Rapid testing in Barangay Immaculate Conception, Cubao were conducted on May 20. Today, no new cases in Quezon City were reported. Photo by Jire Carreon, ABS-CBN News
Culture Spotlight

Quezon City records no new COVID cases for the first time

On a day filled with positive data trends, new cases in NCR also stay below 100, and deaths and hospital admissions have gone down. Are we ready for GCQ? BY BENJAMIN CO MD
ANCX | May 22 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 163 new cases, 92 new recoveries, and 11 new deaths. Compared to the global confirmed cases, the Philippines contributes to 0.26 percent of the cases and 0.25 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 almost 10 days (with more than 50 percent reported after eight days and more) and deaths averaging almost 9.5 days (with around 46 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. Barring any delays, all tests done should ideally be released within 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.

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

Comparison of daily new daily cases, deaths and recoveries. There are now 3,949 closed cases

Case fatality rate remains at 6.3 percent (vs 6.42 percent global average, vs. 2.45 percent ASEAN average) and recovery rate is slightly up at 22.7 percent (vs. 40.7 percent world average, vs. 42.7 percent ASEAN average) for the day. 

The case fatality rate of the Philippines has considerably lowered over the past two weeks with less deaths being reported. 

Globally, the Philippines ranks lower now at 30th place (from being previously 29th) in death rate (6.3 percent CFR) but has gone down to 137th spot in recovery rate in spite of our slight gain in recoveries (22.74 percent).

Figure 1. The first column shows the case fatality rate while the rightmost column shows the recovery rate. 

Figures 2 and 3 below shows 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 approaching almost every 10 days. The Philippines has begun to plateau with the reports on deaths. Notice how Malaysia, Singapore, and Thailand have crossed the threshold of doubling time every 10 days, indicating the abrupt slowdown in deaths in those countries. 

In Figure 3, see how significantly we have begun to bend the curve (and I hope that this trajectory is sustained in spite of the latent data), while Indonesia’s death curve remains on the rise. Death is one major indicator of our ability to “flatten” the curve. This means that our healthcare system is not becoming overwhelmed with severe cases requiring intensive care.

Figure 2. Trajectory of cases of deaths in the Philippines compared to Indonesia, Malaysia, Thailand, and Singapore.

Figure 3. Are we bending the curve? Trajectory of deaths in the Philippines, compared to Indonesia 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 1.69 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 four countries: the Philippines, Indonesia, Malaysia, and Thailand. The Y axis represents daily confirmed cases while the X axis represents the total confirmed deaths. 

The trajectory of the Philippines is now following the same trajectory of Malaysia and Thailand–bending the curve—while Indonesia continues an uptrend of deaths. Notice that this seven-day rolling average shows that over the past weeks, the number of our total daily confirmed cases have significantly slowed down, together with a decline in the death rates. And that’s great news!

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

DOH Reporting

More than half (459 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 163 new cases announced today, 91 (56 percent) are from the National Capital Region, 56 (34 percent) are from Region VII, and 16 (10 percent) are from others. This is the second day in a row where the cases from NCR is less than 100, and is in fact lower than yesterday’s. 

Of the 91 cases in NCR, Pasay had the most cases with 16. This is followed by Taguig (11), Parañaque (8), Las Piñas (5), Muntinlupa (4), 2 cases each for Manila and Makati, and 1 case apiece for Pateros and Caloocan. For the first time, Quezon City has 0 new case. The remaining 41 are for validation.

Region VII has 56 cases. All these cases are for validation. 

Other areas with reports include: Rizal (1), Laguna (4), Cavite (1), Batangas (4), Quezon (1), Occidental Mindoro (1) 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 5) 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 225 new confirmed cases daily for the next week to see if we’re further bending the curve. (This is based on a 10 percent decrease in the average cases of 242 last week.) 

 

Testing Capacity

As of May 15, 2020, based on the DoH Data Drop and DoH website, there was a total of 224,633 tests conducted (or an average of 9,639 tests daily for the past seven days) with 207,823 total individuals tested. The current capacity of the Philippines is 35 testing centers—30 licensed RT-PCR laboratories and 5 GeneExpert laboratories—accredited to conduct testing for SARS-CoV-2 in the country. Nevertheless, it would be helpful that we have information on actual daily testing as it has been almost a week where no data is provided regarding the testing capacity. 

 

The current scenario

We have prolonged the doubling time (approaching 10 days on a logarithmic scale), decreased the growth rate which is now at 1.69 percent (all time low), lowered significantly the death rate (averaging 12 cases in the last week) and decreased hospital admissions. 

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Due to some delays on the part of the agency in providing more timely data, one way of looking at these data is that this is where we probably were 10 to 14 days ago. Assuming that the data is constant, and if we continue this trend toward the end of the week, we should be able to test a new seven-day average threshold that is 10 percent lower than the current threshold of 225. 

It is a good day to see the gains in what we do. And for once, it is nice to blog about some good news—and I keep my fingers crossed that we remain in this trajectory. 

It does not mean that we’re out of the woods. We need to keep moving in the right direction. We cannot depend on treatments (because there is none at the moment) or peg our hopes on a vaccine (because that is still far off in the future). We need to be cautious because when we let our guard down, the virus will see that window of opportunity to wipe out all our gains very quickly. 

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

 

Global statistics

Update as of 8PM 22 May 2020 (Friday)

TOTAL CONFIRMED CASES: 5,214,971

TOTAL DEATHS: 335,001 (case fatality rate: 6.42 percent)

TOTAL RECOVERED: 2,094,920 (case recovery rate: 40.7 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 is past the five million mark. The average trend in the past week has begun to average 120,000 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 eight to nine days. The six million mark is projected to be breached on or before May 31, 2020. 

Total number of recoveries worldwide passed 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 1,621,333 with a case fatality rate (CFR) of 5.94 percent with 96,363 total deaths recorded. The recovery rate for the US is up at 23.6 percent. Among the states, New York leads with 366,357 total confirmed cases and 28,885 total deaths with a CFR at 7.88 percent. 

Russia now is second with 326,448 total confirmed cases, 3,249 total deaths (0.99 percent CFR), and 99,825 total recoveries (30.6 percent). 

As the various countries ramp up testing in various degrees, more new confirmed cases are being reported. This means that with more testing and aggressive contact tracing, we are now able to identify patients who are asymptomatic or pre-symptomatic and are potentially infective to the vulnerable population. This explains why with more testing, we now see a better picture of the extent of the pandemic. With more testing, the death rates go down. 

The median average of case fatality rates worldwide has declined further from 6.46 percent yesterday to 6.42 percent today. From the current data for the past two to three months, around 80 to 90 percent of patients are either asymptomatic or have mild disease and recover unremarkably. 

As of this writing, of the 2,429,922 closed cases (cases which had an outcome), 86 percent (2,094,920) had recovered or discharged while 14 percent (335,002) died. The remaining 2,785,049 cases remain active. 

Recoveries far outnumber the deaths with a ratio of approximately 6.25:1.