Test samples are checked at one of the laboratories of the Philippine Genome Center-Mindanao. Yesterday, Davao City had a surge of new reported cases. Photo by ABS-CBN News
Culture Spotlight

With 38 new COVID cases overnight, Davao’s growth rate shoots past national average

However, NCR continues to be the country’s hotbed with an overnight surge of cases. On the other hand, six more testing laboratories get licensed to operate. BY BENJAMIN CO MD
ANCX | May 24 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 258 new confirmed cases, 72 new recoveries, and five new deaths overnight. While there is an increase in new confirmed cases, this can be attributed to the backlogs and the increased testing capacity of the country. Because of the erratic numbers that come in on a daily basis, my recommendation is always based on a seven-day rolling average. Daily data does not necessarily refer to the number of new confirmed cases on that day, but to the cases that were reported on that day.

As you can see in the daily reports provided by the health agency, reporting can vary significantly from day to day irrespective of any actual variation of cases. Because of this, it is helpful to look at changes from week to week. This provides a slightly clearer picture of the trajectory and trend in the cases and deaths data. 

The most important indicator here is death rate. The number of new deaths remain in the single digit.

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 4,117 closed cases

Case fatality rate remains at 6.17 percent (vs 6.35 percent global average, vs. 2.41 percent ASEAN average) and recovery rate is slightly up at 23.1 percent (vs. 41.6 percent world average, vs. 44.4 percent ASEAN average) for the day. 

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

Globally, the Philippines ranks lower now at 33rd place (from a previous 30th) in death rate (6.17 percent CFR) but has gone down to 139th spot in recovery rate with our slight gain in recoveries (23.15 percent).

While the case fatality rates of the Philippines is higher than Indonesia or even the United States, note that death rates are based on deaths divided by confirmed cases. This means that, even if there are more deaths reported but the number of positive cases are high, the fatality rate will always be lower. For example, if you have only 10 deaths but 100 reported cases, then the fatality rate is 10 percent. Compare this to 1,000 deaths in 1,000,000 reported cases, it gives you a fatality rate of 0.1 percent. The outcomes are better when your death rates are lower. Hence, the value of lower deaths compared to recoveries.

Figure 1. The second the last column shows the case fatality rate while the last column on the right most end 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. 

Figure 3 shows that we are now able to bend the curve with single digit deaths being reported over the past week. The average deaths is ~6 cases/day due to COVID-19. While Indonesia has a lower case fatality rate, the number of deaths continue to increase. Death is a major indicator of our ability to “flatten” the curve. This means that our healthcare system is not 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 1.65 percent.

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. 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. The sustainability of this trajectory should be maintained with a 10 percent decline in week to week averages.

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

DOH Reporting

More than half (467 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 258 new cases announced today, 195 (75 percent) are from the National Capital Region (NCR), 51 (20 percent) others, and 12 (5 percent) from repatriates. NCR remains the hotbed for cases in the Philippines. [As of this writing, the Department of Health has not updated its website on the breakdown of the specific cities in the NCR.]

Figure 5. New daily cases, death, and recoveries as of May 23, 2020.
 

Testing Capacity

Figure 6. Laboratory capacity in the Philippines

There are 33 licensed RT-PCR laboratories and 8 accredited GeneXpert Laboratories as of May 22, 2020. The additional laboratories include: PNP Crime Laboratory (NCR), Ilocos Training Regional Medical Center (Region I), Laguna Provincial Hospital-San Pablo City District Hospital (Region III), and Bataan General Hospital (Region III). 

Figure 7 below shows the total tests conducted. The average positive individuals among the tested patients is eight percent. Meaning out of every 1,000 patients tested, most likely 80 will be positive. There is a backlog of over 6,000 samples. Assuming an eight percent positivity rate, that would mean around 480 positive tests have remained unreported to date.

Figure 7. SARS-CoV-2 Testing in the Philippines as of May 22, 2020.
 

The current scenario

The doubling time is almost 10 days and the growth rate is less than two percent (1.65 percent). The death rate is also significantly lower with single digits seen. The hospital admissions have dramatically declined as well.

Figure 8. Facility capacity in the Philippines (ward beds, isolation bed, ICU beds and mechanical ventilators).

 

The week that was

(May 17 to 23, 2020. Note that all data are summaries up to yesterday and do not include data released today by the Department of Health).

  • Over the past week, we had a total of 1,472 new confirmed cases (down from 1695 the week before), 46 new deaths (down from 113 the week before), and 616 new recoveries (down from 719 the week before). The seven-day average this week is 210 new cases/day, 6 to 7 new deaths/day, and 88 new recoveries/day. To see if we are bending the curve further, we will test a new seven-day average next week in cases (190/day) and deaths (4-5/day). 
  • The National Capital Region (NCR) maintained a growth rate of 2.07 percent last week. This week, it ends with a seven-day average growth rate of 1.62 percent. We saw a total of 772 new confirmed cases (versus 977 the previous week) for an average of 110 cases/day in the NCR. 
  • Quezon City still has the most number of cases (1,900), followed by Cebu (1580), Manila (1,090), Parañaque (584), Makati (576), Mandaluyong (553), Pasig (443), Taguig (390), Pasay (335), and Caloocan (331) rounding up the top 10 cities. 
  • Among the 17 cities in the National Capital Region the following have growth rates more than 1 percent: Navotas (3.6 percent), Muntinlupa (2.71 percent), Malabon (2.58 percent), Pateros (2.16 percent), Pasay (1.83 percent), Caloocan City (1.76 percent), Pasig City (1.47 percent), and Taguig (1.23 percent). The rest of the cities in the NCR had less than 1 percent growth rates with San Juan having the least (0.16 percent).
  • Davao City had 38 new cases overnight the other day pushing their growth rate up to 2.82 percent.
  • Based on region, NCR has the most cases (65 percent of the total cases in the Philippines) with seven percent case fatality rate. Region VII is second with 1,949 cases (14.7 percent) but with death rate of 1.4 percent. Region IV-A is third with 1,462 cases (11 percent) with seven percent death rate. These three regions alone comprise more than 90 percent of the total cases in the Philippines. 
  • Confirmed cases by age group: Children (0 to 18 years old) make up six percent while senior citizens (60 years up) around 22 percent. The remaining 72 percent of the confirmed cases are between 20 to 59 years old.
  • Fatality by age group: 4.1 percent of deaths are in children 0 to 18 years old (highest in < 9 years old at 3 percent vs 10-19 years old at 1.1 percent). Around 71 percent of deaths belong to those 60 years old and up. The remaining 25 percent of deaths are between 20 to 59 years old.

Let’s end the week on a good note. That we’ve begun to bend the curve and flatten it. The question is, with the kind of data being churned by the health agency, next week is anybody’s guess. Will it be a good surprise, or will it be another shocker? 

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

 

Global statistics

Update as of 8PM 24 May 2020 (Sunday)

TOTAL CONFIRMED CASES: 5,418,495

TOTAL DEATHS: 344,206 (case fatality rate: 6.35 percent)

TOTAL RECOVERED: 2,254,406 (case recovery rate: 41.6 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.

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The total confirmed cases is close to the 5.5 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 30, 2020. 

Total number of recoveries worldwide has 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 1,666,828 with a case fatality rate (CFR) of 5.9 percent with 98,683 total deaths recorded. The recovery rate for the US is up at 26.8 percent. Among the states, New York leads with 369,656 total confirmed cases and 29,112 total deaths with a CFR of 7.88 percent. 

Brazil has surpassed Russia with an average of over 17,000 cases per day. They have a fatality of 6.35 percent and a recovery rate of 40.8 percent. 

As 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 to 6.35 percent. 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 2,598,612 closed cases (cases which had an outcome), 87 percent (2,254,406) had recovered or discharged while 13 percent (344,206) died. The remaining 2,819,883 cases remain active. 

Recoveries far outnumber the deaths with a ratio of approximately 6.6:1. (This is a good indicator that the ratio of recoveries is starting to increase over the deaths because of increased testing.)