilities so that we are able to control the spread of the virus while our numbers are not yet alarming.

If we cross a threshold that would place the whole healthcare system in a predicament, those very limited resources will eat into whatever gains we currently have. There will be no turning back when the numbers escalate into uncontrollable figures. 

The good news for today is that we’re still below the threshold set for the week. And we’re already in the middle of the week. If the numbers hold steady, then we move to a lower threshold to breach next week. To put that simply, we’re actually bending the curve.

Announcement on the DoH website that the latest testing data available was from May 15, 2020

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

 

Global statistics

Update as of 8PM 19 May 2020 (Tuesday)

TOTAL CONFIRMED CASES: 4,905,839

TOTAL DEATHS: 320,368 (case fatality rate: 6.53 percent)

TOTAL RECOVERED: 1,916,359 (case recovery rate: 39.06 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 is close to the five 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 nine to 10 days. 

Total number of recoveries worldwide closes in on the two 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 1,550,294 with a case fatality rate (CFR) of 5.93 percent with 91,981 total deaths recorded. The recovery rate for the US is up at 23 percent. Among the states, New York leads almost 361,266 total confirmed cases and 28,480 total deaths with a CFR up at 7.9 percent. More than 12 million tests have been done as of yesterday (37,188/million population). 

Russia is now second with 299,941 total confirmed cases, 2,837 total deaths (0.94 percent CFR), and 76,130 total recoveries (25.4 percent). 

On the other hand, Cambodia has not seen a new case for the last month and reported its last patient recovering. The country has a 100 percent recovery rate with no deaths reported. 

The median average of case fatality rates worldwide is lower at 6.53 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 2,236,727 closed cases (cases which had an outcome), 86 percent (1,916,359) had recovered or discharged while 14 percent (320,368) died. 

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