A view inside a converted COVID facility in Manila. The city is still third in terms of highest number of cases in the country. George Calvelo, ABS-CBN News
Culture Spotlight

As the PH closes out May with an upward bending of the curve, one expert suggests a different way of reporting

With late data coming in the last week of May, the Philippines now averages 492 cases a day after touching a threshold of 210 cases in the third week. BY BENJAMIN CO MD
ANCX | Jun 01 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.  

--

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.

 

About last night

 

Daily new confirmed COVID-19 deaths (Philippines). Daily deaths with no smoothening of the curve. 

People ask how would the graph of daily measured parameters (deaths, cases, etc) look if we did not “smoothen” them? The figure above shows the actual graph recorded daily since five daily new deaths were reported. Because of daily fluctuations in reporting systems, smoothing the curve using (a) logarithmic scale and (b) rolling seven-day average provides a more meaningful and understandable look on the data.

 

Daily new confirmed COVID-19 deaths (Philippines)

 

Daily new confirmed COVID-19 cases (Philippines)

 

Daily new confirmed COVID-19 tests

The figures above show the trajectory of the Philippines in terms of deaths, cases (fresh or otherwise) and testing done. The Department of Health site last reported the number of tests done in the country on May 28, 2020. 

Based on last night’s data, our seven-day average daily growth rate in cases has gone up from 1.7 percent a few days ago to 3.2 percent today. With the increase in cases, the trajectory now moves in a slightly upward direction, and is expected to move up further as the backlog data come in. As of today, the doubling time for both cases and deaths in the figures below remain around 10 days (based on the logarithmic scale). The drop in cases yesterday from 1,046 the previous day slowed the trajectory. 

I suggest that all the backlogs be addressed in a single day (after they have been processed and validated properly) so that the data will not look unexplainable. Adding it in aliquots on a daily basis is difficult to interpret and sends mixed signals on the competence of those that work with the data.

 

How rapidly is the Philippines increasing in cases?

 

How rapidly is the Philippines increasing in deaths?

 

Good news, Bad news: The wrap for the day

From the 590 cases, we are up to 862 cases today. But there’s a huge drop in “fresh cases” from 252 yesterday to just 16 today! 101 recoveries and seven deaths are publicly announced. 

Of the 16 “fresh cases,” only six are from the NCR, while the remaining 10 are from others.

Of the 338 “late cases,” 162 are from the NCR, 18 from Region VII, and 72 are other areas.

Of the 846 “late cases,” which formed the bulk, 238 are from NCR, 81 from Region VII (which makes it now more confusing because based on yesterday’s Data Drop, Region VII had apparently no more backlogs if you dissected the data), 235 are repatriates, and 292 are others.

This just demonstrates how and why you cannot be reporting backlogs by aliquots. When you find them today, they’re placed into a cut off, either before or after three days. Then all the data gets more confusing. Yesterday, the agency reported 18 “fresh” cases from Region VII and no “late cases.” The Data Drop was consistent; those 18 “fresh” cases from that region were all accounted for. So how did 81 late cases suddenly find their way today? Because if they were “late,” they should have appeared also yesterday. Which goes back to my point that all backlogs should be segregated and reported on a different point in time in the future. As in one big reveal with the caveat that all this added cases are actually “backlogs.” That way, no one, not even the data analyzers from the health agency will get confused on how to explain these discrepancies in classifying the “fresh” bloomers from the “late” ones. 

The finer details of all the report come in tomorrow at 10 A.M. as announced by the Department of Health. 

This brings the case fatality rate of the Philippines to its lowest of 5.26 percent and recovery rate much lower at 21.6 percent because of the higher number of cases.

 

The Philippines remains 39th in world ranking, with Indonesia in 33rd and Singapore in 26th spot. 

According to the Department of Health, based on the 12,466 active cases remaining as of May 30, 2020, 94 percent (11,713 cases) are mild and the remaining 5.5 percent (680 cases) are asymptomatic. Only 0.5 percent of the remain active patients are severe (55) or critical (18).

 

While this information on the clinical status of active cases is encouraging and hopeful, it does not answer the question why so many ICU beds and ventilators are in use, considering that the heading says that these are hospital beds and mechanical ventilators for COVID-19 (which may sound that they’re specifically dedicated to COVID-19 cases).

 

The last day of May is marred by more questions than answers in the way the reporting of fresh and stale cases. And the consistency in infographics and the information that is provided by the health agency. Perhaps, it is time to redo the way data is presented in a more consistent and accurate manner. 

 

The wrap for the week

 

Even with the 7 day moving average, the week ended with an upward trajectory for cases in the Philippines as we address the backlogs and the repatriates. Our average for the week of May 24 to 30 is up at 492/day. 

  • Total tests conducted from May 24 to 29 (date of latest report) was a total of 39,055 tests (or an average of 6,509 tests/day). 
  • The National Capital Region leads with a total of 10,864 cases. This is followed by Region VII with 2,119 total cases, Region IV-A with 1,712 total cases, Region III with 592 cases and repatriates with 579 total cases. 
  • Based on cities, Quezon City leads with 2,250 total cases, Cebu City with 1,699 cases, Manila with 1,227 cases, Makati with 691 cases and Mandaluyong with 671 total cases. 
  • Based on 17,137 data points (there are some data that are not available), 6.8 percent are children 0-19 years old. Senior citizens (60 years up) make up 20 percent of the cases. The bulk of the cases (73.2 percent) are from those 20 to 59 years old. 
  • The pediatric age group had a fatality rate of 2.9 percent (1.9 percent in those less than 9 years old and one percent for those between 10-19). At the other end of the spectrum are the senior citizens that had the highest fatality rate of 68.1 percent. 
  • There’s a new classification system that the Department of Health used to address the backlog data. Beginning Friday, the system used was to categorize patients into “fresh cases” vs. “late cases.” Fresh cases referred to test results released to patients within three days from testing. Late cases referred to test results released to patients > 4 days. While the health agency did that in order to address on how to treat backlog data, what was not addressed was the backlog reports on deaths and recoveries—especially the deaths. Death is the most vital measurement parameter in determining how well the government is addressing the pandemic. 
  • Among regions with more than 50 cases, Region 1 has the highest case fatality rate at 17 percent. Among cities with more than 50 cases, San Juan has the highest case fatality rate at 12 percent. 
  • There are no reported deaths in the repatriate group. While the city with more than 50 cases having the lowest case fatality rate is Cebu City at < 1 percent, in spite of having the second highest number of cases in the country.

It is a capital mistake to theorize before one has data. Insensibly, one begins to twist facts to suit theories, instead of theories to suit facts. – Sir Arthur Conan Doyle, Physician and Writer

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 reporting 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 12 days (with more than 50 percent being reported after eight days or more).

(2) Depending on where testing is done, RT-PCR test results take an average of 12 hours 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 30 days (based on Data Drop), probably due to an overwhelming number of tests being conducted when compared to private hospitals where fewer number of tests are performed.

 

Global statistics

Update as of 10PM 31 May 2020 (Sunday)

TOTAL CONFIRMED CASES: 6,175,099

TOTAL DEATHS: 371,228 (case fatality rate: 6.01 percent)

TOTAL RECOVERED: 2,744,481 (case recovery rate: 44.4 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 global statistics has officially crossed the six million mark today. With more recoveries now, of the six million plus cases, more than half (3,115,709) cases have already had an outcome. Eighty-eight percent have recovered while 12 percent died. The remaining 49.55 percent (3,059,390) of cases remain active. These are good numbers because they indicate that while the number of cases continue to increase (mostly due to testing), majority of them already had an outcome and the fatality rate is significantly lower now.

The global data shows that the average cases is treading the 125,000 limit.

 

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.

And while the daily new cases saw a surge, the number of deaths continue to decline globally. This is evident in the lower case fatality rate today and hovers now around six percent.

 

Daily deaths as of May 30, 2020
The United States of America continues to lead globally in the number of total confirmed cases at 1,816,897 with a case fatality rate (CFR) of 5.81 percent with 105,557 total deaths recorded. The recovery rate for the US is up at 29.5 percent. Among the states, New York leads with 378,951 total confirmed cases and 29,829 total deaths, and remain steady with a 7.87 percent case fatality rate (CFR). 

Brazil remains second with a CFR of 5.77 percent. Russia is in third with a CFR of 1.16 percent. India is in ninth spot with 182,490 total confirmed cases with a slightly lower CFR of 2.84 percent today. Turkey is in tenth with 163,103 cases and a CFR of 2.76 percent.

As several countries ramp up testing in various degrees, more new confirmed cases are being reported. With more testing and aggressive contact tracing, we are able to identify patients who may be asymptomatic or pre-symptomatic and are potentially infective to the vulnerable population. This explains why with more testing, we 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 further declined to 6.01 percent (from 6.07 percent yesterday). For the past two to three months, over 88 percent of patients are either asymptomatic or have mild disease and have recovered. 

Recoveries far outnumber the deaths with a ratio of approximately 7.4:1. (The ratio of recoveries continues to increase, and will reassuringly do so, over deaths because of increased testing and better minimum healthcare standards.)