A health worker at the Ospital ng Sampaloc. The PH COVID fatality rate goes down after more than 150 new COVID deaths. Photo by Jeff Canoy, ABS-BN News
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159 new deaths bring the COVID fatality rate of the Philippines even higher

The bulk of these new deaths are from Region VII, NCR, and Calabarzon. Our active COVID cases—now more than 80,000—also keep on going up, while our recovery rate continues to go down. BY BENJAMIN CO MD
BENJAMIN CO MD | Aug 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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[Disclaimer: Whatever is written here is based on 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 and as they say in their disclaimer: “the total cases reported may be subject to change as these numbers undergo constant cleaning and validation.”]

The Health Agency reports 4,351 confirmed cases from 96 of 103 laboratories (93 percent submission) today. This brings the total cases to 157,918. The seven-day average is now around 4,400 cases/day. And we’re only 15 days into August.

Of the cases reported today, 80 percent (3,469) were between August 2 to 15, 2020. The rest were backlogs all the way back from March 2020. July still had backlogs amounting to over 600 cases. 

National Capital Region (NCR) contributed to 56.5 percent of today’s numbers with 2,460 cases (79 percent of which are recent while the remaining 21 percent as backlogs). Laguna, Cavite, Cebu (is back), and Rizal, round up the remaining top five. 

Ninety three cases were removed from the total for no reason at all.

Of the total active cases, the patients that are severe and critical are at 1.5 percent. And that’s a fairly large number (more than 1,200) considering that over 83,000 cases are still active. 

Based on “date of onset of illness” of the 4,315 cases today, 3,469 were between August 2 to 15 (80 percent). 

NCR and Region IVA accounted for a large chunk of the backlog. If we remove the backlog data for these areas, NCR has 1,952 cases and Calabarzon 566 from August 2 to August 15. 

“Of the 4,351 cases reported today, 3,568 (82 percent) do not have information on date of onset of illness, 289 do not have information on date of specimen collection, while 269 do not have information on both.” (And yet their report is based on date of onset of illness! Go figure!)

“In cases where date of onset of illness is missing, the date of specimen collection (minus three days) was used as proxy. In cases where both date of onset of illness and date of specimen collection are missing, the report date (minus nine days) were used as proxy.”

With the total active cases now surpassing 80,000, even the 885 recoveries could not bring the recovery rate up with the more than 4,000 reported cases the recovery rate is at 45.7 percent. Ten of the reported recoveries were duplicates and removed from the list of recoveries. 

The news of the day are the deaths. There are 159 reported deaths today, bringing up the total deaths to 2,600 and the case fatality rate rises from 1.59 percent to 1.65 percent. 

Of the 159 deaths, 71 were from Region VII, 61 from NCR, 16 from Calabarzon, four from Bicol Region, two each from Central Luzon and Zamboanga, and one death each from Regions I, XII and BARMM.

Fifty-seven of the deaths occurred this month while close to two-thirds occurred between April and July. 

Incidentally, one case that was previously tagged as a death was validated to be alive, while 71 cases that were previously tagged as recoveries on validation were removed from the list. [Did that mean they died? And that accounted for the higher number of deaths today?]

Testing data for August 14, reported on August 15 shows now 107 licensed testing facilities (80 RT-PCR and 27 GeneXpert) in the country. So far, we have tested 1,857,942 individuals (1.7 percent of the population). With our cumulative positivity rate now at 10.2 percent, this means that we’re still not testing enough, and there are more cases out there that are left undetected. 

 

The data yesterday

As of August 13, 2020, 1,845,957 individuals had been tested. There were 3,618 positives among 28,790 individuals tested yesterday from an 86 percent submission rate, with a daily positive rate down at 12.6 percent (previous of 13.7 percent). However, the cumulative positive rate remains at 10.2 percent. This will likely move up by 0.1 percent daily or every other day. Both the daily and cumulative positivity rates need to decline (in spite of more testing). When it is less than five percent, it should stay that way for two weeks before we can see any relief from the increasing cases in the country.

Centering on the remaining two epicenters—NCR and Calabarzon—the table below shows that based on the test results from the facilities in these regions, the bulk of positive cases come from Metro Manila. 

Note the daily positive rate versus the cumulative rates. Of the close to one million individuals tested in the country, close to 60 percent are from NCR alone. With 40 testing facilities (PCR and GeneXpert) in the capital region, test results still come in five to seven days late in most of the facilities. More than 16,000 to 20,000 individuals are tested in NCR daily. Its cumulative and daily positivity rate are higher than the national average and is the driver of the increasing daily and cumulative positivity rates in the Philippines. Close to 8 to 9 percent of the people in NCR have undergone PCR testing. With numbers still this high, the epicenter is undoubtedly in the various cities in Mega Manila.

With 6,216 cases reported yesterday, 62 percent were from NCR. This would be disastrous if NCR breaches more than three fourths of the total cases in the country daily. 

Of the 3,848 cases reported from NCR, 3,044 (79 percent) were up-to-date (with the past 14 days). The remaining were backlogs, with majority from the month of July. 

More than 82 percent reported were up to date while the remaining 18 percent were backlogs. The backlogs were mainly within the interval from July 1 to 30, and majority belonged to NCR and Region VII.

NCR leaped from 81,000 total cases since the start of the pandemic to 85,615 cases overnight. In second is Region IVA with more than 20,000 cases, followed by Region VII with 18,208 cases, Region III with 4,802 and Region VI with 2,648. 

Total for unidentified cases was 4,955 as of yesterday. 

Top five regions for August 14, 2020 were NCR, Calabarzon, Central Visayas, Western Visayas and Central Visayas in that order. While Region VII is still in the top five, it registered only 87 cases. 

There were more repatriates (278) and unknown individuals on a regional level (127) than the cases from Region VII. To date, 7,053 repatriates have tested positive for coronavirus and are likely drivers of increasing cases we are seeing in the country.

With the announcement of the Department of Labor and Employment on more Overseas Filipino Workers (OFWs) returning home in droves, I am not sure what the capacity of the country is at addressing the mandatory testing and quarantine period upon their return and how the government intends to assist them in case their clinical conditions turn for the worse while in quarantine.

In the meantime, here is a general overview of the pandemic in the country. Only Region VII has a seven-day average growth rate below one percent and has a doubling time now of almost three months. The rest of the regions have significantly high growth rates, with the highest belonging to Region VI at 6.46 percent and the shortest doubling time of 10 days.

 

The unknown

There were 409 unknowns (6.7 percent) with no tagged location on various levels: 127 no known region, 90 with no known province (53 from Central Luzon and 37 from Calabarzon). The rest were unknowns from the level of city/municipality. The majority in the latter category is as usual, NCR, with no tagged location in 166.

 

The known

Close to 62 percent of the total cases yesterday were from NCR. Of the 3,848 cases there were 166 with no tagged location (4.3 percent). 

Fifteen cities reported triple digits with two cities reporting more than 500 cases: Quezon City (816) and Manila (513). 

The rest of the cities with more than 100 but less than 500 cases were: Caloocan, Makati, Pasay, Pasig, Taguig, Parañaque, Valenzuela, Muntinlupa, San Juan, Las Piñas, Mandaluyong, and Navotas. 

Cities with double digits and more than 50 cases were the remaining: Marikina, Pateros and Malabon.

Among the remaining four top regions, the following provinces had the highest cases in the respective region were: Laguna with 302 cases for Region IVA, Bulacan with 178 cases for Region III, Negros Occidental with 59 cases for Region VI, and Cebu with 74 cases for Region VII.

Laguna, Rizal, Cavite, and Batangas reported triple digits in Region IVA with a total of over 1,000 cases overnight. There were 37 cases with no tagged location on a provincial level. 

Twenty-six cities/municipalities reported double digits with Antipolo, Calamba and Cabuyao reporting more than 50 cases per city. On a city/municipality level, there were 54 unknown cases. 

A total of 107 cities/municipalities reported at least one case in the region.

Region III was third yesterday with unidentified individuals leading the pack. There were 61 that no known location among the 311 reported. 

For those with city/municipality tagged locations, many cities in Bulacan lead the haul with double digits.

Region VI is in fourth with a little more than 100 cases. Bacolod and Iloilo City reported double digits while the rest of the 44 cities and municipalities that reported a case were single digits. 

There was one case with no known tagged location on this level.

Region VII had less than 100 cases yesterday and continued on the downward trend as evidenced in the 0.77 percent growth rate of cases in the region. Cebu City and Mandaue reported double digits but had less than 25 cases each.

The seven-day average for cases are up at 4,415 cases/day while deaths are at 39 deaths/day (which I am highly skeptical is an underestimate of the real situation for COVID deaths in the country). As the Health Agency announces that it is ready to release more recoveries over the weekend, the true count on fatalities will be something that will change the way the pandemic is enfolding in the country. And that is data that is expected to come out soon as well.

The over-all number of active cases have jumped in a span of two weeks. From 22,286 on July 30 to 79,813 on August 14 or a total of 57,527 new active cases for the period. And that shows the likely potential of the virus to spread widely in the community.

 

The world

With more than 288,000 cases yesterday, and close to 7,000 deaths, the world has breached its next million. As of this writing, there are now 21,072,125 coronavirus cases. Majority of the world’s cases are from the Americas (North and South America) being the major drivers to the pool of cases in the world. 

As of yesterday, the Americas trump the overall number of cases in the world with more than 11 million cases. Among the regions classified by the World Health Organization the least number of cases is the Western Pacific Region, where the Philippines belongs. Of the close to 400,000 cases in the WPR, 39 percent (up from 37.9 percent the previous day) is owned by the Philippines alone.

The global case fatality rate remains at 3.59 percent and recoveries a bit up at 66 percent. [Recovery rates are not very reliable indicators because they are subjective based on the country’s definition of how and when they consider patients “recovered.” There are some countries also that do not count recoveries like the U.K and Denmark. Death rates on the other hand, while more definitive of outcomes take a longer time to report and validate.]

Data from WorldOMeters.info.

The United States closes in the 5.5 million cases mark with California, Texas and Florida reporting the top three cases yesterday. The US reported the highest deaths in the world yesterday with 1,120. 

Brazil remained in second with more than three million cases and a little less than 50,000 new confirmed cases. 

India continues to report the most number of cases in the world with more than 65,000 cases yesterday, pushing their total past the 2.5 million mark.

Top 10 countries contributing to the pool of cases yesterday were:

  • India – 65,609
  • USA – 60,600
  • Brazil – 49,274
  • Colombia – 11,306
  • Peru – 8,300
  • Mexico – 7,371
  • Argentina – 6,365
  • South Africa – 6,275
  • Philippines – 6,216
  • Russia – 5,065

The numbers don’t seem to be abating anytime soon. Together with the rainy season in Southeast Asia, particular in areas that are at the typhoon belt, flooding and filled evacuation centers will be the challenge to the government as we now cross the path of the perfect storm.