There is a saying that goes “it’s hard to teach an old dog new tricks“.

And there’s no better situation to apply that saying than today – the COVID-19 pandemic in our midst.

When the various phases of the enhanced community quarantine begins to ease up, the question is – when do we go back to our “usual” normal lives?

By nature, every animal is a social being. Even the lowest form of animal engages in some kind of social interaction. From time of conception, our interaction with another life form is deeply ingrained with the attachment of that umbilical cord. Growth and neurodevelopment milestones are dependent on human interaction with both the environment and other beings in our midst. Humanity evolves because of social interaction and adaptive behavior.

It’s difficult for anyone to even imagine living in a world where the new norm means having to don a face mask each time you step out of your home, stay a meter away from another person, and avoid crowds and other social gatherings.

The last decade saw the boom of social media. Where friends were virtually in touch with one another through Facebook. Or where one’s opinion was simply Tweeted into the air. Or where food and travel places were Instagrammable. Where likes and shares were the norm rather than the exception.

As we were just getting settled into planning our annual vacations, post our successes and failures, and organize our future – a lowly respiratory virus perturbs our social milieu.

So how do we gradually settle into the “new normal”?

Over the past days, an article came out suggesting that experts ranked 36 activities risk level during the pandemic https://www.al.com/news/2020/06/from-hair-salons-to-gyms-experts-rank-36-activities-by-coronavirus-risk-level.html. It’s an interesting read, but let me put my 2 cents worth on that article by making it simpler for everyone to remember how to calculate those risks and eventually incorporate into our daily lives.

I guess the ‘no brainer’ here is we start by changing our daily routine. There are things we do that put us at highest risk in catching the virus. Knowing the extent of risk can help workplaces, schools and homes adjust activities of daily living to help us lower our risk to getting exposed to it. After all, it will be quite awhile before we get to see a vaccine or treatment (if there ever will be one).

On an individual capacity, we should decide for ourselves which places we should avoid and which ones pose little risk of getting infected from the virus.

There are basically five factors when it comes to risk assessment: (1) indoor or outdoor activity, (2) exposure time, (3) how likely we are to comply with the risk presented, (4) social distancing, and (5) personal risk level.

As a general rule, activities outdoors are generally safer because the virus does not get recirculated especially when the space you converge in is large.

Activities that don’t allow social distancing are riskier. Because the infection is acquired from droplet transmission. Activities that involve singing and shouting should be avoided for the meantime.

Exposure time is an important factor as well. Casually walking by a person along the street who may be infected with the virus is less risky than being seated beside someone in the mall or coffee shop the next 2 hours waiting for your friend to arrive.

Then there’s the risk on a personal level. If you know you belong to the vulnerable group (have comorbids or health risks that make you susceptible to getting infected), you should know better than anyone else on what steps to take.

Assign a score between 0-2 for each of the factors provided. 0 meaning no risk, 1 for intermediate risk and 2 for highest risk. Add up the factors with the scores and anything that puts you between 0-3 should be lowest risk, 4-7 as intermediate risk and 8-10 for highest risk.

Bars and Brothels

Now that’s a definite 10. And it’s worse if there’s even smoking, vaping and a lot of socializing. Who’s even going to bother wearing a mask inside a bar?

Adding the strippers and those gyrating men and women in scanty clothing (wearing a mask?) isn’t really the kind of stuff people trek to watch.

When the crowd gets rowdy, and they definitely will with all that booze and most likely drugs, that’s enough to become loose to keep your guard down.

It’s not only COVID-19 that you’re going to catch in a brothel, it’s more likely that you’re bound to even get pathogens that are sexually transmissible. Either ways – you’re going to die faster.

Concerts

Not too sure with anyone who’s willing to pay P100,000 to see someone sing and dance because the 10,000 seater venue can only allow 1,000 people -seated 2 seats apart on the side and two seats apart front and back.

But that would defeat the purpose of having the performer even get a standing ovation from a jam-packed audience all wearing a face mask. Or have a jam-packed audience rub arms, elbows, crotches and butts against each other singing, screaming and gyrating to the music and the show.

Definitely a risk level of 10.

Sports (and Gyms)

Definitely a no-no when you’re going to be splattering saliva and sweat against each other. So gyms for that matter should remain closed for the time being unless you can make sure that you allow only 3-5 people at a time (which is impossible to do) and that people are limited to working out by appointment and at a designated time limit (1 hour maximum) instead of parking their whole day inside the gym.

Reopening the gym will be a nightmare considering that you will have less manpower (gym instructors) and will need to make sure that all the equipments are cleaned after very gym rat uses it. But that’s hard to do because some of them jump from one equipment to another and then back to the same equipment for a routine for the chest, the back, the legs, the arms, the trapezius muscles….and cleaning up with sodium hypochlorite after every person using that piece of metal is potentially toxic.

And those spin, Yoga and Zumba classes will need to go for awhile. If you need to burn those calories, walking/running outside is healthier than doing it on the indoor treadmill (which is probably located less than a meter from the next treadmill in a 200 sqm size gym).

Anything that will require huffing and puffing for the whole duration of the activity will need to stay closed for awhile, unless you can make sure that the place is immaculately clean.

But let me put that in another context. If you won’t allow your kids to go to a park to mingle with other children who run around in the wild, or take your children to Fun Ranch because you’re afraid of who had the last touch on that slide, then the gym is the equivalent for the big boys (and girls) . For gyms, I’d give it anywhere between 8-10. Depending on several factors how they’d probably assure that there’s never going to be a crowd or that every piece of equipment is going to be cleaned down after every use or that there will be limited use and access by every customer or that the locker rooms won’t even have fomites and will be kept to a distance between one user and the next.

Any contact sports is definitely out of the reopening bid. Basketball, wrestling, volleyball, football, soccer, rugby, martial arts, boxing…they should be in park-mode for the meantime as they are a definite 10!

Sports activities in open spaces where people are far apart from one another (golf and outdoor or open-space tennis) carry very low risk. As long as socializing is not within the agenda, then it should pose a risk between 0-3.

Swimming is controversial. That would depend on how close you probably are to the next person. As a general rule, if you have a pool at home, swim there. If you want to use a public pool, then that would entail risks depending on how large the pool is and how many people are in the pool that given day. Even if the pool is chlorinated, you cannot help when people splatter saliva and blow air bubbles after several laps. Because we don’t know how SARS-CoV-2 is transmitted when swimming, it’s best that if and when we need to swim, consider swimming in a more open space like the sea or ocean. Of course, the ideal would be if you had a private beach…and that would put the risk to totally ZERO. In the meantime, the ordinary folks like us would have to contend with risk between 4-7 when swimming in public places.

Parks and amusement centers

They’re meant to draw a crowd. Especially those themed parks. The photo-ops. Those instagrammable moments. Yup! They’re definitely a perfect 10! It’s just not a fun place to have no parades anymore in the amusement park.

Then there are the private parks in the enclaves of the upper class of society. As long as the nannies there don’t congregate to exchange juicy stories with their wards in tow, these pose lower risks than the themed amusement centers (Enchanted Kingdom, Disneyland, Universal Studios, etc). I’d give the public amusement centers anywhere between 8-10 while the private parks in the various villages a 3-5.

Schools

Definitely high risk.

And I base that from experience in dealing with kids. Children are social animals. Adulthood is different from childhood.

Parents worry about not having to send their kids to school because it would mean one year (or longer?) loss…and I get that. However, schools are complicated when it comes to the risk for spread.

Each year, when the flu season comes, it’s also when our clinics are full to the brim. With kids coughing, sneezing, colds, sore throat and fever. The flu shots help diminish the risk of getting flu but it’s not 100% protective. And there are other respiratory viruses you need to contend with. The best way really for children not to get sick is not to go to school, because let’s face it – school is after all one of the biggest Petri dish in the world. But that’s a no-no. And somehow, they’ve got to get their education back on track.

The problem is, how do you get the smaller children (and yes even those teenagers that need to “hang out”) stay separated, wear a mask or even wash their hands well. Seriously, hygiene is the last thing that they’ll even remember.

Let’s put a little scientific evidence to this. As of June 10, 2020, of 22,992 data points (individuals positive for SARS-CoV-2) in the Philippines, 573 (2.5%) kids 0-9 years old, 1012 (4.4%) children 10-19 years old, and 4492 (19.5%) school-aged adults 20-29 years old comprised part of the total patients who were positive for the virus. That means that 7% belonging to the 0-18 years old age group alone were positive for the virus. If we threw in the college students and the age group that would potentially attend postgraduate studies, 27% of those less than 29 years old were positive for the virus.

Restarting school should not only benefit those who send their children to private schools. The public school system is the larger community we need to draft guidelines for. After all, the private schools will be able to manage this better than those kids who go to public school. But the public school system is more overwhelmed with more students per class than private schools. And more challenged because majority of its students have the least access to a stable internet connection, let alone a tablet or computer.

School opening should be an all-or-none phenomenon. We either start school or we don’t. Because it will not be fair for those who have less in life compared to those who have more.

A hybrid model can be studied. Face-to-face may not be required daily and classes can go in shifts for face-to-face engagements. Students can be divided into 2-3 groups (or even 4) and be seen every day of the week per month with the rest being seen online or having tasks and assignments conducted online. However, this may be challenging to apply to those that are 8 years old and below. Getting all the school children without having break periods is ideal so that immediately after classes, they are sent home.

Because of the challenging task ahead – this gets an 8-10 on my meter scale.

Church

In a country where more than 80% of its total population are Catholics and where celebrating Holy occasions is the rule rather than the exception, the devotees definitely miss the physical presence and ambience of our churches.

But one can’t help point out the fact that the two outbreaks in Singapore and South Korea came from churches. The one in the Philippines started from a mosque in San Juan City.

It’s totally different when the mass is online compared to having the priest celebrate mass in front of us and receiving holy communion.

The only issues with mass are the social distancing and the singing. Yep, singing. While it is best that songs of joy and peace and happiness and veneration are offered to God, singing is also one of the most aggressive way of transmitting the virus. That, and a lot of people verbalizing together. But masses can be held without having a person sing (it can be a minus one or a taped song for that particular segment of the mass), and that people don’t need to respond verbally to every sentence of the presiding priest. For now, we can be a passive audience and quietly shout out (in our mind and heart) the responses. After all, when we come from mass, it is the deep faith and practice of that faith that counts the most.

The churches can continue to offer online masses for the faithful that may be vulnerable and challenged to physically attend mass. Because of the limited number of people that can physically come, if possible try to offer more masses a day.

Risk level for churches? 4-6 depending on the capacity of the place of worship.

Movies

The advent of Netflix, Viu, iFlix and other downloadable sites has changed the entertainment industry dramatically. We now get to enjoy the “movies” within the confines of our homes – when we want to. Some homes even have their own room dedicated to an 80″ screen and surround sound! Seriously, I don’t think a lot of us would have our sanity intact during this lockdown were it not for these entertainment sites.

Movie houses, like concert halls will need to practice a lot of social distancing (as people will need to sit down for hours) and all will be operating at a loss unless they charge exorbitantly just to watch a film. It’s also going to be challenging sharing that bucket of popcorn a meter away from one another or even being intimate between seats.

In this day and age of digital technology, going to the movies is in the least business priority. With a pandemic that isn’t going to go away anytime soon, the return of the indoor movie houses will probably take awhile.

The risk level? 6-8 depending on how well prepared they are at keeping the place immaculate show after show.

Hair salons

It’s impossible to keep a social distance with barbers and hair stylists. But it’s the same line of reasoning I would dare say – that it’s impossible to keep a social distance between the dentist, the doctor, the veterinarian, the bank teller, the supermarket cashier, the gasoline boy, the market vendor…

Because any face-to-face interaction is RIGHT IN YOUR FACE, and you just need to make sure that we wear a mask (or include a face shield if you must) and keep the chit chat to zero. Go get your hair dyed and make the hair stylist leave the premises after coloring, return to have it washed, then voila, you’re done.

The article on AL.com suggested that hair dryers shouldn’t be used because it could potentially circulate the virus. I am not too sure where that idea came from and what ballpark they actually live in, but seriously, if everyone is wearing a mask, what virus to circulate are they even talking about?

A haircut will not usually take more than 15-20 minutes. But it’s the same amount of time (or even shorter) than a face-to-face appointment with a healthcare provider.

Similar to health care clinics, salons and barbershops should be BY APPOINTMENT ONLY. The waiting areas can be closed off. There should also be no simultaneous procedures that will require the whole salon staff to be at your hands (manicure), feet (pedicure), head (shampoo and haircut), and face (make-up artist). Now that, is a crowd.

Remember, part of hygiene is good grooming. So yes, open those barbershops and salons but make sure to keep the risk low by taking these pointers into consideration.

My risk assessment is salons and barbershops would be between 3-4.

Dining and restaurants

If there’s one business that has been extensively hurt during this pandemic it’s the food business.

From the make shift food stand to the fine dining places, these were businesses that became a challenge to survive the lockdowns.

Luckily, they could still operate using “take outs” or “deliveries” as part of the “new normal” in their business setting. In my observation, the food deliveries and take outs had lesser portions or ended up more expensive. They were charging for the containers as add on to the orders. Which I found unfair. In the first place, these foodies were not operating with dishwashing machines and busboys any longer. There were lesser staff and lesser utensils to clean. In short, their operational costs are much lower. To pass on additional cost to customers in order to meet the same profit margins as BEFORE a lockdown is called greed.

The other day, I ordered take out from a Japanese restaurant and they charged 10% additional to the total bill for two dishes! So that means that if you order food worth 1000p, they’d still add 100p on top of that. Seriously? Talk about taking advantage of the customer! I mean, yes you need to survive. The question is, don’t we all?

So yeah, we go back to the point, how will these restaurants survive?

Similar to other establishments, dine in should be allowed but on a BY RESERVATION ONLY basis. If the space can accommodate 100 people, then the accommodations should be cut by 50%. Tables and chairs spread apart. All food should be ala carte and NO SHARING of dishes. Buffets are definite no-nos.

The requirement by the IATF of installing acrylic or clear barriers between customers is a bit too much and off. First of all, it makes no sense in having a barrier between people in one table. I understand that no one eats with a mask on and therefore placing barriers will minimize the splattering of saliva and transmission from droplets during a conversation, but the barriers in itself will be a potential source for the virus to adhere to after every customer leaves the dining table. So it will need to get cleaned, wiped and dried before the next people come in. Tedious, taxing and well…unnecessary.

I still have to find a scientific paper that provides evidence that acrylic barriers help control the transmissibility of the virus. Since there is none, that’s another white elephant and an extra expense for the business.

I think more importantly than just making sure the dine-in restaurants practice good hygiene, is to make sure that people don’t park their bodies there. If I were to allow Starbucks and other coffee shops (and yes, even restaurants to operate already), all wi-fi access should be turned off and people should not be allowed to bring work and laptops for use in these places where they park their lives, sip a cup of coffee for the next two hours, or use it as a destination to have pocket meetings with clients.

The risk verdict? 3-5 if the above recommendations are all met.

Air Travel

We all want to get on that next flight to our fave destination.

The tourism industry has seen the worst outcomes during this lockdown and it’s really hurting the economy.

The truth of the matter is – air travel was responsible for the pandemic. Any way you place it, the bottom line is – were it not for air travel, we wouldn’t be in this health crisis at all.

In spite of the warning signs, we kept our borders opened. The red flag was there. Three cases among foreigners with one death traveling from Wuhan. Their entry point was Cebu. The rest is history. We let our guard down. Because the president was partial to our Chinese neighbor.

That’s a large difference when we look at how Vietnam dealt with the pandemic. China is their next-door neighbor. They totally shut down the border and began testing patients that were found to be sick, walled-off villages that had cases and did aggressive contact tracing from the get go. They stopped all flights in and out of the country. Today, they have no case for the last 3 weeks and had zero deaths.

But that is all water under the bridge.

Reopening the airline industry is going to be challenging. The trouble with travel is that people will always declare that they’re “fit to travel”. All you need is one sick person on that flight and all hell breaks loose.

Wiping down the seats, making sure that economy class is not full (difficult for budget airlines and good luck to getting flights that will charge you rock bottom prices as they used to). You can lay out the economy area with one person allowed per row and every other row unoccupied for a 2-2 configuration plane. The shorter the flights the better. The long hauls will probably be a bit more challenging.

Will requiring swabs a few days prior to departure help? Not necessarily because if the patient is a pre-symptomatic, those swabs may turn out negative initially and by the time he boards the plane, he may have mild symptoms. And we all know that it’s difficult to cancel our flight bookings without getting penalties in the end.

The level risk? For short hauls, probably 3-5. For the long hauls, 6-8.

The malls

Like the supermarkets and the wet markets, it’s the crowd that matters. Going to the supermarket is an exercise in risk exposure. You can’t really help the fact that you’re one bunch of people congregating at the meat, fish and vegetable section. So yes, the supermarkets and wet markets are a definite risk and even though they wipe down the carts and take your temperature upon entry, it’s difficult to tell who had the last touch on the tens of thousands of goods you just picked up (and eventually returned and picked up again).

In the malls, as long as you’re able to separate people close to one another and maintain distance in the individual stores (like 2-4 people at a time depending on how big or small the store is), then the risk is going to be low. People will want to eventually fit the clothes they pick out. And people get icky over the fact that the clothes on the rack may be contaminated. But the likelihood that the virus will stay on the rack is very low.

It’s always best that if you know your size, don’t try on the clothes that you like in the store. Remember, during the three months quarantine period, you probably gained more weight that you think. So make room for that extra paunch. Pick a size bigger than what you used to wear.

When you get home, and you’re a tad paranoid, wash the clothes you bought.

And there should be a NO RETURN NO EXCHANGE policy, for everyone’s safety.

No mall sales and no other mall activities (like concerts or fashion shows or gigs or promos) should be in place.

My level risk if these are observed for the supermarkets? A definite 6-8 depending on the staff and size of the supermarket. For the malls and stores? Anywhere between 3-5.

The hospitals and medical clinics

It is obvious that the biggest misconception among the lay is that hospitals and medical and dental clinics are the dirtiest places in the world.

On the contrary, they’re super clean. Believe me when I say that hygiene is the top priority of any hospital or medical and dental facility. After all, we make sure that any procedure that needs to be performed requires aseptic techniques. We observe protocols to the tiniest detail in keeping the hospital and clinic environment as clean as possible.

But hospital acquired infections are a different matter altogether. They occur among the immunocompromised, those that stay longer than expected, entertain guests (even if we have policies on guest restrictions, there are just some entitled patients) without screening who visits them. I recall once when I was making my rounds that there were more than 10 people in the room of a newborn patient. I couldn’t help but blurt out – “wow the whole barangay is in town”. Only to have one of the relatives reply, “oh, we’re just 1/8th of the family.”

But that’s a Filipino tradition that’s hard to let go. If you look at the arrival area in the airports, you have one truckload of welcomers who probably are waiting to get a “pasalubong” from the balikbayan or OFW relative who is arriving. Some with babies and oldies on a wheelchair in tow.

The same is true in the hospital setting. There are kids that run around on the hospital floors and despite my having to inform the guards, nurses or anyone else for that matter – they just need to sign a “waiver” – because we don’t want to perturb the guest relations system.

Now that most of I and my colleagues have returned to the clinic and tell our patients that we’re ready to see their children, the parents ask the question – is it safe? Duh?!?!!?

The risk would probably be between 2-4. And with your doctor wearing a PPE, most likely 0-2. You don’t know the extent we go through just to make sure that the procedures we provide is to make sure that not only YOU don’t get sick but that we don’t get sick because someone was not truthful enough!

The gatherings

Then there are the parties.

In my family alone, we’ve had three birthdays uncelebrated because of the quarantine. We were ribbing at the fact that it officially meant we’re not another year older this year because there was no official celebration.

But yes, the most difficult of all to manage would be a social gathering of friends and family because you’re celebrating an occasion. No matter how you put it, there will always be children and elderlies that will need to attend these events (for fear of being ostracized from the family later on and because it is a family tradition to have the whole caboodle invited to the event).

And because there is no way anyone can even police a private affair like this, the only answer to the question on risk level is that this is a definite 8-10, unless you have an intimate dinner with the immediate family that resides in the same place as everyone else then that risk is now 0-3.

Public transportation

Taking an Uber or Grab or a cab is always the safest option. Driving yourself to work (or ride sharing with one to four people if you’re in a car) is another great option. The trains, jeeps, buses, tricycles and motorcycle rides pose greater risks because of social distancing issues. Then there’s also the handling of money for fare payment. There are no beep cards for tricycles, buses, jeeps and motorcycle rides in the Philippines. Barter is done through cash exchange – which are really really infested with all forms of microorganisms.

Then there is the crowd that needs to get transported from point A to point B. Majority of the people get to work by public transportation. We know that the roads are congested enough with private vehicles. The public transportation is the Philippines is bad. Really bad. To make a handful of people go to work by opening up the economy without transportation is hell on earth.

In short, we just created a mob.

And whatever social distancing measure you try to apply, it’s every man for himself because by hook or by crook, their mantra is “ I owe I owe so off to work I go.” And nothing matters anymore when the stomach is empty. Not even COVID-19.

The risk level? 2-4 if it’s a private transportation or share riding app. Definitely 6-9 if it’s a public transportation system.

The workplace

Last but not the least is your work area. And I’m talking about offices here and not the other work spaces mentioned above.

Arrangements can be made requiring a subset of workers who report to the office on certain days of the week while spending the other days working from the confines of their home.

In the offices, during work hours, people are more often than not separated from each other. Working quietly in their desk or work space. It’s the break time gaps that allow a crowd to come together. It’s lonely to eat alone on your desk. Workers will always find the opportunity to converge in order to share stories and food during break time. And share the virus as well.

While difficult, gatherings in the pantry is highly discouraged. Eating alone is the rule so that there will be no food sharing as well. It cuts down conversation time, decreases gossip in the workplace, and increases productivity. Not to mention that those are just the bonuses from the primary goal of decreasing transmission of infection in the work environment.

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This is not an exhaustive list. And you can make your own. I’ve provided 5 essential points that you can use to assess the level of risk. And you just need to score them from 0-2 (0 – no risk, 1-intermediate risk, 2- high risk). Total them and you should get your answer to your question.

Data as of June 30, 2020, 8PM Manila Time.

THE WORLD

After the breaking the 10 millionth case in the world last weekend, and over 150,000 cases being reported daily, it will not be surprising that we will have a million cases weekly.

There were less than 160,000 more cases added. And deaths are slightly up with 3676 deaths globally.

The global case fatality rate is now at 4.88% (lower than yesterday’s 4.92%) with a recovery rate of 54.5%.

Almost 6.2 million are closed cases with 92% recoveries and 8% deaths. While the fatality may seem low in terms of percentage, the numbers are staggering because of the sheer number of cases. While some countries are beginning to see a decline in cases, others are just beginning to see cases in their own communities.

The half of 2020 closes with a high note – the continued upward trajectory of new reported cases. The report on lesser death rates is something that we should be cautious in interpreting as death reports are usually latent.

The United States continued to surge with the highest number of cases in the world overnight (+44,734) bringing their total count to past 2.68M.

The top three states that contributed to the cases overnight were: California (+6,896), Texas (+6,135) and Florida (+5,266). The death rate in the US is lower today at 4.80%, lower than the global average fatality rate.

Top 10 countries with most cases yesterday were: USA (+44,734), Brazil (+25,234), India (+18,339), Russia (+6,719), South Africa (+6,130), Mexico (+4.050), Chile (+4,017), Bangladesh (+4,014), Saudi Arabia (+3,943), and Pakistan (+3,557).

The table below shows the top ten countries with the highest number of cases reported. These ten countries alone contribute to 2/3 (almost 6.9 million cases) in the world.

The Philippines remains at 38th in the world in number of cases of coronavirus.

Based on infection density (infection based on the population of the country), Qatar remains to have the highest infection density with 33,581 cases per million population. While Oman has displaced Singapore for the 10th spot, Panama has displaced Singapore for the 11th position.

With the Philippines averaging almost 800 cases/day in the last week, we move up from 107th to 105th spot in terms of infection density with 340 cases/million population.

For every 1 death, there are 11.2 recoveries.

The Philippines

The last day of the month of June. The last day for half the year. The last day of the second quarter.

And it ends with a bang!

Today we have the second highest total new confirmed cases since the start of this pandemic in the country with 1,080 cases today. Of course, the Department of Health will provide the disclaimer that they will need to verify these numbers, particularly the “others”.

Of the cases reported at the 4 o’clock habit, Region VII reported 468 total confirmed cases (430 fresh and 38 late), followed by the “others” with 409 cases (270 fresh and 139 late) The NCR had 203 cases (158 fresh and 45 late).

Of the 11 reported deaths, 9 of them died in June. The death rate continues its downward trend at 3.37% while the recovery rate is at 27.28% (lower than yesterday’s recovery rate of 27.32% because there are significantly more cases than recoveries).

According to the Department of Health data, of the remaining 25,227 active cases, 99.4% of them are mild (24,137 or 95.7%) or asymptomatic (942 or 3.7%). There are four less severe cases today – either the patients recovered or passed away.

The graph on deaths by date of death had some data with proxy. Proxy in data analytics and machine learning may pose discrimination and bias in the outcome of the data. Choosing proxy variables is subjective and while the health agency does not explain what proxy variables it chose to arrive at this extrapolation, hopefully, they are weak variables.

The day before

Of yesterday’s 985 cases, the 4 o’clock summary of the DOH COVID-19 bulletin announced 531 cases supposedly came from “others”, while NCR had 319 cases and Region VII with 135.

WRONG!

Yesterday was a blood bath day for the National Capital Region. NCR did not have 319 cases. At 10 AM today, the final tally was 545 cases with 6 deaths. Region VII had 135 cases and four deaths. Region IVA is in third with 84 cases and one death. Of the 985 cases yesterday, 121 (12.3%) had no tagged location.

Other regions that reported double digits were: Regions III, IX, V, and VI. There were 14 repatriates with positive results yesterday.

Of the 545 cases from the NCR yesterday, 338 (62%) were unknown. The way data is reported in the NCR makes this exercise of reporting unknowns frustrating. The numbers reported daily out of NCR are undoubtedly the highest in the country. Yet it’s such a pain to see them unable to verify their actual locations, making this exercise of counting cases by city an exercise in futility. How do they even reconcile all those “unknown” later on (if ever)?

Based on those with tagged locations, the highest cases were: Quezon City (+51), Caloocan (+24), Manila (+20), Valenzuela (+15), Parañaque (+14), Marikina (+13), 11 cases each for Makati and Navotas; and ten cases each for Malabon and Mandaluyong.

The other cities that reported single digits were: seven cases each for Las Piñas and Pasay City, five for Taguig, four each for Pateros and Pasig, and one for Muntinlupa. Only San Juan had no reported case two days in a row.

Six deaths were reported in NCR – three from Caloocan, two from Manila and one unknown location. (Seriously, I don’t even know why there is an unknown death, when the death certificate should indicate the place of death and the residence of the person that died.)

Region VII reported 135 cases with 4 deaths yesterday. As mentioned in the previous blogs, the number of fewer new confirmed cases are most likely due to lack of testing kits in the region (and not due to the enhanced lockdown as purportedly being attributed to from some reports). This is evident in the report below on testing capacity and in the almost 400% surge in number of cases out of Region VII today.

Those with tagged locations reported yesterday were: Cebu City (+77) and three deaths, Cebu Province (+26) and one death, Lapu-Lapu City (+25), Mandaue (+5), and one apiece for Negros Oriental and an unknown.

Region IVA had the third highest number of cases with a total of 84 and one death. As in the case of the other regions, nineteen (23%) were unknown. Those with tagged locations were: Rizal (+30), Cavite (+17), Laguna (+17), and Batangas (+4). The lone death was from Laguna.

Region III had 28 cases. Twenty one came from Bulacan, two from Pampanga and one apiece from Nueva Ecija, Zambales and Tarlac. Two had no tagged residences.

There were twelve cases each from regions IX, V and VI.

The highest cases in region IX? The unknown had 8. Three cases were from Zamboanga del Norte and one case from Zamboanga del Sur.

For region V – Camarines Sur had 4 cases and two cases each for Camarines Norte, Masbate, Naga City and Sorsogon.

The twelve cases of region VI were from Iloilo (4), Negros Occidental (3), Guimaras (2) and 1 apiece from Aklan, Capiz and Iloilo City.

While all other regions reported single digit cases, CAR, MIMAROPA and region XII had no reported case.

These formed the majority of the “others” yesterday.

The results in testing capacity is unusual. While they report an additional 14,014 samples tested on June 28 in 13,182 individuals, bringing the cumulative positivity rate up at 7.1%, it was unusual to alter the data the day before.

On June 27, the initial report of the Department of Health was 13,040 samples were tested in 12,127 individuals. The daily positive rate for June 27 was also the highest at 10.14% since more testing had been performed.

Surprise of the day? The graph for tests done on June 27 changed. It now claims to have 16,289 tests done with 1481 positive (instead of 1323 positive cases) and the daily positive rate went down to 9.1%.

On June 28, total tests done was 14,014 samples in 13,182 individuals. The cumulative positive rate is now at 7.1% due to an increase in daily positive rates at 9.32%. In short, out of every 100 people tested, 9-10 will turn out positive.

However, the positive rates vary per testing facility, as they are in actuality a reflection of the locality.

For example, Region VII has three testing facilities – Cebu TB Reference Laboratory, Vicente Sotto Memorial Medical Center and Allegiant Regional.

Allegiant has not provided any reports in the past 4 days. On June 28, it submitted a report – no tests done.

Let’s examine the two facilities.

Cebu TB Reference Laboratory Gene Expert. One hundred ninety seven out of 748 individuals tested positive on June 28. This gives you a daily positive rate of 26.3% for this facility.

At VSMMC, a total of 265 out of 527 samples tested positive. For a daily positive rate of 50.3%. The highest positive tests for any testing facility in the country.

Now let’s merge both facilities to represent testing results on June 28 for Region VII. You get 462 positives out of 1275 samples or 1268 individual tested.

If you correlate that with the total number of cases out of Region VII today, the 468 cases reported are more or less from the testing results from June 28.

As of today, there are 53 licensed RT-PCR laboratories and 19 licensed Gene-Expert Labs accredited to do confirmatory testing in the Philippines, bringing the total of testing laboratories to 72.

Results vary according to the facility and below is the list of the facilities with > 10% positivity rate. Those highlighted in yellow show the highest cumulative positive rates. While 56 of 64 laboratories submitted reports on June 28, ironically, some of them just submitted reports even if NO samples were tested.

This is observed in the summary of the testing facilities that have >10% positivity rates. On June 28, 2020, Allegiant, Dr. Jose N. Rodriguez Memorial Hospital, UP Philippine Genome Center submitted reports but had zero (-) samples tested. Which means they report they submitted just said “no samples were tested” but they reported. Singapore Diagnostics did not submit any report at all. [Those in asterisk (*) submitted zero cases today].

The following testing facilities had a >10% cumulative average positivity rate. Those highlighted are the ones with increase positive rates overnight.

Using the same list above on facilities with >10% cumulative positive rates, highlighted in red are those with increased daily positive rates compared to their cumulative average. [Again, those in asterisk (*) did not test today and therefore had zero percent positivity rate].

We end the quarter today on a high note. More cases. Discombobulated information. Gaps in data management and integrity. Confusion in the accuracy, capacity and capability of testing centers in the country.

How will the third quarter fare?

With this kind of data being presented – optimism isn’t even a kind description to it.

It will be a miracle if we can bring the numbers down.

[Disclaimer:

All data are verified based on the Data Drop of the Department of Health. All information used in the analysis are from the health agency’s data drop site https://www.doh.gov.ph/2019-nCoV.]

How many tests do we need to say we are testing enough?

It’s a question that’s been going around since the start of the pandemic. Of course, while some would profess that the more we test the better, testing everyone makes no sense.

The right utilization of resources is fundamental in the delivery of health care in countries with limited funds. Remember, even if one tested negative now, it is not a guarantee that you don’t have the virus (tested too early) or that you will never have the virus – ever!

What is a good parameter to say that we’re probably testing ‘enough’?

In communities where RT-PCR testing is done, and a high number of those tested are coming back positive, it’s a sign that we’re not testing enough. In short, there are many more cases that have not been found.

Because we’re currently prioritizing who’s getting tested, more positive result means that the tests are being used to confirm the obvious (clinically symptomatic) cases.

In areas where close contacts and suspected cases are being tested as well, the negative tests coming back are high. Michael Ryan, executive director of the WHO Health Emergencies Program points out that among countries with extensive testing, <12% of their tests are positive.

The benchmark of a system that’s doing enough testing to pick up all the cases is 10-30 negative cases per confirmed positive case (or an overall positivity rate of 3-10%).

The scatter chart above shows another way of seeing the extent of testing relative to the scale of outbreak in various countries in Asia. The one encircled in black is the Philippines.

On a logarithmic scale, the X axis represents the daily confirmed cases per million people. The vertical or Y axis shows the number of tests done (as of the date in the graph).

Based on latest data, the total number of tests the Philippines has done is 378,396 or 3456/M population (with our population of almost 110M). The scatter chart shows that countries that have done more tests have actually lower case fatality rates. For example, Thailand, South Korea, Malaysia, Saudi Arabia, Singapore have had more tests done per million population. And considerably a lesser case fatality rate.

Then there are other countries who have done less tests than us (based on tests per million population) and have had case fatality rates lower than ours.

Except for Iran that had seen an unprecedented number of deaths (8,012) and one of the highest number of cases (160,696), countries like Bangladesh and Taiwan have done less testing compared to us and yet have had very low fatality rates. Indonesia and Japan on the other hand, have done less testing than the Philippines and have seen higher fatality rates than us.

As of June 2, 2020, we have tested 378,296 people with a positive rate of 7.3%. This positive rate of 7.3% is not exclusive to new confirmed cases as the health agency does not discern whether some of these reported tests are retests done among previously positive patients or not. This is one gap that should be addressed as the public feel that the almost 20,000 total cases yesterday still contains a backlog of more than 5000 patients because the positive individuals is more than 25,000. Because of this unknown variable, there may be a further decline in positive rate if we now exclude patients whose positive results are retests.

More importantly is the judicious use of the RT-PCR as a testing tool for declaring patients as recovered. The graph below shows the usefulness of varying testing methods. While PCR is most useful within the first three weeks of symptom onset, its value declines significantly among most patients after the second week of illness.

Patients who have clinically recovered after 14-21 days, may be tested ONCE and when negative end testing there, instead of having to test negative two consecutive times (just to fulfill a diagnostic end point that is not clinically justified). Now, we know that there are quite a number of patients that continue to test positive even after 30 days of recovery and attribute that to genetic viral remnants in the oropharyngeal tract. It is therefore recommended that after a patient has tested ONCE to be negative after 14 days of isolation/quarantine AND is clinically well, no additional testing should be done. If patients continue to test positive after this period, they can be observed for 7 more days and if they are clinically well after an extended week of observation, should be considered a recovery with no additional tests done.

Last April 30, 2020, LiveScience published a report on the phenomenon of patients still testing positive even when they clinically recovered. And this phenomenon may be shortcomings in the current testing kits available.

More than 260 COVID-19 patients in South Korea tested positive for the coronavirus after having recovered, raising alarm that the virus might be capable of “reactivating” or infection people more than once. But infectious disease experts now say both are unlikely.

https://www.livescience.com/coronavirus-reinfections-were-false-positives.html

It is a fact that the PCR is unable to distinguish genetic material from an infectious virus and the “dead” viral fragments may linger in the body even after some people have recovered. And that can be explained by the fact that the body has its way of cleaning up broken down cells. This “garbage” is referred to a s cellular corpses destroyed by the virus and within this “garbage” are fragmented remains of non-infectious viral particles.

As a result of the findings in South Korea, under the new protocols, no additional tests are required for cases that have been discharged from isolation and will refer to “re-positive” cases as “PCR re-detected after discharge from isolation” and people should no longer be required to test negative for the virus before returning to work or school after recovering from their illness and completing their isolation period.

On May 30, Singaporean Daviest Ong tested negative for the virus after 68 days in isolation and 22 uncomfortable swab tests in Gleneagles Hospital. On May 28, Health Minister Gan Kim Yong announced that COVID-19 patients in Singapore who are assessed to be clinically well by day 21 of the onset of illness can be discharged without further tests. This new policy took into consideration clinical and scientific evidence on the limitations of the RT-PCR test after a window of recovery.

This comes a few days after the World Health Organization also published its recommendation to shift from transmission-based discharge to time-based discharge for patients who are clinically well. The WHO now recommends that patients who are clinically well can now be discharged after 10 days from the onset of illness, plus at least 3 days without respiratory symptoms or fever.

As we know more about the clinical course of the disease, and see more recoveries as well as the actual picture of SARS-CoV-2 and its disease COVID-19, we are learning how to manage this infectious agent more rationally today than when it began its story in Wuhan, China 6 months ago. Without a vaccine or treatment on the horizon yet, we will need to reinvest on our clinical acumen to reboot the economy…and our lives.

[The updates for the topic “Pandemonium” on this blog site provides a rundown on the daily statistics of this viral infection. As the number of cases globally have spread, it’s difficult to keep up with each and every case. The “brief” will be kept short and simple and center on the cases in the Philippines based on information from the Department of Health. Readers are asked to refer to other sites, especially https://www.worldometers.info/coronavirus/ or https://www.who.int/emergencies/diseases/novel-coronavirus-2019 or https://ourworldindata.org for specific information in particular countries. For references for Philippines data, they are cited separately.]

Update as of 7PM 07 June (Sunday)

TOTAL CONFIRMED CASES: 7.007,698

TOTAL DEATHS: 402,683 (case fatality rate: 5.75%)

TOTAL RECOVERED: 3,428,961 (case recovery rate: 49%)

https://www.worldometers.info/coronavirus/

Total cases worldwide (note that every reference has its own cut-off time for reporting. For the global data, https://www.worldometers.info/coronavirus/ is used as its reference.)

We have officially crossed the 7M mark at 7PM. Almost half the total cases having recovered. Of the more than 7M cases, more than half have already had an outcome – 89% have recovered while 11% died. Only a little more than 45% of the cases remain active.

These are good numbers because they indicate that while the number of cases continue to increase (driven by more testing and contact tracing), majority of them already had an outcome and the fatality rate is generally lower now. This could also mean that most the positives were identified from contact tracing and that they are probably mild or asymptomatic/pre-sysmptomatic.

The global data shows that the average cases is still more than 100,000 case per day. The total number of cases are now over the 130,000 per day mark.

And while the daily new cases plateau at over 130,000 for the 3rd consecutive day, the number of deaths declined from 4906 yesterday to 4253 today.

The United States of America continues to lead globally in the number of total confirmed cases at 1,988,545 (up by more than 22,000 cases overnight) with a case fatality rate (CFR) lower today at 5.64% with 112,096 total deaths recorded. Among the states, New York leads at 396,699 total confirmed cases and 30,372 total deaths up with a lower 7.66% case fatality rate (CFR) as the number of deaths slows down for the last week.

Brazil remains in second with a lower CFR at 5.32% with a haul of over 30,000 cases. Total cases are now at 676,494. Russia is in third with a CFR of 1.25% and total cases of 467,673. India remains in sixth spot with 247,195 cases and a CFR steady at 2.81%.

The South American countries are now the hotbeds in terms of cases for the last two weeks. Brazil tops the list at number 2 in the world, Peru stays at 8th today, and Chile remains in a close 13th place. These three countries combined make up more than 1M cases in the world.

In Southeast Asia, Singapore slips down further to 29th in the world, with Indonesia going up to 32nd spot and the Philippines moves down to 39th from 38th in the world.

Based on the dashboard of the World Health Organization https://covid19.who.int, the global data shows the Americas leading the number of cases, followed by Europe and the Eastern Mediterranean.

As several countries ramp up testing in various degrees, more new confirmed cases are being reported. With more testing and aggressive targeted contact tracing, patients who may be asymptomatic or pre-symptomatic and who may potentially be infective to the vulnerable population are being identified. With more testing, we see a better picture of the extent of the pandemic. There are, however, some countries who may not not be performing a lot of contact tracing and/or testing, but have better outcomes than others that do.

For a discussion on how much testing is “enough” testing, the link to this discussion is here https://relativejoyforyou.wordpress.com/2020/06/04/enough/

There are multiple factors that determine how outcomes of pandemics play out. Policy responses include school and workplace closures, cancellation of public events and gatherings, restrictions on public gatherings, public information campaigns, stay-at-home restrictions, international and domestic travel (public transport, restrictions on internal movement and international travel controls), and of course, testing and contact tracing.

The median average of case fatality rates worldwide has further declined to 5.75% (from 5.8% yesterday). For the past 2-3 months, over 89% of patients are either asymptomatic or have mild disease and have recovered.

The good news? Recoveries far outnumber the deaths with a ratio of approximately 8.5:1. (The ratio of recoveries continues to increase, and will reassuringly do so, over deaths because of increased testing and better minimum healthcare standards.)

Philippines Statistics

Refer to the link https://www.doh.gov.ph/2019-nCoV for up-to-date data or to http://www.covid19.gov.ph (this latter is not a secure site). The new site for the Department of Health is supposedly migrating to COVIDKAYA so that data is updated. The current site still maintains the COVID19 tracker. Readers can check their official site where Data Drop for raw data can be found.

One useful site is https://covid19stats.ph where one can see the dashboard of information from the DoH website. Unfortunately, because of the migration of the data drop into COVID Kaya, no one is able to break down the numbers to the finer details as in the previous posts.

Good news. Bad news: The wrap for the day

There are 555 new confirmed cases today compared to the 714 yesterday. And expectedly so. Since we’re doing an average of 10,000 tests a day, and the positivity rate is around 7%, (assuming that the positive rate is constant), we should have an output of approximately 700 positive cases a day (not including backlogs).

Today we breach the 1,000 mark for deaths at 1,003 total deaths with 9 deaths publicly reported.

Of the 555 new confirmed total cases, there are more fresh cases (378) than late (177).

Of the 350 “fresh cases”, Region VII has 104 cases, NCR with 67, others at 204, and repatriates with 3.

Of the 177 “late cases”, Region VII has 63 cases, NCR 25 and Others 89.

Fresh or late, the other regions are bothersome because we have 293 of the 555 cases from these “other” areas. Region VII continues its upward trajectory with 167 total cases while the NCR has 92 reported today.

With more backlogs coming in, the numbers are expected to rise. The good news is that the deaths remain low in spite of the increase in number of positive cases. Whether these remaining positive cases are retests from previously positive patients who are recovering or have recovered are unknown.

As of today, the Philippines still adopts the criteria of having two negative consecutive tests to be considered a recovery. This most likely accounts for the low recovery rate because many patients don’t take the initiative to have retesting done, especially when they are mild or asymptomatic and have clinically recovered. Other patients who are retested over and over but remained positive in spite of clinical recovery past the clinical course of illness are probably included in the count on positive tests.

Today’s total brings the case fatality rate of the Philippines to its lowest of 4.58% (good news) and recovery rate is again a tad lower at 20.7% as the number of total cases are still more than 500 today. The low recovery rate is probably due to the reporting system of recoveries in the country with the LGUs having different data from the national agency.

According to the Department of Health, based on the remaining 15,905 active cases remaining as of June 06, 2020, 95.1% (15,131 cases) are mild while the remaining 4.4% (698 cases) are asymptomatic. Only 0.5% of the remaining active patients are severe (57) or critical (19).

With the current data, the growth rate eases at around 3% but the doubling time remains approximately 10 days. While Indonesia has a higher case fatality rate compared to the Philippines (6% vs 4.58%), recovery rates in Indonesia are far better than ours (32% vs 20.7%). Overall, 82% of all cases in the Philippines are recoveries, while 18% lead to death. Making us the lowest among the Southeast Asian countries in terms of recoveries-to closed cases ratio.

Testing capacity

As more RT-PCR laboratories are being licensed, we’re having more tests conducted. At least 3735 test/M population are being carried out per day. As of June 5, a little over 2,000 samples are left in the backlog. Hopefully, this closes in towards the middle of next week.

Of the 420,166 total tests conducted in 386,726 individuals tested, the positivity rate is now lower 7.1% from a previous 7.3% (which means that we are testing enough to see the prevalence of the pandemic in the country. The number of positivity is also going down in spite of the higher testing capacity). This is an important issue to discuss as certain areas in the country have a very high death rate compared to the over-all case fatality rate. It is recommended that those areas with high death rates (>10-12%) should have more aggressive testing and contact tracing done.

For example in one community if there is one death in 1 case, the case fatality rate is 100%. Because the virus is highly infectious, there must be other cases undetected within the community. Targeted aggressive contact tracing should be done within that community so that those that are positive can be quarantined or isolated, in order to contain a potential outbreak.

Majority of the patients tested (~93%) tested negative. This means for every 13 patients, 1 would most likely test positive.

Breakdown the day before

Yesterday, of the 714 new cases announced by the Department of Health, 415 had residence information tagged. 273 cases were reported in Luzon, 173in Visayas, and 5 in Mindanao. There was no report among the repatriates.

Based on cases per region, the NCR still has the most number of cases followed by Region VII and Region VI-A. While Region VII may have more than 3100 cases, it has the lowest fatality rate.

Based on cases per city, 9 of the top 10 cities are within the NCR. Quezon City ranks first, followed by Manila and then Makati. While most of the cities have seen a growth in cases over the past week, the highest increase in growth rate goes to Cebu City with a 4.73% growth rate overnight (from 4.4% the previous day).

These places matter

How many tests should be done to say we’re doing enough testing?

Among countries that do extensive testing, if < 12% are coming back as positive results, then we’re most likely doing enough tests in the country. The benchmark of a system that’s doing enough testing to pick up all or most of the cases is getting 10-30 negative cases per confirmed cases for an overall positivity rate of 3-10%.

How does that kind of data extend to the 7,641 islands of the Philippines? And how can the community use this kind of information in order to determine if they are testing enough?

The death rate or number of deaths is another good indicator if there is sufficient case finding in the community. The same parameter above can be used to determine if the regional or local community is doing enough to combat the virus through targeted testing.

Based on region breakdown for example, Regions 1, 10 and BARRM have >10% case fatality rates, Region 1 has 16% death rate (12/74), Region 10 has 24% (9/34) and BARMM 18% (7/22). [In parenthesis are deaths/confirmed cases]. An indicator that we’re not testing enough or looking for more cases in those regional communities. The likelihood missing out positive cases among deaths due to COVID in these regions is high.

As I previously mentioned, breaking down the cases per barangay or city provides better information to the local community on mitigation actions that they may need to take in order to control the spread of the pandemic. As a general guide, if the death rate in the area is >10-12%, they’re probably not testing enough.

Sometimes the numbers look impressive because the general rule is that the region is doing fine in numbers but the better numbers are being carried by the general data of the region. For example, in the National Capital Region (NCR), where we do extensive testing, the case fatality rate is 6.3%. This is driven by the fact that there are 752 deaths in almost 12,000 cases as of yesterday for the NCR. If you break them down according to cities on the other hand, Pasig (10% CFR), Muntinlupa (10% CFR) and San Juan (13% CFR), have the highest case fatality rates in the National Capital Region.

What is confusing in the gap of information is the disparity in the data on confirmed cases, deaths and recoveries per city compared to that of the Department of Health. This must be reconciled at the soonest.

Remember, there should be ‘enough’ cases for every death because a high death rate implies that the specific locality is not doing enough in contact tracing. It is highly unlikely that the locality had 1 case with 1 death with no other person in the community being infected.

Outside of the National Capital Region, the following cities (according to the Data Drop of the Department of Health as of June 6, 2020) have death rates more than 10-12% and positive cases less than 50: Lipa Batangas (15%), San Mateo Rizal (18%), Marilao Bulacan (12%), Malolos Bulacan (17%), General Trias Cavite (13%), Nasugbu Batangas (14%), Meycauayan Bulacan (17%), Angono Rizal (12%), Bacolod (19%), Cagayan de Oro (33%), Silang Cavite (15%), Trece Martires Cavite (17%), Calauag Quezon (10%), Tarlac City (10%), Calapan Mindoro Oriental (11%), Candelaria Quezon (13%), Naga Camarines Sur (14%), Naic Cavite (14%), Guinobatan Albay (17%), Lambunao Iloilo (21%), Iligan Lanao del Norte (40%), Bayambang Pangasinan (40%), Alitagtag Batangas (25%), Norzagaray Bulacan (25%), Obando Bulacan (25%), San Miguel Bulacan (25%), Labo Camarines Sur (25%), President Roxas Capiz (25%), San Jose Occidental Mindoro (25%).

33% each (1 death in 3 cases) for the following cities: Tabaco Albay, Alfonso Cavite, Guimbal Iloilo, Dumaguete Negros Oriental, Solano Nueva Vizcaya, Bacolor Pampanga, Floridablanca Pampanga, Lingayen Pangasinan, Malasigui Pangasinan, Rosales Pangasinan, Jalajala Rizal, Castillejos Zambales, Pagadian Zamboanga.

The following municipalities/cities reported only 2 cases but had either ONE or TWO deaths: Cuenca Batangas, Taal Batangas, San Ildefonso Bulacan, Carcar Cebu, Daanbantayan Cebu, Samal Davao del Norte, Malta Davao Occidental, Barotac Nuevo Iloilo, Agoo La Union, Banaue La Union, Mantao Lanao del Sur, Tudela Misamis Occidental, Jimalalud Negros Oriental, General Mamerto Natividad, Jaen Nueva Ecija, Puerto Princesa Palawan, Candaba Pampanga, Alaminos Pangasinan.

The following areas had 1 case and the only reported case had died for a 100% death rate: Catarman Cebu, San Juan La Union, Sta. Maria Laguna, Tayasan Negros Oriental, Naujan Oriental Mindoro, Apalit Pampanga, Barista Pangasinan, San Fabian Pangasinan, Urbiztondo Pangasinan, Tiaong Quezon, Lambayong Mariano Marcos Sultan Kudarat, and Indanan Sulu.

[Disclaimer: The aforementioned data are from the Department of Health data drop as of June 6, 2020. LGU data may be different and the author recommends that the LGU coordinate with the DILG and the DoH regarding reconciliation of data.]

The week in review

To recap the week in one word – shocker!

With all the backlog details returning in bulk, the Philippines had seen a significant rise in cases as more tests were being conducted as well.

While we had an upsurge in cases at the start of the week, the good news is that the number of deaths have remained low. As a matter of fact, generally the average deaths for the week was 6 deaths/day, while the average number of confirmed cases (fresh or otherwise) was 588 cases/day. Recoveries were very slow considering that most of these patients should have recovered as the majority (~94%) are mild and around 5.5% are asymptomatic. Cases as far back as May 22 should have seen outcomes already based on the DoH claim that of the remaining over 15,000 active cases being mild/asymptomatic.

In the last graph above, this shows a summary of how we’re doing overall since the beginning of the pandemic. The blue curve showed a decline in cases (bending of the curve) until a week ago when the backlogs and more testing results came in. This resulted in the increase in the number of cases for the past week. But the green curve shows a continuous trajectory of the death rates in the country in spite of the single day surge of publicly announced death reports.

• Over the past week, the National Capital Region had 1,174 additional cases but the 7 day average growth rate was at 1.49% with a CFR of 6.31% and recovery rates at 27%. Region VII on the other hand saw a spike of 1,164 additional cases over the week with a 7 day average growth rate at 6.48%, a low CFR of 0.86% and a low recovery rate of 4.16%.

• Children below 19 years old make up 7.57% of the total cases while 18.14% are the senior citizens (> 60 years old). This means that almost 75% belong to the 20-59 year old age group (out of 21,340 data points). The group that’s actually allowed to roam around and go out.
• In terms of fatality rate, those below 19 years old have a death rate of 2.3% whole those above 60 years old have a death rate of almost 65%.

How is the coming week going to fare?

With the backlog data coming in and more testing being done, we may probably still be averaging over 500-1000 cases a day in the coming week. As long as the death rates remain low, then that’s the good news. The better news? The positivity rates decline significantly so that the numbers start going down. If we get both, it’s called a blessing.

To get in touch with the Department of Health, the COVID hotline is (02)894-COVID loc 1555.

Disclaimers:

(1) These three parameters (new confirmed cases, new recoveries, new deaths) ARE NOT real-time data. The data provided by the Department of Health is the date of public announcement. Even global data will vary in time of reporting, depending on the reporting capacity of that country. To date, the latency period of the Department of Health on reporting recoveries averages almost 10 days (with more than 50% reported after 8 days and more) and deaths averaging almost 12 days (with more than 50% being reported after 8 days or more).

(2) Depending on where testing is done, RT-PCR test results take an average of 12hrs – 2 days to process. Barring any delays, all tests done should ideally be released by at least 48 hours (the earlier the better). However, the test results released from government facilities now range from 3-7 days (based on Data Drop) when compared to private hospitals where fewer number of tests are performed.