COVID-19 data dive: Victories and alarm bells

Warren de Guzman and Edson Guido, ABS-CBN News

Posted at Jul 30 2020 03:41 AM

The government continues to insist it is winning the fight against COVID-19. It has cited the death rate and the positivity rate as its basis. The ABS-CBN Data Analytics Team finds the data isn’t exactly in their favor. 

President Rodrigo Duterte, in his 5th State of the Nation Address (SONA), appeared confident in the government’s handling of the pandemic and did not discuss any details of plans to get the COVID-19 virus under control so the Philippine economy might begin its recovery. 

Senator Imee Marcos later defended the President’s SONA, saying hammering out the details is the job of the economic team and legislation. 

Spokesperson Harry Roque also noted three pre-SONA forums were held to discuss the details of the plans, which include anti-corruption, tax reform, infrastructure spending, food security, improved social support systems, and of course, the improvement of the Philippine’s healthcare system including its testing, quarantine, and critical care capabilities. 

During one of the pre-SONA forums, Health Secretary Francisco Duque infamously declared the Philippines had flattened the COVID-19 curve since April. He later clarified his statement, saying the curve was bent, given improving case and mortality doubling time. 

Later, Roque used the word "plateauing" for the COVID-19 outbreak. Most recently, the Health department claimed the positivity rate had improved drastically from April levels, using figures it later clarified as incorrect. 

But the government isn’t the only one saying the Philippines is doing well in the fight against COVID-19. 

A post by global activist and civil society leader Nicanor Perlas decries the alarmist views of some in government and the media. 

An excerpt from a recent blog he wrote reads “We keep talking about infected people instead of test-positive people. The high numbers remain in memory, and that creates fear.” 

Perlas agrees with Malacanang that the death rate is the most important statistic, and it is not going up. He also argues the rising number of test positive individuals should not be alarming because the majority of these are in age groups whose death rates are practically zero. 

He even argues the testing equipment and methodologies used to detect COVID-19 may not even be as foolproof or trustworthy as the government makes them out to be. 

Perlas’s article reads “Nobel Prize winner Kary Mullis, the inventor of the PCR, the core bases of the RT-CPR tests used all over, warned repeatedly that his invention should not be used for diagnosis of viral disease. It is prone to large mistakes.” Perlas, in fact, believes normalcy is just around the corner.

It is true that all of the data the government and the media has on COVID-19 comes from testing. 

The merits of RT-PCR, rapid antibody testing and other methods of diagnosing and detecting COVID-19 have been discussed extensively.

Government chose to use a combination of testing methodologies to expand its testing capacity. International media company Reuters, meanwhile, fact checked the quote of PCR inventor Mullis, determining it to be false and taken out of context. 

The quote was actually from a different man altogether, John Lauristen, who was discussing the use of PCR in HIV and AIDS diagnosis. 

The Reuters article reads “PCR is intended to identify substances qualitatively, but by its very nature is unsuited for estimating numbers. Although there is a common misimpression that the viral load tests actually count the number of viruses in the blood, these tests cannot detect free, infectious viruses at all; they can only detect proteins that are believed, in some cases wrongly, to be unique to HIV. The tests can detect genetic sequences of viruses, but not viruses themselves.” 

FATALITY RATE

Now let’s look at the data. Let’s start with deaths.

This chart shows the case fatality rate in the Philippines, meaning the number of confirmed COVID-19 cases that result in death. 

As of July 29, the case fatality rate of the Philippines is at 2.3%, lower compared to previous months. It is also lower than the global average of around 4%. In this sense, the government and Perlas are correct in saying things have improved. 

However, the Philippine fatality rate is still the second highest in Southeast Asia. The Philippines’s total fatalities are also the second highest in the region. Only Indonesia has a worse COVID-19 death toll and fatality rate. 

Considering Indonesia was criticized as ‘slow’ to lockdown while the Philippines is still under one of the longest, if not the longest COVID-19 lockdown in the world, the result becomes less impressive. 

This is a case bulletin from the Department of Health (DOH). 113 COVID-19 deaths were reported by this bulletin on July 18. But the breakdown shows most of the deaths reported actually happened at an earlier time, with 58 occurring in June, and 15 happening in May. 

If this many new deaths are going to be reported late on a regular basis through August and even September, the Philippine case fatality rate could actually look much different compared to what we see now. 

In other words, while the fatality rate is indeed going down, the late manner in which the DOH reports deaths compromises that accuracy of the data. More information is needed to determine if deaths are indeed going down. 

Late reports on COVID-19 related deaths were actually used by the DOH as justification for a spike in deaths on its press release last June 14. 

The DOH said in its report that "deaths have actually been decreasing" and "the recent increase has been due to late reports." 

However with now updated data, we find there were actually 32 deaths reported on June 14th, nearly double the 7-day moving average of 17. Using late reports as an excuse to explain away a spike in the trend can actually be used in the same way to challenge the current downtrend. 

The DOH has to do a better job of reporting COVID-19 related deaths in a timely manner, otherwise the time series and trends observed using the current data cannot be seen as reliable. 

POSITIVITY RATE

This chart looks at the positivity rate, with the daily rates shown by the orange bar graphs, and the 7-day moving average shown by the blue line. 

The positivity rate compares the number of positive cases against the total number of individuals tested. If testing goes up, the positivity rate should go down, as long as less COVID-19 cases are found. However, the positivity rate continues to increase even with daily testing finally exceeding 30,000 last July 23. 

The cumulative positivity rate as of July 27 has risen to 9.0% from 6.9% in mid-June. If more people are testing positive, outpacing the increase in tests, it could only mean there is more transmission and infection happening on the ground. 

The World Health Organization (WHO) says a true flattening of the COVID-19 curve would require a positivity rate of 5% or lower for 2 weeks. The Philippines is not yet there, and is in fact headed in the wrong direction with a positivity rate of nearly 12% over the past two weeks.

BACKLOGS

This chart is another measure of the DOH’s data collection efficiency. With daily testing hitting 30,000 per day, data collection has become a huge task. Testing backlogs refer to samples drawn from patients that have not yet been fully processed. 

There is also that matter of confirming each test result. On July 27, the total backlogs in testing hit 10,248. That is a huge number, which the DOH blamed on expanded testing, overwhelmed laboratories, and limited supplies, among others. 

The number of new cases being reported each day has averaged nearly 2,000 over the last few days. This can be higher once testing backlogs are eliminated.

Another effect of backlogs, a growing disparity between positive tests and confirmed cases. As of July 27, laboratories have reported a total of 116,758 positive tests. But total positive cases, confirmed, were only at 82,040. 

The difference can be attributed to the backlog in case validation, as well as repeated tests on certain individuals. While the two are apples and oranges and will never be equal, the disparity needs to be smaller for the existing DOH data to be more timely and accurate.

HEALTHCARE CAPACITY

Healthcare capacity is another key in the fight against COVID-19. We’ve delved into the monitoring of intensive care unit (ICU) beds dedicated to COVID-19 patients in several articles.


 As of July 26, DOH reported that ICU bed utilization or occupancy rate for the Philippines is at the warning zone. 
 
 NCR and Region IV-A, the two regions with the biggest contribution to the Philippine economy, reached the danger zone, both at 73%. 
 
The Health department also tracks severe and critical cases of COVID-19. Oddly, these are lower than ICU bed occupancy rates. The DOH says this is because suspect and probable cases with severe or critical conditions also utilize these beds. 
 
 This is another demonstration of how the data collected doesn’t match with conditions on the ground. Could there be more suspect and probable cases with severe conditions that were not classified properly due to backlogs? 

HOSPITAL BED OCCUPANCY

This chart shows us three kinds of bed occupancy, ICU in red, isolation in orange, and ward beds in grey. All three appear to be on an upward trend in the National Capital Region. 

Ward and isolation bed occupancy is much higher compared to ICU beds in the region. We see there is a steeper incline for ward and isolation as well compared to ICU beds in recent weeks. 

One of the possible reasons for this is that the current strain of the virus is more infectious and slightly less virulent. 

We should also note that some of these patients may have chosen to stay in either isolation or regular wards, or have been forced to stay hospitalized, due to a lack of other options. There are multiple reports of communities rejecting positive COVID-19 patients.

There are some victories, and there are some alarm bells. The death rate is going down, but the positivity rate and bed occupancy rates on multiple levels are going up. 

The DOH has also shown its data collection efficiency is suffering because of expanded and more aggressive testing. Regardless of how people view the data collected, it is not wrong to remain cautious as the virus is clearly still present in the Philippines. 

If the forecast of many is correct, and COVID-19 will become a part of the roster of diseases the Philippines has to deal with on a regular basis, like dengue or the flu, the most important goal would be to improve the Philippines’ capacity to live with the virus. 

Investing in the healthcare system, and enforcing health and safety standards go a long way in achieving that while a vaccine is not yet available. In the meantime, it is important to continue to look at these data points, not for signs of impending doom, but for signs of improving healthcare and decreasing transmission. COVID-19 has knocked all of us down. 

Now we have to get off the mat and collectively fight for our health and livelihoods.