[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.)
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.
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.
(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.