Rapid testing is conducted at a private clinic in Quezon City. NCR had many cases falling under “for validation,” or “unknown” yesterday. Photo by Fernando G. Sepe Jr., ABS-CBN News

70 percent of Metro Manila’s cases yesterday were either unknown or not validated

It was one of the worst days of reporting for NCR yesterday as 272 out of 391 cases yesterday were either not validated or were unknown. Data that is clear and accurate is needed for the government to create evidence-based policies, emphasizes our resident expert. BY BENJAMIN CO MD
ANCX | Jun 29 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 29, 2020, 8 P.M.

At the 4 o’clock habit of the Health Agency, there are 985 new confirmed cases: 643 fresh and 432 late (65:35 ratio, worse than yesterday’s 75:25 ratio). 

The surprise of the day? For the first time, the “others” haul in the most number of cases—531 total (314 fresh and 217 late)—for a total of 54 percent. National Capital Region follows in second with 319 cases (223 early, 96 late) and Region VII with 135 cases (106 fresh and 29 late). The decrease in cases in Region VII is likely attributable to the fewer tests being done in the region.

Of the 11 reported deaths, eight of them died in June. The death rate continues its downward trend at 3.44 percent while the recovery rate is at 27.32 percent. This is a minuscule improvement from yesterday’s 27.3 percent recovery rate considering that most of our cases are mild and asymptomatic, and the rest of the world averages more than 50 percent recovery rate. The poor recovery rate is mainly driven by overwhelmingly more cases than recoveries being noted by the Health Agency.

According to Department of Health (DoH) data, of the remaining 24,525 active cases, 99.4 percent of them are mild (23,451 or 95.6 percent) or asymptomatic (922 or 3.8 percent). One added case of severe and one critical case are added today.

Photo 4

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. While the Health Agency does not explain what proxy variables it chose to arrive at this extrapolation, we hope that they are weak variables.


The day before

Of yesterday’s 653 cases, almost 60 percent (391) of the newly confirmed cases came from NCR, which also reported six deaths. Region VII reported 131 new cases with one death. Region IVA was in third with 31 cases and one death. A total of 29 repatriates were included in yesterday’s count. Fifteen of the 653 had no tagged residence or region. 

The “others” that reported double digits were Region IX (+11) and Region X (+10).

It was one of the worst days for reporting for NCR as 272 (70 percent) of the 391 cases yesterday fell under the category “for validation” or “unknown.”

This was worse than the previous day’s 46 percent cases under the category “For Validation/Unknown.”

Yesterday’s highest documented positive cases were from Pasig (+26), followed by Manila (+20) and 10 each for Caloocan and Quezon City. 

The other cities with single digit cases were Makati and Valenzuela (+8), Malabon (+7), Parañaque (+5), four cases each for Pasay and Taguig; two cases each for Muntinlupa and Navotas; while Las Piñas and Marikina had one case each. Two cities had no cases reported, San Juan and Pateros. 

Six deaths were reported in NCR. The other day, all six deaths with locations came from a single city, Malabon. Yesterday, four deaths were from Malabon while one death each was reported from Quezon City and Taguig.

Region VII reported 131 cases with one death yesterday. 

Among those with tagged locations, Cebu City had 72 (with 1 death), Cebu Province had 31, Mandaue with 10, Lapu-Lapu with nine, and Bohol with three cases.

Region IVA had the third highest number of cases with a total of 31. Cavite led the haul with seven cases, followed by Rizal with four, and Laguna with eight. Twelve of the remaining cases are “unknown.” The lone death in Region IVA was from Cavite. 

Region IX had 11 cases with eight of them “unknown,” while three were from Zamboanga Del Norte. 

Region X reported 10 cases with four of them “unknown,” three from Lanao del Norte, two from Misamis Occidental, and one from Cagayan de Oro.

These formed the majority of the “others” yesterday.

In terms of testing capacity, we are now close to 700,000 tests with over 13,000 tests in 12,147 individuals were reported on June 27, 2020. Sadly, of the 63 testing laboratories, only 49 submitted reports on June 27. Surprisingly, after logging into the COVID19 Tracker website today, the Research Institute for Tropical Medicine had “reported” test results last June 26, 2020.

The positivity rate for June 26, 2020 is higher at 10.14 percent compared to the previous day positive rate of 7.8 percent. The cumulative average is seven percent. 

Based on the report of RITM, they had 163 positives out of 1,718 tests done last June 26. On June 27, 2020, 189 out of 1,348 patients tested positive. While the cumulative average of RITM is at nine percent, their daily rates increased from 9.5 percent last June 26 to 14 percent on June 27, 2020.

There is an increasing trend for higher daily positive rates in areas with high transmission rates and cases. 

VSMMC (Vicente Sotto Memorial Medical Center) exemplifies this point. The cumulative positive rate is 20.6 percent (up from 20.2 percent). However, its daily rate is an astounding 47 percent, or almost one out of every two patients tested are positive. Notice in the graph below that there are significantly fewer tests being done recently than the period April 28 to May 10. With more than 73,000 remaining available tests, one cannot but wonder why only 336 samples were tested on June 27 at VSMMC considering that Allegiant has not provided any test reports three days in a row.

As of today, there are 53 licensed RT-PCR laboratories and 19 licensed Gene-Expert Labs accredited to do confirmatory testing in the Philippines, bringing the total of testing laboratories to 72. And while the government can boast of more laboratories being accredited, there are also more laboratories that are not testing or testing less or not submitting any data on time. 

With more laboratories able to test, why are the number of tests being done daily still not reaching the 30,000 to 50,000 daily test targets of the government?

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 cumulative positive rates. Of the 63 accredited testing centers in the country, only 49 submitted data last June 27. That’s 14 laboratories out of the 63 (22 percent) that have no reports submitted. 

This is observed in the summary of the testing facilities that have >10 percent positivity rates. On June 27, 2020, Allegiant and Singapore Diagnostics have no reports submitted based on the DoH COVID19 tracker. While Lung Center of the Philippines Gene Expert and National Kidney and Transplant Institute submitted reports, Lung Center Gene Expert did not test anyone and reported 0 percent daily positive rate while NKTI performed 33 tests in 33 individuals and none of them tested positive (0 percent daily positive rate). 

The following testing facilities had a >10 percent cumulative average positivity rate. Those highlighted are the ones with increase positive rates overnight. However, one is cautioned in the interpretation of cumulative averages. It simply means these are the total positives since the start of operation of the facility and not the daily positive rate for the facility.

All data are cumulative average of positive tests.

Using the same list above on facilities with >10 percent cumulative positive rates, highlighted in red are those with increased daily positive rates compared to their cumulative average.

CA – cumulative average; DA – daily average.

The pandemic in the Philippines was seen the first quarter of the year. Three cases. One death. All foreigners. 

With 2,000 testing kits at our disposal, and the way we initially handled the problem, we were ripe for the spread of the virus. 

The second quarter showed us the resilience and tenacity of the virus. While stringent measures were implemented, not everyone followed regulations. The difference in social status in highly dense urbanized populations propagated the transmission to the lower socioeconomic class. And no matter which social class we belong, our behavior will find difficulty in changing during these trying times. 

The government needs to direct its efforts at evidence-based policies with programs that make people responsible and accountable for their actions. Partnering with them in decision-making for every action done is more effective than punitive measures for every misstep. After all, we all did not ask to be part of this pandemic, but this pandemic will be part of us until we learn to destroy its very source of energy—transmission.

Government needs to acknowledge gaps and lapses which are obvious. Sometimes, it takes humility to defeat an unknown enemy. Time and again, we are reminded how deadly a mix politics and health is. The earlier we recognize how chaotic the plans and outcomes are, the earlier we can rebuild our lives from this pandemic. 

The third quarter is the final test on how we do as a people.

[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

After the 10 million cases and 500,000 deaths mark, dreadful as it may sound, the next record to break is 20 million cases and 1,000,000 deaths. The question is when? 

There were 160,000 more cases added today. The past two weeks, the global data has been hovering at more than 150,000 cases daily. If this trend remains constant for the next four weeks, we would see one million cases almost every week. Or 10 million cases in the next 10 weeks. 

The deaths have significantly declined overnight, but that’s a very volatile figure because of the various swings in the data from continent to continent, and the resurgence of the virus in areas that have once seen a vast decline in cases. 

The global case fatality rate is now at 4.92 percent (lower than yesterday’s 4.97 percent) with a recovery rate of 54.23 percent.

More than six million are closed cases with 92 percent recoveries and eight percent deaths. While the fatality may seem low in terms of percentage, in reality the numbers are staggering. Unlike other disease outbreaks in the past years, some countries have just started their pandemic while others who have seen a drastic decline are encountering a new upsurge. 

The United States surged with the highest number of cases in the world overnight (+40,540) bringing their total count to past 2.63 million. At the rate it is reporting confirmed cases, the US is set to breach a record high of 3M cases in one week.

The top three states that contributed to the cases overnight were Florida (+8.530), California (+5,240), and Texas (+4,330). The death rate in the US is lower today at 4.87 percent, and lower than the global average fatality rate. 

Top 10 countries with most cases yesterday were USA (+40,540), Brazil (+29,313), India (+19,620), Russia (+6,791), South Africa (+6,334), Mexico (+4.410), Pakistan (+4,072), Saudi Arabia (+3.989), and Bangladesh (+3,809).

The top 10 countries in the world contribute to two-thirds with close to 6.8 million reported cases. 

The Philippines stays at 38th in the world in number of cases of coronavirus. 

Based on infection density (infection based on the population of the country), Qatar remains to have the highest infection density with 33,337 cases per million population. Oman displaces Singapore for the 10th spot with 7,668 cases/million people. 

With the Philippines averaging almost 800 cases/day in the last week, we move up from 109 to 107th spot in terms of infection density with 330 cases/million population. 

For every death, there are 11 recoveries.