A cyclist crosses the footbridge at the Congressional Avenue corner EDSA in Quezon City. For the third straight day, Metro Manila logs close to 2,000 new cases. Photo by George Calvelo, ABS-CBN News
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For the third straight day, Metro Manila reports close to 2,000 cases with latest tally of 1,824

Manila, QC, Mandaluyong, Navotas, Parañaque, and Las Piñas continue to lead the way for NCR. Also, our resident expert explains the difference between doubling time and ‘flattening the curve.’ BY BENJAMIN CO MD
ANCX | Jul 18 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. 


[Disclaimer: Whatever is written here is based on information released by the Department of Health at the time of publication. Whatever changes the DoH makes in their data later on…well that’s a different story in itself and as they say in their disclaimer: “the total cases reported may be subject to change as these numbers undergo constant cleaning and validation.”]

National Capital Region continues to haul in the cases this week with surges in number of positive cases.

The Health Agency announced 2,357 new confirmed cases from 76 out of 84 (90 percent) laboratories. This brings our total cases to 65,304. Of the 2,357 cases, 1,824 (77 percent) are from NCR. Three of the provinces rounding up the top five are in the Calabarzon (Region IVA) area: Laguna (108), Cavite (62), and Rizal (39). Cebu is in fourth with 49 reported cases.

Tomorrow we breakdown the cities in NCR that raked in the highest number of new confirmed cases.

The number of active cases is up from 39,593 to 41,464 as there are fewer recoveries compared to the overwhelming number of cases over the past days. There were 321 recoveries reported today, lowering our recovery rate to 33.8 percent. We also had 113 reported deaths, bringing our case fatality rate to 2.71 percent from 2.63 percent.

Of the 113 deaths reported today, 87 of them were from Region 7, 23 from NCR, one apiece from regions V, VI, and IVA. Forty of these deaths occurred in July, 58 in June, and 15 in May. 

Fifty-four duplicates were removed from the total case count, two of which were previously reported as recovered. 

There is no correlation between deaths and cases, or the number of cases and deaths being reported on the same day have no direct relationship with each other. Due to the lengthy clinical course of the disease, recoveries usually occur sooner while deaths will occur much later and reported four to eight weeks after they are reported as cases.

As of July 18, 2020, there are now 88 testing sites (66 RT-PCR and 22 GeneXpert laboratories) in the country. The Philippines has tested close to one percent of the total population as it registers 1,039,511 individual tests done. (As to how many are repeat tests from previous positive patients or new confirmed cases is not indicated.)

There is an interesting infographic provided by the Department of Health and is related to case doubling time and mortality doubling time. 

Case doubling time (otherwise known as the doubling rate) is defined as the number of days it takes for the number of cases, hospitalizations, or deaths to double. When doubling rates slow down (meaning you have a longer doubling rate), it implies that there is a flatter surge. This is not the same as “flattening the curve.”

The concept of doubling time is taken out of proportion in this case because of the time frame of events. In March 15, the Philippines had a total of 125 cases. The doubling time was around two days. The community quarantine was a useful measure in prolonging the doubling time; It slowed down the doubling time. But as the number of cases continue to increase, the doubling time will eventually become prolonged as well. What is not shown here in the infographic is that our doubling time actually was much better sometime in May, where we had >10 days doubling time. With more than 65,000 cases, a doubling time of 8.47 days is not good news. It needs to even be longer because anything shorter than this would be a national catastrophe. 

The doubling time concept should take into consideration the framework of the hospital or healthcare capacity of the regional epicenters instead of using the general healthcare capacity of the Philippines where it provides a diluted picture of how the hospitals, particularly NCR and region VII, are faring in the pandemic.

In the graph below, notice that after the Philippines crossed the “every 10 days” mark, we still continued to take an upward trajectory in terms of new cases and reported deaths.

To illustrate, I will use Malaysia as a comparator for the concept of doubling time. In the graph below, both the Philippines and Malaysia have similar trajectories at the beginning of the pandemic. Notice how they separate from each other as early as 30 days since the 100th confirmed case. The Philippines continues its upward trajectory instead of plateauing, or better yet, bending the curve downward.

The same trend is seen with cases in deaths. In the graph below, Malaysia actually had more deaths reported early on in the pandemic. Before 20 days since the fifth total confirmed death, the Philippines overtook the number of deaths of Malaysia. And while “graphically” our doubling rate for deaths is >10 days, we are still on an upward trajectory with the latent reports coming in.

So that everyone is on the same page—including the people who use various statistical measures in the guise of rationalizing easing up quarantine measures— let me reiterate that doubling times are mathematical jargon aimed at guiding policymakers in producing a smaller, flatter surge. It serves as only one measure on how we are doing at containing the pandemic. That would mean that in order to maintain the trajectory of staying “flat,” the intervention should be over a longer period of time.

Extensive preparation should have been taken into consideration at the time of the implementation of various mitigation measures in order to assure that there is no continued increase in the number of cases. People need to be given necessities to control the spread of the disease. Masks should have been provided for free. Testing and contact tracing should have been done much earlier. 

What are we watching for? The peak of the curve. That peak is important to determine because it is the inflection point when coronavirus cases and deaths begin steadily decreasing day after day. But even that can be elusive if people change their behavior. Old habits, after all, are difficult to break. And that is apparent as the economy begins to open up.


The data yesterday

As of July 16, 2020, with 79 out of 85 laboratories reporting, there are now 1,012,911 individuals who have been tested for SARS-CoV-2 by RT-PCR. The cumulative positivity rate (total number of positive patients since testing began during the pandemic) is up at 8.3 percent (a steady rise of 0.1 percent daily). 

Of 26,161 samples tested in 24,916 individuals tested, there were 2,683 positive results. So far, this is the highest number of samples tested in any given day in the Philippines. The daily positivity rate is now at 11.4 percent.

Data for Region VII showed 1,874 samples tested in 1,785 individuals tested from its three testing centers revealed 298 positive results. An increase in the daily positivity rate from 13.9 percent yesterday to 16.7 percent today, but still lower than their cumulative positivity rate of 21 percent.

Of the 1,841 new confirmed cases yesterday more than 60 percent (1,107) were from NCR. For the past days, NCR has been seeing four digit numbers. And today, with 1,824 cases, is no exception. 

Only MIMAROPA had no reported cases yesterday. Based on region, NCR had 1,107 cases, followed by Region VII with 261, Region IVA with 176, Region VI with 64, BARMM with 60, and Region X with 44 cases.

The 1,107 cases from NCR were from the following cities with more than 40 cases: Manila (441), Quezon City (140), Mandaluyong (96), Navotas (86), Parañaque (60), and Las Piñas (47). Other cities with double digit cases but less than 40 were Caloocan (36), Makati (32), Malabon (33), Muntinlupa (35), Pasig (22), Pasay (28), and Taguig (27).

Single digits were reported from Marikina (5), San Juan (1), Pateros (1), Valenzuela (9), and eight unknown (no tagged location).

Region VII registered 261 new cases yesterday with 87 from Cebu City, 63 from Cebu Province, 74 from Lapu-Lapu, 36 from Mandaue, and one from Bohol. 

Region IVA ranked third yesterday with 176 total cases. They are distributed as follows Cavite (54), Laguna (82), Rizal (22), Batangas (7), Lucena (1), and Quezon (3). Seven additional had unknown locations. 

Region VI came in fourth with 64 total cases. Negros Occidental had 37 cases followed by Guimaras with 13, Iloilo Province with 10 and Iloilo City with two, and Bacolod City with two. 

The surprise of the day rounding up the top five regions is BARMM, which reported a total of 60 cases yesterday. Fifty nine of the 60 cases were from Maguindanao. One case was from Basilan. 

While Region XI had only 25 cases compared to the 49 the previous day, more than half (14) of these cases were from Davao City alone.


The world

We have finally surpassed the 14 million mark as predicted and with 245,702 new cases overnight (seven-day average of 221,171/day) and 6,509 new deaths (seven-day average of 5,194/day).

The next million is predicted in the next four days based on the seven-day moving average. 

The global case fatality rate is lower at 4.22 percent and recovery rate up at 59.7 percent. 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.

With another record high of 74,987 cases yesterday, the United States now has over 3.77 million total cases. They recorded 946 deaths yesterday. Top three states contributing to yesterday’s haul were Florida (+11,466), California (+9,608), and Texas (+9,496).

Brazil stays in second spot with 2,048,697 total cases and continues to report the highest death cases in the world with 1,110 deaths overnight. 

India had 34,820 new cases overnight for a total of 1,040,457 cases. 

With 13,373 cases reported overnight, South Africa stays in sixth spot but is set to overtake Peru overnight for the fifth place.

Top 10 countries that had the highest new cases overnight were:

  • USA – 74,987
  • India – 34,820
  • Brazil – 33,959
  • South Africa – 13,373
  • Colombia – 8,934
  • Russia – 6,406
  • Mexico – 6,406
  • Argentina – 4,518
  • Peru – 3,951
  • Bangladesh – 199,357

The Philippine overtakes Belgium for the 32nd spot in the world, while Indonesia overtakes China for the 25th place.

Closely being monitored is Japan as it has a jump in the daily cases with a seven-day average now of 393 cases.

Based on the recent WHO data for the Western Pacific Region, the Philippines remains number one in terms of total confirmed new cases as of July 16, 2020 followed by Japan, Australia, and Singapore.

It will be quite a while before we all get out of this pandemic. We have no choice but to adjust to the virus, because the virus will definitely not adjust to us.