Iloilo has the third highest number of cases reported today. Photo from Iloilo Human Resource on Facebook
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With 86 reported, Iloilo had the third highest COVID cases tallied among PH provinces

NCR continues to lead with 708 cases followed by Cebu with 198. Overall, we had 1,392 today, bringing our overall total to just over 1,000 shy of 60,000. BY BENJAMIN CO MD
ANCX | Jul 15 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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Let me start off with a disclaimer, as the Health Agency would do. Whatever is written here is based on the information released by the Department of Health (DoH) at the time of publication. Whatever changes DoH makes in their data later on, well, that’s a different story in itself. As they say in their disclaimer that “the total cases reported may be subject to change as these numbers undergo constant cleaning and validation.”

As of the 4 PM report, there were an additional 1,392 new confirmed cases from 73 out of 82 laboratories (89 percent submission rate). The Philippines now has a total of 58,850 cases. National Capital Region (NCR) led with 708 new cases, followed by Cebu with 198, Iloilo with 86, and two provinces in Region IVA—Laguna with 64 and Cavite with 46 cases.

The number of active cases significantly now up from 35,483 to 36,260. There are 11 new deaths reported today (5 occurred in July with 6 in June). Of these deaths, eight were from NCR, one from Region III, one from Region IVA, and one from Region IX.

The case fatality rate is lower at 2.74 percent (from 2.79 percent), but the recovery rate is up a bit at 35.64 percent from a previous 35.6 percent with 517 recoveries reported. 

According to the case bulletin, as of July 13, 2020, there are 85 testing sites (63 RT-PCR and 22 GeneXpert laboratories) in the country. A total of 964,850 total individual tests have been done. And there is no breakdown on the total tests done provided.

However, on the COVID-19 tracker, there is data for the previous day.

On July 13, 2020 at 4PM, the Department of Health (DoH) announced an additional 634 new confirmed cases based on test results from 65 out of 82 (79.3 percent) laboratories. However, in the COVID tracker of the Health Agency, as of July 12, in 76 of 81 testing laboratories (93.8 percent), there were 17,859 samples tested (a significant drop in the last two day from more than 20,000 tests per day last week). A total of 2,257 positive results from 16,694 individuals drove the daily positive rate up to 13.5 percent from 12.4 percent yesterday. The cumulative positive rate is also up at 8 percent (a rise in 0.1 percent daily).

[There is a breakdown of the cases reported today but I will separate that because the reporting has become so complicated and confusing that I will wait for any changes overnight before reporting the breakdown of the day.]

Of the 634 new confirmed cases yesterday afternoon, 57 percent (360) were from the National Capital Region alone. The other contributors included Regions IVA (111 cases), VII (32 cases), III (31 cases), VIII (21 cases) and XI (21 cases). 

All cities in the NCR have at least one reported case. The top five cities yesterday were: Pasay (49), Quezon City (46), Taguig (42), Makati (37), and Parañaque (35). 

Other cities with double digits included: Manila (28), Pasig (25), Valenzuela (21), Mandaluyong (16), Caloocan (15), Las Piñas (14), and Muntinlupa (13).

Those with single digits were: Malabon (8), Navotas (4), Marikina (3), San Juan (2), and one for Pateros. There is one case with not tagged location.

Region IVA ranked second for the second straight day in yesterday’s report with 111 cases. The majority came from Laguna (58) followed by Cavite (21), Batangas (19), Rizal (10) and Quezon (3). 

The other cities with the highest reports for yesterday were Cebu City (22), Cagayan de Oro (19); San Pedro, Laguna (18); Davao City (16) and Biñan, Laguna (12). 

One of the facilities with the highest number of tests done daily is the Research Institute for Tropical Medicine. It also serves as the Reference Laboratory for RT-PCR testing in the Philippines. As of July 13, 2020, of 1,263 samples tested in 836 individuals, 252 tested positive – for a daily positive rate of 30 percent. In the graph below, there are two distinct events. The first is the lower number of tests done in the last two days compared to the previous days. The second, and most alarming is the very high daily positive rate (30 percent). The last time it had a very high daily positive rate was seen on April 22, 2020 with 339 positives out of 1,039 individuals tested. The past two weeks saw a general and up and down swing, indicative of a rise in positive cases.

Our seven-day average for new cases and deaths? Based on July 14, 2020 data, 1,369 new cases a day and 42 deaths per day. With 16 days left in July, are we flattening the curve?

The concept of flattening the curve basically looks at the “shape” of the curve. The dotted line in the graph below shows the health care capacity of, say, a nation. When the curve is a steep one, the spread of the infection is exponential. A steep rise that exceeds the maximum health care capacity results in overloading and burdening a health system that has limited or finite resources (e.g., ICU beds, ventilators, PPEs, etc) and eventual exhaustion and depletion of the healthcare manpower.

At the start of the pandemic, we went through the exercise of an enhanced community quarantine. Come to think of it, while the government relaxed the quarantine, NCR and various other regions remain in some form of lockdown. The longest in the world. 

The precautions—physical distancing, wearing masks, hand washing, avoiding crowds and public facilities—including the lockdowns were meant to “flatten” the curve.

In medical parlance, “flattening the curve refers to community isolation measures to keep the daily number of disease cases at a manageable level for medical providers.”

If the curve is steep, the there is a rapid rise in cases and the number of days it takes to achieve the highest number (considering the population of the city/region/country) is short. These interventions therefore aim at (1) slowing the acceleration of cases, and (2) reducing the peak number of cases and related demands on hospitals and infrastructure.

And so we go back to the basic question. Is the Philippines flattening the curve?

In order to say we’re actually flattening the curve, the two criteria mentioned above should be met. 

The number of cases continue to go up. As a matter of fact, while we were able to slow it down during the ECQ, the relaxing phase was partially responsible for the increase in cases because our testing capacity was sadly very late. Even up to today, we are unable to reach the 30,000 to 50,000 target number of tests per day. And our isolation and quarantine facilities were not used early on. A lot of things that we could and should have done during the early stages of the pandemic would have not come to this point.

While the case fatality rate shows that we’re probably not doing too bad, the data is erratic. The graph below shows the up and down swings in the death reports of the Philippines.

The second parameter is the healthcare capacity. 

As a general outlook, bed occupancy and number of hospitals in the “safe” zone look good.

However, when broken down to the major locations where the epicenters are—NCR and Cebu City—note how overwhelmed these places are. Definitely posing a demand on the healthcare of these financial hubs in the country.

These answer the question of whether we’re actually flattening the curve. It depends on how you’re looking at the glass, half empty or half full.

 

The world

The number of cases in the world reported yesterday is up again with 194,690 new confirmed cases and the seven-day average is now at 211,162 new confirmed cases per day. Which means that in three days, the world is set to cross the 14 million mark. Total deaths last night was slightly up with 3,944 deaths and the 7-day average is up at 4,965 deaths per day. 

The global case fatality rate is lower at 4.32 percent and recovery rate a bit up at 58.4 percent due to record high number of cases over the past week. Recovery rates are not very reliable indicators because they are subjective to the country’s definition of how and when they consider patients “recovered.”

Data from WorldOMeters.info.

The United States has quickly passed the 3.5 million mark with 65,594 new confirmed cases. A breaking record of 935 deaths were reported yesterday. Top three states contributing to yesterday’s haul were Texas (+11,060), California (+9,561), and Florida (+9,194). 

The case fatality rate in the US is now at 3.92 percent with 3,546,278 cases as of this report. 

Brazil stays in second spot with more than 1.9 million cases and continues to report the highest death cases in the world with 1,340 deaths overnight. Brazil is set to approach the next million milestone in two days. 

South Africa had more than 10,000 cases reported overnight, overtaking the United Kingdom for the ninth spot.

Top ten countries that had the highest new cases overnight were:

  • USA – 65,594
  • Brazil – 43,245
  • India – 29,842
  • Russia – 6,248
  • Colombia – 5,621
  • Mexico – 4,685
  • Peru – 3,744
  • Argentina – 3,645
  • Bangladesh – 3,163

The Philippines remains in overall 33rd place in total number of cases in the world, second to Indonesia in Southeast Asia, and first in the Western Pacific Region based on the World Health Organization.