MANILA - It is the last month of 2020, a year that will forever be synonymous with the virus COVID-19. The whole year has been spent improving the Philippine healthcare system’s ability to combat the global pandemic. That includes increasing testing capability, and beefing up hospital and healthcare capacity. The latest data from the month of November provide a promising picture. But there are still some warning bells ringing.
Let’s take the most telling data first, intensive care unit (ICU) occupancy rates for beds allocated to COVID-19 patients.
As of November 30, data from the Philippine Department of Health show 15 out of the Philippines’ 17 regions are in the safe zone, with less than 60 percent occupancy of ICU beds allocated for COVID-19 patients. The National Capital Region, the epicenter of the pandemic in the Philippines, has 400 vacant beds against 321 occupied. It still has the most occupied beds by far, with Region 3 coming in at a distant second at 116 beds. But it is no longer in the danger zone of between 70 and 85 percent occupancy, which it breached earlier in the year.
Central Visayas, or Region 7, is also now safe after breaching the danger zone in July. Central Visayas only has 50 occupied beds against 99 vacancies.
What is troubling is the data from two regions, which have now entered the danger zone. Region 2, or Cagayan Valley, has 27 occupied beds against only 11 vacancies. What is worse, this is the same area ravaged by recent typhoons. Testing in November was interrupted by those storms, so it is still unclear how bad the COVID-19 outbreak in that part of the Philippines is. The level of uncertainty regarding that is much greater, but that will be discussed a little later in detail.
Region 11, or the Davao Region, has 38 occupied ICU beds against only 13 vacancies, also placing it in the danger zone of above 70 percent ICU bed occupancy. Cases in the region have also risen in recent weeks, which prompted the national government to put Davao City and Davao del Norte under General Community Quarantine (GCQ).
This chart shows us the overall status of confirmed COVID-19 cases, broken down by status. Red shows us the total number of active cases. Green shows us the recoveries. Black shows us total deaths.
While the earlier chart paints a picture of how COVID-19 patients are doing inside the hospital system, this chart provides a bigger and more complete picture. A great number of COVID-19 patients don’t even make it to hospital, as we discussed in an earlier article.
The data as of the end of November looks good. Active cases are on a downtrend, and recoveries very clearly make up the majority of the cases. As for fatalities, every single one remains unfortunate, but thankfully deaths do not make up the majority of outcomes for those who contract COVID-19.
Confirmed COVID-19 cases are shown in this chart, with the 7-day moving average reflected by the blue line, and daily reported cases reflected by the red bars. This is also on the decline. November’s numbers are in fact very encouraging, and look much better compared to the number of cases being confirmed every day in recent months. In fact, the total number of cases confirmed in November only hit 51,101, the lowest monthly total since June. In the NCR, daily cases reported have also shrunk to less than 500, and that is a big reason why total cases reported daily have been hitting below 2,000 consistently for the month of November.
Confirmed cases by month:
March - 2,078
April - 6,380
May - 9,532
June - 19,253
July - 54,979
August - 127,819
September - 90,544
October - 69,938
November - 51,101
The number of COVID-19 tests conducted everyday meanwhile remains erratic. This number should be going up in step with the increase in accredited COVID-19 laboratories and testing facilities. From an average of 37,585 tests per day in September, the number has gone down to 31,410 tests per day in November, a difference of over 6,000 tests.
Some of the valleys in this chart can be directly linked to bad weather, including Typhoons Rolly and Ulysses. These stopped testing efforts in badly hit regions, and even raised the likelihood of COVID-19 transmission by forcing displaced Filipinos into crowded shelters and evacuation centers.
A row over unpaid bills between government run insurer PhilHealth and the Philippine Red Cross was another issue that led to erratic testing.
This chart shows the average number of individuals tested daily based on region. Important to note, the geographic data here refers to the location of the testing laboratory, not to the origin of the test subject. We can assume that residents of a certain region would have their tests done in laboratories in the same region. However, it is possible they could have had tests done in another region.
We cannot yet determine the extent of the damage done to the campaign against COVID-19 by the combination of decreased testing and consecutive typhoons hitting the Philippines. This chart however tells us that testing has been largely centralized and focused on NCR. That is understandable, as the Philippine government wants to reopen the heart of the economy as soon as possible.
But the drop off in the amount of testing outside the capital region is staggering. Cagayan Valley or Region 2 has only tested 305 individuals a day in the last two weeks of November. Davao Region or Region 11 only tested 1,405 individuals a day over the last two weeks. The NCR tested over 17,000 a day in the same period. These tests aren’t just meant to provide patients with accurate diagnosis, they are meant to give the government the ability to see the extent of the COVID-19 outbreak across the country and do the necessary interventions. It's simple. The government does not know the extent of the COVID-19 infections in areas with low testing numbers.
This data becomes more important with the drop in testing. Positivity rate measures the number of positive test results against the number of individuals tested. If the number of tests drop and the number of positive test results stays constant or increases, the positivity rate will go up.
However that was not the case in November as the positivity rate actually trended down. This is a great development. Furthermore, with a national average positivity rate of 5.2 percent in the last two weeks of November, the Philippines is inching closer to the World Health Organization’s recommended level of 5.0 percent or lower for two weeks, prior to the resumption of economic activities. From a positivity rate of 12.2 percent in August, the rate has steadily declined to 9.3 percent in September, 7.3 percent in October, and 5.7 percent in November.
However, all this also comes with the caveat that testing has been erratic. It is possible the government did not find more COVID-19 patients because they were not testing enough.
We do have data breaking down the COVID-19 positivity rate of the Philippines based on region in the last two weeks of November, but again this is only based on the location of the laboratories, not the test subjects. Even so, we find very different positivity rates when the data is broken down in this fashion. NCR is even more encouraging as its positivity rate is just 4.0 percent. Regions 1 and 7, and the Bangsamoro Autonomous Region in Muslim Mindanao are all also below the 5.0 percent threshold.
Region 2 or the Cagayan Valley has a positivity rate of 5.9 percent. Region 11 or Davao Region has a positivity rate of 9.1 percent. The worst region is CARAGA with a positivity rate of 17.8 percent. Only four regions in the Philippines are below the 5.0 percent threshold (in orange). In contrast, there are also four regions with positivity rates above 10.0 percent: CARAGA, Region 4-B, Region 12 and Region 9. These four regions are also the same areas with lower number of tests as illustrated in an earlier chart.
While it’s good to see that cases are declining, the question remains: are we testing enough especially in rural areas? How significant is the underreporting in areas outside Metro Manila, where the positivity rates are relatively higher?
More importantly, Region 2 and Region 11 both have ICU bed occupancy rates of over 70 percent. That, coupled with relatively higher positivity rates spell trouble, even if the data is just based on the location of laboratories.
So what do all these things tell us? We have two regions, Davao and Cagayan Valley, which have high ICU bed occupancy rates. Their local fight against COVID-19 needs more attention. The high positivity rates in a majority of regions outside NCR also tells us that these regions should at least conduct more tests to verify the level of COVID-19 infections there.
Whether the let-up in testing is due to circumstances out of the government's hands such as the recent string of devastating typhoons, or avoidable situations such as the unpaid bills row with PhilHealth, testing needs to increase. It would be a shame if another wave of infections erases all of the gains made against the virus this year just because of complacency or some other needless setback.
In the meantime, everyone needs to do their part, adhere to the minimum health requirements of the government, including the wearing of face masks and physical distancing. It would also be best to avoid large gatherings this holiday season, to keep loved ones and friends safe. COVID-19 is still around.