June opens with the Philippines’ lowest COVID-19 death rate so far 2
The COVID-19 death rate of the Philippines has fallen despite having an influx of fresh and late cases. Photo by George Calvelo, ABS-CBN News
Culture

June opens with the Philippines’ lowest COVID-19 death rate so far

PH cases today are 552, whether fresh or stale, a distinction that our resident expert points out the world doesn't care about. Despite the flow of backlogged numbers, the case fatality rate of the country has gone down to 5.15 percent.  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. 

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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.

June opens with the Philippines’ lowest COVID-19 death rate so far 3

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

The figure above shows the actual graph recorded daily since 5 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 same data set. (Please refer to the figure below on the daily new conformed deaths.)

June opens with the Philippines’ lowest COVID-19 death rate so far 4

Daily new confirmed COVID-19 deaths (Philippines)

June opens with the Philippines’ lowest COVID-19 death rate so far 5

Daily new confirmed COVID-19 cases (Philippines)

June opens with the Philippines’ lowest COVID-19 death rate so far 6

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 30, 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 3.84 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).

 

Good news, Bad news: The wrap for the day

From the 862 cases we are down to 552 cases today. But there’s a huge rise in “fresh cases” from 16 yesterday to 119 cases today! Seventy recoveries and three deaths are publicly announced. 

Of the 119 “fresh cases,” 94 came from the NCR , one from Region VII, 20 from other areas, and four repatriates. 

Of the 433 “late cases” that formed the bulk of the total, 137 are from NCR, 98 from Region VII, 182 from other areas, and 16 repatriates. 

In whatever manner we report the “fresh” or “late” cases, let’s make it clear to whoever came up with this idea, the global data records all these as events that were reported today. There is no preferential lane for the Philippines for “fresh” and “late” cases. 

The bottomline is, we had a total of 552 new confirmed cases today. Period. Publicly announcing which are “fresh” or stale in the manner it is presented does not change the fact that there are more new confirmed cases in the past days and do not add informative data to the confusing way it is being presented. 

Reporting backlogs in health should be avoided. Not only is it useless because it provides no added value to the information being shared, but just rubs in the unsolved challenges of an overwhelmed health agency.

Today’s total brings the case fatality rate of the Philippines to its lowest of 5.15 percent and recovery rate much lower at 21.35 percent due to the higher number of total cases.

June opens with the Philippines’ lowest COVID-19 death rate so far 7
June opens with the Philippines’ lowest COVID-19 death rate so far 8

According to the Department of Health, based on the 13,220 active cases remaining as of May 31, 2020, 94 percent (12,285 cases) are mild. The remaining 6.5 percent (859 cases) are asymptomatic. Only 0.5 percent of the remain active patients are severe (57) or critical (19).

June opens with the Philippines’ lowest COVID-19 death rate so far 9

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).

June opens with the Philippines’ lowest COVID-19 death rate so far 10

The first day of June is still marred by disorientation in the way of reporting of fresh and stale cases. The consistency in infographics and the information that is provided by the health agency has a lot of room for improvement. It is time to redo the way data is presented in a more consistent and accurate manner. 

 

Testing capacity

June opens with the Philippines’ lowest COVID-19 death rate so far 11

Based on the DoH website, the current dashboard is under construction as they migrate to the COVID Kaya system. Until then, we will have to depend on the daily pronouncements of the Department of Health. As to when full migration would be completed is anyone’s guess. The last time they announced it, was a week ago. 

In the meantime, the DoH has announced that there are officially 38 licensed RT-PCR laboratories in the country. And while there are more applying to be accredited, I can only hope that all these laboratories have good quality control and that we have the capacity to conduct proficiency testing in all these laboratories in the country.

All these equipment will need proper after sales maintenance and good proficiency testing to make sure that there are no false positives because of contamination of the specimens. It would be disastrous if we were getting false positive results in batches due to contamination.

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As of May 30, 2020, we have had a total of 347,592 total tests conducted or 3,176 tests/million population.

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 9PM 01 June (Monday)

TOTAL CONFIRMED CASES: 6,282,383

TOTAL DEATHS: 374,233 (case fatality rate: 5.96 percent)

TOTAL RECOVERED: 2,854,430 (case recovery rate: 45.4 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. With more recoveries now, of the six million plus cases, more than half (3,228,663) cases have already had an outcome. Eighty-eight percent recovered while 12 percent died. The remaining 48.6 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 generally lower now.

The global data shows that the average cases is still between 100,000 to 125,000 a day.

June opens with the Philippines’ lowest COVID-19 death rate so far 13

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 at < six percent. The total daily deaths recorded overnight was one of the lowest at 3,191 over the last week. 

Photo 12

Daily deaths as of May 30, 2020

The United States of America continues to lead globally in the number of total confirmed cases at 1,837, 170 with a case fatality rate (CFR) of 5.78 percent with 106,195 total deaths recorded. The recovery rate for the US is up at 32.7 percent with close to 600,000 cases having recovered. Among the states, New York leads with 379,902 total confirmed cases and 29,918 total deaths, and remain steady with a 7.87 percent case fatality rate (CFR). 

Brazil remains second with a CFR of 5.69 percent with 514,992 total cases. Russia is in third with a CFR of 1.17 percent and total cases of 414,878. India jumps to 7th spot, overtaking France and Germany, with 191,041 total confirmed cases with a slightly lower CFR of 2.83 percent today. Peru displaces Turkey for the 10th place with 164,476 total cases and a CFR of 2.74 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. 

There are multiple factors that determine how outcomes of pandemics play out. Policy responses include school and workplace closures, cancellation of public events and gatherings, restrictions on public gatherings, public information campaigns, stay-at-home restrictions, international and domestic travel (public transport, restrictions on internal movement and international travel controls), and last but not the least, testing and contact tracing. 

Testing is useful only if the results come out early. It allows early and aggressive contact tracing and isolation of those that are positive or exposed to positive individuals. I cannot overemphasize that latent test results are useless in epidemics except for the statistical recording of data.

The median average of case fatality rates worldwide has further declined to 5.96 percent (from 6.01 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 7.62:1. (The ratio of recoveries continues to increase, and will reassuringly do so, over deaths because of increased testing and better minimum healthcare standards.)