An emergency quarantine facility is built at Tondo High School. A total of 2,614 beds for COVID cases are available in NCR. Photo by Mark Demayo, ABS-CBN News
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While NCR has the most cases, it has one of the fewest quarantine beds

Where do we put the rest of the potentially infectious patients, particularly those coming from the informal settler community, asks our resident expert. BY BENJAMIN CO MD
ANCX | May 25 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 284 new confirmed cases, 74 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 (but it’s difficult to correlate it statistically because data are latent). Since the erratic numbers come in on a daily basis, I recommend using the seven-day rolling average as it provides us a clearer picture of what is going on.

Daily data does not necessarily refer to the number of new confirmed cases that actually occurred that day but rather, to the cases reported on that day. Reporting will vary significantly on a daily basis (obviously from the daily reports from the health agency). 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.

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 4,196 closed cases

Case fatality rate remains at 6.18 percent (vs 6.29 percent global average, vs. 2.41 percent ASEAN average) and recovery rate is a tad up at 23.2 percent (vs. 41.6 percent world average, vs. 45.6 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. 

Rolling seven-day average of daily confirmed COVID-19 deaths (Philippines).

Rolling seven-day average of daily confirmed cases (Philippines).

Rolling seven-day average of daily confirmed tests (Philippines).

The figures above show that the death rate continues to be in the single digit, the number of cases averaging 250/day has plateaued at that number, while the government has increased its testing capacity. With more testing done, more positive patients may be identified. The most important parameter is that deaths remain low in spite of the 10 days latency period of reporting deaths and recoveries.

There are many factors that we need to contend with including the issues on backlog of reports. The number of samples in the backlog are lower at 4,166 (from a previous of 6,198). The average number of tests conducted daily is ~8000 for the past seven days. The figure below shows that around 7.6 percent of patients tested would turn out positive.

Testing Capacity as of May 24, 2020 (Philippines).
 

Daily vs confirmed cases and deaths: Are we bending the curve?

Daily vs total confirmed COVID-19 cases (Philippines).

Daily vs total deaths due to COVID-19 (Philippines)

To say that we are controlling the pandemic will require fulfillment of two parameters. The number of confirmed cases and the number of deaths must take the same trajectory. As long as there are active cases in the community, there will be ongoing transmission of the virus and the potential to cause disease. While there are less deaths noted, this may imply that the healthcare system is not overwhelmed and that most likely majority of the remaining cases are less severe. With continued expanded targeted testing, we should be able to identify those who are positive, perform aggressive contact tracing among those the patient has come in contact with, and isolate/quarantine them in order to curtail the chain of infection.

The government needs to prioritize testing in areas of high endemicity. Do aggressive contact tracing in these regions, and isolate or quarantine them. Unfortunately, while the National Capital Region has the highest number of cases, it also has the lowest number of quarantine or isolation facilities. Where do we put the rest of the potentially infectious patients, particularly those coming from the informal settler community?

The figure below shows that while NCR has over 9,063 cases with still around 6,000 active, the total number of beds allocated to the NCR are disproportionately few compared to other regions. A total of 2,614 beds for COVID-19 cases are available in the NCR. Region I, on the other hand, has only 64 confirmed cases and have only 19 active cases left. However, there are 8,008 dedicated beds for COVID-19 cases.

Ligtas COVID and Mega Ligtas COVID Facilities

 

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 284 new cases announced today, 171 (60 percent) are from the NCR, 70 (25 percent) from Region VII and 43 (15 percent) others. 

Data coming from Region VII continues to alarm, considering that the population of the region is only 7.4 million with a land mass of 15,487.69 aquare kilometers versus the National Capital Region that has a population of almost 13 million but with a land mass of only 618.57 sq km. [As of this writing, the Department of Health has not updated its website on the breakdown of the specific cities in the NCR.]

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

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.

 

Global statistics

Update as of 8PM 25 May 2020 (Monday)

TOTAL CONFIRMED CASES: 5,514,011

TOTAL DEATHS: 346,877 (case fatality rate: 6.29 percent)

TOTAL RECOVERED: 2,309,440 (case recovery rate: 41.9 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 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. 

Daily confirmed cases since December 31, 2019. The last time we looked back at the lowest numbers was on February 24, 2020. It has been an upward trajectory since and has plateaued at >80,000 confirmed cases per day since April 5.

The United States of America continue to lead globally in the number of total confirmed cases at 1,686,436 with a case fatality rate (CFR) of 5.89 percent with 99,300 total deaths recorded. The recovery rate for the US is up at 26.78 percent. Among the states, New York leads with 371,193 total confirmed cases and 29,231 total deaths with a CFR of 7.9 percent. 

Brazil has surpassed Russia with an average of over 17,000 cases per day. They have a fatality of 6.23 percent and a recovery rate of 41 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 6.29 percent. (It was 6.35 percent yesterday.) For the past two to three months, around 80 to 90 percent of patients are either asymptomatic or have mild disease and recover unremarkably. 

Recoveries far outnumber the deaths with a ratio of approximately 6.67:1. (The ratio of recoveries continues to increase, and will reassuringly do so, over the deaths because of increased testing.)