Metro Manila, Central Visayas still struggling to fend off COVID-19

Warren de Guzman and Edson Guido, ABS-CBN Data Analytics

Posted at Jun 26 2020 09:26 PM | Updated as of Jun 26 2020 11:01 PM

Members of the PNP-SAF prepare to board the BRP Gabriela Silang at the Eva Macapagal Terminal in Manila on June 25, 2020. George Calvelo, ABS-CBN News

MANILA -- Most of the new COVID-19 cases being found daily in the Philippines are now centered in two regions: the National Capital Region (NCR) and Region 7 or Central Visayas. NCR is pandemic ground zero in the Philippines. Many of the cities in the capital region, including San Juan, were hit hard very early in the year. Quezon City and Manila, meanwhile, remain hotspots for COVID-19 to this day. Central Visayas, meanwhile, has emerged as a new hotspot, including metropolitan Cebu City.

Data suggest the two regions are on divergent paths, with the NCR showing some signs of improvement, and Region 7 headed in the opposite direction.

Understanding the numbers will be key for decision-makers, as there are many claims circulating to downplay COVID-19 test findings.

Senator Sonny Angara is one advocate for more testing, tracing and data use. He told ABS-CBN News: “According to some experts, the increases in NCR are because of increased testing while those in Region 7 are new cases, not a result of increased testing. In either case, there is still a need to change people's behavior and habits--wearing masks, observing distancing, and in the case of Region 7, improving testing and contact-tracing given the rising numbers, and given the fact that hospitals have reached the warning levels set by the health department. These could be some of the reasons for President Rodrigo R. Duterte sending Secretary Roy Cimatu to see these things are done.”

Former adviser to the National Coronavirus Task Force on COVID-19, Dr. Tony Leachon, said the numbers mean one thing: the government needs to beef up its anti-COVID efforts. "We can’t fight too many battles given our finite resources. There’s a blueprint that Region 7 can use based on our first 100 days experience."

Leachon, however, said NCR isn’t out of the woods either. “The numbers speak of continued viral transmission--surges. We must prepare for a second wave for NCR. The cases are still rising due to the number of tests but the LGUs should step up to the plate to contain the viral transmission as we reopen the economy. Real time and granular data are needed for agile and appropriate response”

What do the numbers show? Let’s take a look.

This chart shows the number of individuals tested as of latest data on June 24. NCR is shown in blue while Region 7 is shown in orange. Without looking at any numbers, we know immediately that NCR labs are conducting much more tests compared to those in Region 7. Blue dominates both the bar graphs, showing the daily totals, and the line graphs, showing the moving 7-day average of daily testing. This is important as more testing provides more accurate information, which leads to more accurate monitoring of the virus. 

More testing can lead to more positive test results. In this chart tracking the number of positive cases reported daily by labs, NCR is again represented in blue, while Region 7 is represented in orange. Important to note, the cases were geographically tagged using the location of the labs they were processed in. Note that while NCR testing is by far more extensive compared to Region 7 testing, positive test results out of Central Visayas are substantial, particularly in the month of June. Despite less testing in Region 7, more individuals are testing positive there. Both the orange bars and line graphs, representing daily tests reported and the 7-day moving average figure prominently in the chart. 

But paying closer attention to the line graphs of both NCR and Region 7, we find another difference. Positive results reported by labs in NCR are on a steep uptrend over the last week. Region 7 positive cases are on a very slight downtrend in the same time frame. These could both be attributed to testing numbers that were explained earlier. Either way, we do not observe any clear signs to indicate COVID-19 is going away in either locale in the near future.

To better measure daily testing and daily reported positive cases, we can look at the positivity rate of both regions. This rate measures how many individuals test positive, relative to the total individuals tested. Again, blue reflects NCR and orange reflects Region 7. Orange dominates the chart. The orange 7-day moving average line graph shows the positivity rate in Central Visayas is going up, even hitting the 30% level. This means some 30 individuals test positive for every 100 individuals tested. The NCR, meanwhile, has remained steady at below 10%. For much of June, it has stayed at around 7%, meaning 7 out of ever 100 individuals tested are positive for COVID. 

The World Health Organization says a positivity rate of 5%, maintained over 2 weeks, would be a clear indicator of a slowdown in the disease’s spread. We do not yet see that in either NCR or Region 7. But the results tell us NCR is in a better place compared to Central Visayas, despite a wider COVID-19 testing operation.

There is also data available as of June 25 on critical care capacity in NCR and Central Visayas, as shown in this chart measuring intensive care unit (ICU) bed occupancy and ventilator utilization. These ICU beds and ventilators are dedicated for COVID-19 patients only. For ICU bed occupancy, NCR is shown in dark blue while Region 7 is shown in orange. For portions of the chart, Central Visayas has a higher occupancy rate, at above 50%. This means there are more COVID-19 patients in ICU beds then there are vacancies. In fact, this situation is only observed in Region 7 among all regions in the Philippines. NCR’s occupancy rate meanwhile is below 50%. This means NCR healthcare facilities have ICUs that are better equipped to handle more COVID-19 patients, if the need arises.

Looking at the ventilator utilization graphs, NCR is shown in light blue while Region 7 is shown in yellow. NCR’s ventilator usage is very low, at below 30%. Central Visayas has spikes above 50%. This means there are times when patients outnumber vacant ventilators. 

This chart differentiates critical care capacity in the province of Cebu and Cebu City. Keep in mind, the Cebu province data include Cebu City, while Cebu City’s numbers are exclusively from the city itself. ICU bed occupancy in Cebu, shown in dark green, is high at above 50%. ICU bed occupancy in Cebu City, shown in dark red, is even higher. This means both areas have more critical COVID-19 patients than vacant ICU beds.

The Department of Health is eyeing both Cebu Province and Cebu City carefully. For Cebu City, it has 716 total beds for COVID-19 patients, with 551 occupied and only 165 vacant as of June 25. That is a 77% occupancy rate, which is the definition of DOH’s ‘danger zone classification. For Cebu as a whole, 848 out of 1,264 total beds are occupied with only 416 vacant. That is an occupancy rate of 67%, very close to the 70% threshold for ‘danger zone classification.’

In terms of ventilator use, Cebu is shown in light green, while Cebu City is shown in pink. Cebu has a rate higher than 50% and it spikes above that threshold several times in June. Ventilator use in Cebu City mirrors the line of Cebu province. This means both areas have more COVID-19 patients than vacant ventilators and these are signs more such machines are needed.

These two regions are different, but they are both significant to the national economy. NCR is the economic capital of the Philippines with a nearly 14 million strong population. Region 7 is home to Cebu City, which is a key economic hub as well, and it has a sizable, albeit smaller population of about 8 million. The numbers tell us the two are having different levels of success across different indicators in the fight to contain the virus. But both remain as hotspots in the ongoing pandemic.

The government will certainly look into these numbers in the coming days as President Rodrigo Duterte will decide on either extending, lowering, or raising current quarantine conditions.