More than 20% positivity and 287 new deaths on 08.08.2021

While there were relatively fewer cases reported today with 9,671 for more than 50,000 tests done on August 6m the whopping 20.3% positivity rate is definitely concerning. The number of active cases are up and climbing and are close to 80,000.

ICU bed utilization in the National Capital Region is at 63%, higher than the previous days and week.

Total new deaths at 287 puts the case fatality ratio for outcomes now to 1.84% (Note that the author uses the outcomes – recovery and deaths, and not total number of cases, as the denominator. This is a better reflection of the case fatality ratio because the total number of active cases have no outcomes yet. When the healthcare system becomes overwhelmed, this may tilt the balance in favor of poorer outcomes than recoveries).

Okay, so here’s where I cannot understand the discrepancy. While the Health Agency announced 9,671 new cases yesterday, the data drop reveals 9,753 cases. So much for addition and subtraction. I only wish that someone vetted all this information before releasing them.

NCR continued the lead with 2,352 (24%) of the total cases followed by CALABARZON and Central Visayas. Central Luzon came in fourth with quadruple digits as well. Northern Mindanao, Western Visayas and Davao Region had more than 500 cases.

Cebu province led the provinces, reporting more than 1,300 cases. They had more cases than the total cases of Cavite and Laguna combined.

On a LGU level, Quezon City continued to lead with 431 cases followed by Cebu City. Twelve of 17 LGUs in NCR were among the top 20 cities with most cases in the country. Three top cities in Cebu made it to the top 20 cities as well.

OCTA MONITORING REPORT

As Mega Manila breached 2,800 cases yesterday, the 7-day average is up at more than 2000 new cases daily. With this incline, the reproduction rate moves up to 1.8 from 1.56 a week ago.

Compared to the second surge last March, the quick increase in cases can be attributed to the rise in delta variant locally. This can only be extrapolated based on what data has been provided by the Health Agency as the Philippine Genome Center will certainly be unable to sequence all RT-PCR samples.

While the ICU occupancy is considered still “safe” at 59%, this is a tremendous rise over the past two weeks.

As NCR is back into its third ECQ since the start of the pandemic last year, we will still see a continued rise in cases in the next week (or so) as the number of active cases also rise disproportionately. The positivity rate is critical considering that more than 50K tests are done, yet we are yielding positivity between 16-19%.

Unlike the surge in March this year, hospital utilization and severe and critical cases requiring admission hopefully slows down as more people in NCR have been vaccinated over the period of March to August and that the number of patients who have had previous COVID-19 infections (more than 1.4M have recovered) may still have immune protection from the previous infection.

To appreciate better the OCTA data, see the week in summary below.

THE WEEK IN REVIEW

Without a doubt, we are back in our third major surge. When cases plateau, that is usually a precursor to a “surge” or increase in cases. As explained months ago when we saw the numbers fall, the country needs to maintain that momentum using the reproduction number as the primary indicator in continuing to bring down the cases, especially with the fact that the vaccination roll out is not as wide and as fast as expected.

From the graph below, one can see the decrease in cases after April and a sudden hunchback rise in cases in May and June from regions outside NCR, particularly in the Visayas and Mindanao area. That pattern was also seen in the surge of August of 2020. After a stricter lockdown in the National Capital Region, the regions outside of Luzon accounted for the uptick in cases.

Unlike the first surge last year, however, this was more manageable and easier to bring down considering that we came from a lower baseline. The second surge in March of this year could have been averted had a stricter lockdown been called earlier by 2-4 weeks. The take home lesson from the recent surge was declaring a lockdown at the first sign of a surge. And a plateauing of cases will always be the forerunner for a surge.

The entry and rise of the delta variant is undoubtedly responsible for the current ‘exponential rise’ in cases. That is because we were unable to maintain the Rt. All eyes should be kept on that variable and any increasing trend is a foreshadow to a most likely future rise in cases. This was seen locally with the recent surges in Mindanao and Visayas. Rubbing salt to an open wound is the fact that our numbers have not gone down to levels we saw before the March surge. We were at 5000 daily cases before hitting this new high.

For the nth time, the government should use this time to increase testing capacity in the country. Antigen swabs test kits for patients that have one or a constellation of the 15 key symptoms of COVID-19 should be used as their sensitivity and positive predictive value in patients who are symptomatic are high. Rapid diagnostic tests during outbreaks help identify patients that need to be isolated/quarantined faster than RT-PCR results, the latter of which are overwhelmed and take days before the tests come out during surges. The Health Agency can opt to do RT-PCR in documented rapid swab positive patients later on or just include them in the daily statistics.

Testing is a key component at managing pandemics. Without testing, there will be no contact tracing done and patients who are sick will continue to infect other people.

While the country has slightly more tests done this week, the positivity rate is also up. To bring the positivity rate to <5%, daily tests should average more than 120,000.

While it is true that many of our Asian neighbors (and other countries globally) are seeing a rise in cases, some are slowing down that increase and resorting to lockdowns as well, as they grapple between deciding on how to maintain the delicate balance of choosing an overwhelmed healthcare system or an economic downtrend.

In the graph below are the same countries noted above with rising cases. Notice that while the cases continue to rise in almost all countries, the reproduction number has slowed down in many, with countries like Indonesia, Singapore and Taiwan maintaining their Rt <1.0. By bringing the reproduction numbers below 1, you don’t only slow down the rise but eventually see a decreasing trend in the daily cases, eventually falling to manageable levels over a period of time. The higher the number of daily new cases, the longer it will take to bring down the numbers to manageable levels enough to reopen the economy.

Vaccination and the delta variant has been the ultimate challenge at this time. The infographic below shows how the delta variant has taken over as the predominant variant of concern circulating in various countries and the share of people who have been vaccinated against COVID-19, regardless of vaccine brand.

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