PH tops ASEAN countries with most number of COVID-19 cases; possible underreported recoveries: data experts

Kristine Sabillo, ABS-CBN News

Posted at Apr 15 2020 12:32 PM | Updated as of Apr 15 2020 03:40 PM

MANILA — The Philippines has surpassed Malaysia this week as the Southeast Asian country with the most number of cumulative coronavirus disease (COVID-19) cases. 

As of April 14, 7 p.m., the Johns Hopkins University (JHU) coronavirus dashboard recorded 5,223 COVID-19 cases in the Philippines compared to Malaysia’s 4,987.

Data from Johns Hopkins University. Graph from ABS-CBN Data Analytics Team

Like Malaysia, Indonesia has also breached the 4,000-mark at 4,839 cumulative COVID-19 cases.

Following the top 3 countries are Singapore (2,918 cases), Thailand (2,613), Vietnam (266), Brunei (136), Cambodia (122), Burma/Myanmar (63) and Laos (19).

In terms of fatalities, Indonesia has the largest number of deaths at 459, followed by the Philippines with 335 as of Tuesday evening. 

Other countries with double-digit COVID-19 fatalities are Malaysia with 82 and Thailand with 41. 

While the public has complained of the inadequate testing in the Philippines, which might not reflect the true numbers of COVID-19 cases in the country, the number of unique individuals tested are almost at par with our neighbor countries.

Based on data compiled by the ABS-CBN Data Analytics Team, the Philippines has tested more than 35,000 unique individuals by April 12, Malaysia tested more than 81,000 by April 13, Indonesia with more than 27,000 by April 13 and Singapore with more than 47,000 by April 7.

The Philippine government has started implementing “enhanced testing” measures in a bid to reach 8,000 to 10,000 tests daily by end of April.

In terms of population, Indonesia has the most number of people at around 270 million. At a far second is the Philippines with 100 million, followed by Vietnam with more than 95 million, Thailand with 67 million and Myanmar with 53 million. 

UNDERREPORTED RECOVERIES

Despite having the most number of cumulative COVID-19 cases, the Philippines has only recorded 295 recovered patients.

This is extremely low compared to Malaysia’s 2,478 recoveries and Thailand’s 1,405 recoveries. It is even lower than Singapore’s 586 recoveries and Indonesia’s 429 recovered patients.

“Most countries in the ASEAN have significantly higher recoveries than deaths except for Indonesia and Philippines,” ABS-CBN Data Analytics Head Edson Guido said. 

“However, recent data show that recoveries are surging in the country as 138 recoveries were reported in the last 3 days alone,” he said. Recoveries in the Philippines has reached a record-high for the last 3 days.

Data from Department of Health. Graph from ABS-CBN Data Analytics

On Tuesday afternoon, the Philippine Department of Health said it has finally included those who recovered from home quarantine in their figures of recoveries. For the last two months, they have been only counting those who were confined and discharged by hospitals.

Dr. Elvira de Lara-Tuprio, who served as the lead for mathematical disease modeling for the government’s FASSSTER project, pointed out that the Philippines has “a lot more recovered patients than what is being reported in the news.”

“It's just a matter of updating the database of confirmed cases,” the Ateneo de Manila mathematics professor said, supporting the DOH’s earlier statements that it has yet to include home quarantine patients in the recoveries count.

The Feasibility Analysis of Syndromic Surveillance using Spatio-Temporal Epidemiological Modeler or FASSSTER is a government-funded online tool that is being used for disease modelling for COVID-19. It involves experts from the government and the academe.

Dr. Regina E. Estuar, who is the project lead of FASSSTER and also a professor at the Ateneo de Manila University, said the challenge of the Philippine government now is to get a regular submission of reports by health facilities.

The DOH has earlier explained that it has been getting paper forms with incomplete data from hospitals, slowing down their data encoding process. For the last weeks, the health department had been able to release information on the location and hospitals of the new cases. This was addressed during the Holy Week as the DOH promised to address their backlog data.

DIFFICULT TO COMPARE

The World Health Organization said the case number for each country “doesn't really tell the entire story.”

“It is difficult to compare the number of cases across countries,” said Dr. Socorro Escalante, acting WHO Representative for the Philippines in a message to ABS-CBN News. 

“The number of reported cases for any infectious disease will depend on several factors, including the sensitivity of the surveillance systems, case definitions, and testing strategies.”

She said the same can be said for the reported deaths. 

“There are many factors that contribute to severity and more deaths, including the prevalence of underlying health conditions and access to healthcare, and these differ between countries,” she explained.

Escalante said a more accurate number of the recoveries will also require “close follow up of the clinical course of all the cases that are admitted in the hospital and those that recovered at home and isolation centers.”

Based on the WHO dashboard, of the 6 countries in Southeast Asia with the most number of confirmed cases, 5 recorded their first COVID-19 case back in January. Only Indonesia, which now ranks 3rd in the list, had its first confirmed case in March.

Cambodia, which has 122 cases, recorded its first case in January 27 but the remaining three countries of Brunei, Myanmar and Laos all had their first confirmed case in March. 

What happened before and after their first confirmed case will likely be different for each country.

COMMUNITY TRANSMISSION

The US-based think tank, The Stimson Center, wrote back in March that the response of some Southeast Asian nations to the COVID-19 pandemic was initially delayed.

The group said member states of the Association of Southeast Asian Nations (Asean) reacted quickly at the start.

“Thailand, Singapore, and many other countries responded swiftly by establishing screening, contact tracing, and quarantine protocols for suspected cases. Vietnam’s government and many individual airlines halted flights from China, but most ASEAN members merely applied screening for travelers,” a commentary by Stimson research analyst Courtney Weatherby read.

Weatherby pointed out that the situation changed in mid-March as cases surged. She cited community transmission linked to sports events and entertainment venues in Bangkok and large-scale religious gatherings in Malaysia.

“Charted out, the rapid rise in cases in Indonesia, Malaysia, the Philippines, and Thailand starting in mid-March indicate a shift in trajectory from a slow and manageable rise in cases towards a more serious outbreak,” she said.

Weatherby said “the delay of widespread local infection reflects the limited success of the region’s initial approach, but Thailand and its ASEAN neighbors are now facing a much more complex challenge as they belatedly endorse social isolation and containment efforts in a bid to slow the spread.” 

“Only time will tell if this late response will be enough to flatten the curve and curb a more serious outbreak,” she added.

Around mid-March, the Philippines imposed a lockdown first in Metro Manila and then the whole of Luzon to hamper the spread of COVID-19. Institutions have yet to release new models and projections on the new estimated peak of COVID-19 in the Philippines. Experts are hoping that the social distancing measures would be enough to “flatten the curve” or slow down the spread of the virus in the country and in return lower the number of potentially infected citizens.

NEED FOR DETAILED REPORTS

Looking ahead, Estuar said DOH must provide more information “to have a more accurate picture” of the situation.

“The numbers that we see published, especially those that deal with comparison across countries, do not reflect the local or country-based efforts,” she pointed out.

She also explained that while the numbers can be used as baseline for analysis and projections, “it has to be assumed that they are underreported and that increase or decrease in reported numbers may be due to factors related to efficiency in submission of reports.”

Estuar said there will also be "better estimates" if "testing facilities report the number of positives over the total population tested per day."

She said the confirmed positive cases should also be broken down to the categories of mild, severe and critical, in addition to the number of recoveries and deaths.

There is no information yet on how exactly COVID-19 spread in the Philippines. The first three cases were Chinese nationals but most of the patients now are Filipinos. The DOH earlier discussed the use of gene sequencing to determine the source of the virus but the results have not been released to the public.

With most countries focused on containing the spread of the virus, Filipinos are now more concerned on whether the enhanced community lockdown has indeed been able to help flatten the curve. 

As Weatherby said, only time can tell for now.