Both severe and critically-ill cases rose in the country. Photo by George Calvelo, ABS-CBN News
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Both severe and critical COVID cases have gone up significantly overnight

Severe and critically-ill COVID cases—those in the ICU and those that need intubation, respectively—rose today. It would be helpful if we knew where this sudden surge is coming from, says our resident expert. BY BENJAMIN CO MD
ANCX | Jun 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. 


Data as of June 24, 2020, 8 P.M.

A relatively quiet day? 

With 470 new confirmed cases, the National Capital Region takes back the crown from Region VII with 225 cases (159 fresh and 66 late) today. Region VII reports 145 cases (141 fresh and 4 late). The “others” total exactly 100 cases (57 fresh and 43 late). 

Tomorrow, we dissect the “others” and see where they are coming from.

Of the 18 reported deaths today, 14 of them occurred in June. The other four are latent cases. Our death rate remains at 3.73 percent and our recovery rate is up from 26.52 percent yesterday to 26.8 percent today. 

We remain in 39th rank today. At the rate our cases are coming in, it should not be a surprise that we overtake Poland for the 38th place soon.

According to the Department of Health data, of the remaining 22,197 active cases, 99.4 percent of them are mild (21,362 or 96.2 percent) or asymptomatic (710 or 3.2 percent). The numbers for severe and critical have gone up significantly. They report 102 cases today (from 67 yesterday) while the critically ill are also up at 23 (from 18 yesterday). It would be helpful if we knew where this sudden surge in severe and critically ill patients are coming from.

The graph on deaths by date of death had some data with proxy. Proxy in data analytics and machine learning may pose discrimination and bias in the outcome of the data. Choosing proxy variables is subjective and while the health agency does not explain what proxy variables it chose to arrive at this extrapolation, hopefully, they are weak variables.


The day before

Let’s dissect yesterday’s 1,150 cases.

Remember the wastebasket cases I referred to yesterday as “others?” 

Among them are 276 (~25 percent) cases “for validation.” The Health Agency used to report the repatriates separately. Now they belong to the “others” and 60 (or 5.2 percent) repatriates were included yesterday. Region III (+14), Region IVA (+39), Region XI (+27), BARMM (+12), Region VI (+11), and a sprinkling of cases from other regions. 

NCR had 378 cases (not 317 as reported initially in yesterday’s 4PM report), and Region VII had 320 cases. In short, NCR hauled in the bulk of the 1,150 cases yesterday. 

Of the nine deaths yesterday, seven were from NCR while two were from Region III (1 from Bataan and 1 from Tarlac City).

Of the 378 cases in the NCR, note that a whopping 198 (52.4 percent) are unknown. And if you look at the trend in the past days, the story has always been the same—more unknowns and for validations even in the city level. These are patients that are tagged as NCR cases (based on region), yet when it is broken down to the specific city or province in that region, they have no specific location! Amazing!

Among those with the highest cases are Quezon City (+50), Manila (+36), Makati (+14), Taguig and Caloocan (+13 each), Valenzuela (+12), Malabon (+10), Navotas (+8), Pasay (+7), Mandaluyong (+5), three each for Marikina and Muntinlupa, two each for Parañaque and Pasig, and one apiece for Las Piñas and San Juan. Only Pateros had no case yesterday. 

Of the seven deaths in NCR, two came from Las Piñas, two from Pasig and one each from Manila, Parañaque, and Quezon City.

Region VII had in reality, the second highest cases to NCR yesterday at 320 total cases – Cebu City with 160, Cebu Province 81, and Mandaue with 57 cases. Lapu-Lapu City had 15 cases, Bohol with five and Negros Oriental with two. 

Note how different the reports from the provinces are from NCR. They have few to almost no unknowns. Because the reports are coming in from the LGUs, it seems there’s really a problem in the reporting from the LGUs in NCR.

Region IVA reported the third highest cases per region with 39 cases distributed as follows: Rizal (+20), Cavite (+9), Laguna (+3), Batangas (+1), and unknown (+6). 

In terms of testing, we are now at over 617,000 tests with over 11,000 tests done overnight. The positivity rate for June 22, 2020 is at up at 8.7 percent. It was 6.35 percent the day before. 

According to the website of the DoH Covid19 Tracker, the positivity rate of 6.9 percent in the website is the cumulative average of all the positives based on the number of individuals tested from the beginning of time. Reporting based on cumulative average does not provide a clear picture of the daily positivity rate and would advise the reader to discern the positive rate by scrolling over the last bar of the histogram in order to see the positive cases divided by the total number of individuals tested for the day.

As of today, there are now 48 licensed RT-PCR laboratories and 17 licensed Gene-Expert Labs accredited to do confirmatory testing in the Philippines.

The results vary according to the facility and below is the list of the facilities with > 10 percent positivity rate. Those highlighted in yellow show the highest positive rates. Note that all the testing facilities in Region VII show not only >10 percent positivity rates but a continuous increase in positive rates daily. While the positivity rate at Dr. Jose N. Rodriguez Memorial Hospital has slightly declined, Caloocan remains one of the higher number of cases in NCR. 

The data you see below are the cumulative average of positive cases based on testing sites since the time these facilities became operational. Notice that the positivity rates decline in certain areas but tend to remain high in regions where there are reportedly more cases. 

If you compare the cumulative average for positive rate to the daily positive rate for the same hospitals above, see how different the rates look when placed side by side. 

For example, when you look at Dr. Jose N. Rodriguez Memorial Hospital, the cumulative average (CA) positive rate is 41.8 percent when in reality it now has dropped to 40 percent for the same date June 22, 2020. Tondo Medical Center for example has an increase in the CA positive rate from 20.6 percent to 20.7 percent percent in a day. But in reality that’s because on June 22, the positive rate for the day was up at 22.2 percent. Another final example would be the testing facilities in Cebu like Cebu TB reference lab, VSMMC and Allegiant Regional Care Hospital. Notice their minimal increase overnight when you use cumulative data. Cebu TB reference increases from 19.2 to 19.5 percent. VSMMC increases from 18.9 to 19.1 percent. Allegiant increases from 16.3 to 17.4 percent. But in reality, on June 22, 2020, Cebu TB reference lab had 36.12 percent positives, VSMMC had 41 percent positives, and Allegiant had 31.25 percent positives—pushing their cumulative slightly up—but these daily positive rates actually account for the higher cases in Region 7. 

The same is true when you dissect the data for NCR. As a matter of fact, if you look at the data for some places like St. Lukes Bonifacio Global City, its cumulative average is only 8.5 percent. On June 22, it had 40 positives out of 127 tests done (based on the DoH website). A positive average of 31.5 percent for the day.

CA – cumulative average; DA – daily average.

I have always said, with no offense to my colleagues who also take a deep dive into the data analytics, that we need to present data truthfully, no matter how painful some information may be. Window dressing using several statistical tools at our disposal is not helpful. After all, the tools are only there to help us analyze the data. How we use them in order to arrive at the kind of information we share and make policies from is a different story altogether. We need to choose consistent, coherent and reliable parameters for the public and other government officials to understand what the pandemic is about, the challenges we face, and how to make practical and doable policies that are targeted at addressing these issues.

The health agency should kick the 4 o’clock habit of dredging the halfwit data and making us guess at the surprise(s) that await us tomorrow. Clean it. Validate it. Drench it if you must. But release the data when you have more clarity on what happened during the day. Providing a disclaimer that they are still subject to changes overnight (as what we have seen in the data yesterday and analyzed today) is discombobulating and give people a migraine in trying to make heads or tails over the good news and the bad news.

After over 100 days of lockdown, we’re mature enough to take whatever information the health agency will provide. 

As long as it is consistently correct. Like I said before, it is time to call a spade a spade.

[Disclaimer: All data are verified based on the Data Drop of the Department of Health. All information used in the analysis are from the Health Agency’s data drop site.]


The world

The unpredictability of the coronavirus is evident in the seven-day average of cases we’re seeing, and with more than 165,000 cases overnight our race to the 10 million mark has accelerated. 

Death rates are up at over 5,000 overnight once more. This brings the total deaths globally to over 480,000 before half the year is over. 

For both cases and death, the world is on track to meet the 10 million cases and 500,000 deaths at the close of the 2nd quarter. 

Closed cases are at more than 5.54 million with 91 percent recoveries and nine percent resulting in fatal outcomes.

China does not provide much information except for the recent reported cases in Beijing, its capital. And while WorldOMeters reports a sprinkling of cases only from China probably due to unavailability of verifiable information, The New York Times provides a more accurate number of cases in China. The last count of China after the Wuhan re-opening was 83,418 cases. Based on more reliable information, as of today, China has 90,147 total cases (with 4,634 deaths or 5.14 percent fatality rate). 

It’s an important reminder that the sheer volume of cases makes the number of deaths worrisome and a cause for concern by all governments. Because if we have 10,000,000 cases by end of June and 5 percent deaths from them, 500,000 lives would have been lost to a virus. This makes this one of the deadliest diseases in history where 0.5 million deaths occurred in just half a year. 

The United States continues its increase in numbers with various states shifting tides and California bringing the highest rise in cases (+6,503) followed by Texas (+5,370), and Arizona (+3,593). 

The shocker of the day? Brazil had the highest number of cases in the world in a single day—with 40,131 new confirmed cases (and 1,364 deaths overnight). This comes after reporting over 55,000 cases in a single day last June 19. Brazil now has a case fatality rate of 4.58 percent with 52,771 deaths in 1.15 million cases. 

The United States of America still has the highest death toll with an additional 863 deaths yesterday. They now have >123,000 deaths in over 2.42M cases (CFR = 5.1 percent).

Top 10 countries with most cases yesterday were: Brazil (+40,131), USA (+36,015), India (+15,665), Russia (+7,425), Mexico (+4,577), South Africa (+4,518), Pakistan (+3,946), Chile (+3,804), Bangladesh (+3.412), and Peru (+3,363).

These top 10 countries total more than 6.2 million cases, contributing to 2/3 (66.14 percent) of the world’s total cases, with the least number of cases now at more than 200,000 per nation.

Based on infection density (infection based on the population of the country), Qatar remains to have the highest infection density with 31,630 cases per million population. Bahrain moves up to third place with 14,052 cases/million. Kuwait also moves up to sixth place (from seventh), and Singapore takes back its position in eighth place with 7,343 cases/million. USA is now in 10th spot with 7,132 cases/million. 

With more cases reported in other parts of the world overnight than the Philippines, the Philippines moves down from 95th to 109th with an infection density of around 300 cases/million. However, note that the infection density will vary from city to towns and municipalities within the country. 

The global case fatality rate is lower at 5.12 percent with recovery rates up at 54 percent. For every death, there are approximately 10.54 recoveries.