The second to the highest new cases announced in a day since April 2021 is today.

The Health Agency reports 14,249 new cases pushing the active cases a tad shy of 100,000 active cases. This apparently has put the healthcare system in various localities in critical zones as the ICU beds in the NCR fill up to 71% (and 70% nationally).

With more than 52,000 tests only done last August 12, almost 25% positivity rate was recorded. Meaning 1 in every 4 patients swabbed would likely test positive.

With 233 new deaths, we now pass the 30,000 number of people who have passed away from COVID-19. It would also be better if the Health Agency reported the case fatality ratio more realistically by using outcomes as the denominator. They compute the CFR using the total cases as the denominator, making the case fatality ratio look lower at 1.74%. In reality, the denominator is best represented by the total outcome (in this case, those that have recovered vs those that have died). We cannot presume the outcome of the active cases as good, considering that the ICU utilization has now crossed the 70% mark and that the active cases are almost 100,000. The corrected case fatality ratio based on outcomes stands higher at 1.85% today.

With today’s total cases, NCR accounts for 27.8% of the total cases nationally. Together with CALABARZON and Central Luzon, these three regions make up 58.8% of the country’s total for the day. Other regions are seeing rising numbers once more as all regions, except the BARMM report triple or more digits.

Cebu lands again on top as the province in most cases. Today, four provinces in Region IVA are in the top ten provinces – Cavite, Laguna, Rizal and Batangas. Two provinces in Central Luzon join the top ten as well – Bulacan and Pampanga.

At the level of the LGU, 13 of 17 LGUs in NCR are in the top 20 cities with most cases for the day, led by Quezon City, Manila, Caloocan City, and Makati. In fifth spot is Davao City, which is seeing a rise in cases once more.

OCTA MONITORING REPORT

With the current surge, the OCTA monitoring report for August 7-13, 2021, shows the top 40 LGUs ranked by incidence rate (or average daily attack rate) in the table below. Those highlighted are areas at critical risk. This is led by Navotas with a 215% increase in cases and an ADAR of 47.67 per 100,000 population. Tuguegarao, Mariveles (Bataan), Makati City, Santa Rosa (Laguna), Lapu Lapu City (Cebu), Pasay City, Imus (Cavite), Malolos (Bulacan), Cebu City, Cagayan de Oro, General Trias (Cavite) and Meycauayan (Bulacan) have ADAR of > 25 per 100,000 population.

The next 27 LGUs are all at high risk with ADAR > 10. Only Antipolo is at moderate risk with a 7.51 ADAR.

Positivity rate in the Philippines is at 22% (Rt = 1.45). The positivity rate in the NCR is lower at 19% but has a higher reproduction number at 1.85 than the national Rt.

There is no good news.

Friday the 13th ends with unsettling report of 13,177 newly announced cases. The additional bad news is that, of more than 57,000 tests done last August 11, 23.6% of them were positive. Which means that we brace ourselves for more cases in the upcoming days. Please remember that the new cases are not the same are the cases based on the tests done. They are two separate information – one on testing results and the other on newly verified cases.

The new cases now pushes the active cases closer to the 100,000 mark.

With 299 deaths announced today, the case fatality ratio for outcomes is at 1.84%.

While NCR stays on top, it is the CALBARZON area that is fazed with high cases especially Cavite and Laguna that are inundated as their hospitals see full occupancy. NCR now owns 27.3% of the total cases today. Together with CALABARZON and Central Luzon, these three regions account for two-thirds of the COVID-19 cases today.

Cavite is on a three-day streak of more than 1,000 new daily cases (not counting the backlogs of the Health Agency). The provinces of Cavite and Laguna alone were responsible for almost three-fourths of the cases in Region IVA.

Quezon City had a whopping 735 new cases in a single day, with most the LGUs in the NCR seeing triple digit numbers. Ten of 17 LGUs in NCR were among the top twenty cities with most cases. Three cities from Cebu were also in the top twenty, while three cities in Cavite and two cities in Laguna made it to the list.

OCTA MONITORING REPORT

The immediate neighbors of NCR are on the top of the heap among provinces with most cases for several days now. Not withstanding the delayed reporting of actual cases from the Health Agency (with the thousands of backlogs in its data drop), it is worrisome that the IATF declares a less stringent in the CALABARZON area.

While it is the NCR that is and has remained the epicenter of any surge in the country, it is undeniable also that the provinces that annex to the NCR with a very thin line demarcating the borders would carry the same risk the closer that boundary is. After all, it is the enclave for homes and industrial parks and warehousing for the offices of businesses in Mega Manila, where labor, rent, and taxes are lower than parking them in the highly congested Mega Manila.

Which makes common sense that these areas would primarily be affected during a surge in NCR. It is also the same community that utilizes (and usurps) the limited healthcare system of the NCR as those that can afford to be hospitalized in Mega Manila tertiary hospitals will have their sick patients admitted here instead.

In today’s report, CALABARZON is the spotlight as the 16 LGUs enumerated show a marked increase in cases, including incidence rate, hospital beds and ICUs filled to the brim in the majority.

To consider them lowering their quarantine status at this point makes no sense.

The Health Agency reports high of 12,439 new cases today pushing the active cases to an all time high of more than 87,000.

Tests done on August 10 were more than 57,000 but the positivity rate was at 22.5%. Meaning, of every 100 patients tested, more than 22 tested positive (or 1 positive for every 4-5 patients tested).

Total deaths reported today is 165. The case fatality ratio for outcomes is at 1.83%.

NCR now accounts for almost 30% of the total cases in the nation. Together with CALABARZON and Central Luzon, they make up more than 60% of the cases for the day. Four regions report quadruple digits as the country sees a continuing rise in COVID-19 cases.

Cavite continued to lead on a provincial level, accounting for almost 50% of the total cases for Region IVA alone.

On an LGU level, Quezon City led the day to make 13 of 17 LGUs from NCR be included in the top 20 cities with most cases.

The country reports 177 new cases of the delta variant out of the 372 sequenced on August 11. It is important to remember that newly announced cases do not mean that they occurred today. It is only being reported today based on what was sequenced on the date announced. The delta variant now makes up 47.5% of the variants reported on August 11, 2021.

OCTA MONITORING REPORT

With increasing cases in various parts of the Philippines, the top 40 LGUs with most new cases based on the 7-day average from August 5-11 are in the graph below. The Philippines Rt is now at 1.41 while the NCR is up at 1.76. The positivity rate of the country is critical at 21%, while that of NCR is high at 17%.

Only 2 cities saw a decline in the 7-day average – General Santos and Laoag. All the rest had double digit increase in cases.

In terms of ADAR or incidence rate, those considered critical are: Cebu City, Makati, Lapu Lapu City, Imus (Cavite), Pasay City, Santa Rosa (Laguna), Navotas, Malolos (Bulacan), Tuguegarao, Mariveles (Bataan), Kalibo (Aklan), and Laoag (Ilocos Norte).

ICU utilization is at critical risk for Cebu City, Cagayan de Oro, Taguig, Las Piñas, Imus (Cavite), Dasmariñas (Cavite), Muntinlupa, Iloilo City, General Trias, Tuguegarao, Cabuyao (Laguna), San Fernando (Pampanga) and Meycauayan (Bulacan).

With only less than 40,000 tests done August 9, 2021, a positivity rate of 21.9% is very high. What’s worst is that the Health Agency announces 12,021 new cases today, pushing the active cases to more than 80,000.

Total new deaths announced is 154 today.

Health care facilities are once more being deluged with ICU bed occupancy at 69% in the NCR and 68% nationally.

The NCR continued to contribute heavily to the daily tally accounting for 26% of the total COVID-19 cases for the day. Together with CALABARZON and Central Luzon, these three regions brought in 60% of the cases for the day!!!

Cavite province had quadruple digits and led on a provincial level. This was followed by Cebu and Laguna, respectively.

On a LGU level, Quezon City led once more with close to 600 new cases. Nine of 17 LGUs in NCR were in the top twenty cities with most cases. All cases in the top twenty are triple digits and the fewest cases in the 20th spot was Lapu Lapu City with 142 cases for the day. Four cities in Cavite made it to the top 20 list – Imus, Dasmariñas, Bacoor and General Trias.

OCTA MONITORING REPORT

The reproduction number in the NCR slowed down as of August 10, 2021 slowed down to 1.74. But the numbers are still high, and the situation remains volatile at the moment as the ICU occupancy in Mega Manila begins to build up. The ICUs in the NCR may breach the 70% critical level by the weekend.

It used to be called low Tuesdays. That’s because the data announced on Tuesdays are from tests done on a Sunday. Last August 8, only 33,070 tests were done. Driving a whopping 21.9% positivity rate! That meant, more than 1 in every 5 people tested, tested positive.

The Philippines has 8,560 new cases today and 92 new deaths announced. At the rate of new cases, we will most likely exceed 1.7M total COVID-19 cases on or before the weekend.

Active cases are close to 80,000 and ICU utilization is now teetering at the boundary of the critical level with utilization up both nationally and in the National Capital Region. Several private hospitals have already declared their COVID-19 facilities (bed and ICU) full.

We expect more cases the coming days as it is only day 5 of the Enhanced Community Quarantine. Locking down early may have its benefits. After all, things get worse before it gets better.

Where are we with testing?

One of the critical indicators in addressing a pandemic is the number of tests being done to identify positive cases. The ability to test quickly is important, particularly in the face of a fitter and faster variant. The delta variant has changed the way we need to improve our testing capacity, including releasing results as efficiently as possible so that we are able to do the next important step – contact tracing.

The infographic below (from the COVID-19 tracker website of the Department of Health), shows the positivity rate since the pandemic began in 2020. The highest positivity rate of the country was in March 29, 2020 with 1,080 testing positive from 4,687 samples tested. This was forgivable considering there were only a handful of testing centers then. With the commitment of the government, the number of testing laboratories are now more than 260.

The average testing daily in various waves the country has gone through has averaged 30K-50K daily. But the concern is the weekly positivity rate, which has significantly gone up in the last March surge with a peak on March 28, 2021 at 21.7%. While we were able to bring it down over the past months, notice how steep the rise in positivity rate is. This shows the direct correlation between the number of new cases daily with the positivity rate.

We need to bring the positivity rate down by testing more including those that we contact trace.

The NCR continued to record more than two thousand cases, while its annex regions CALABARZON and Central Luzon report quadruple digits as well. These three regions alone now own almost 60% of the total cases in the country today.

Cebu province has the most cases on a provincial level. Notice that the provinces annexed to NCR have high cases as well. Cavite and Bulacan came in second and third, respectively.

On a LGU level, Quezon City kept the lead with 586 cases. This city in NCR, accounted for more than 27% of the cases in Mega Manila for the day. It had more cases than the combined cases of Cebu City and the City of Manila. Eleven of 17 LGUs in NCR were in the top twenty today. For the first time, Cavite saw three of its provinces in the top twenty. They are: Bacoor, Dasmariñas, and Imus.

OCTA MONITORING REPORT

The data of August 3-9, 2021 shows that the current positivity rate is 19% (high) in the Philippines, with the positivity of NCR up at 15%. The reproduction numbers are also increased at 1.79 for NCR.

The top 40 LGUs are shown in the table below. Only 5 did not show an increase in cases for this period. All 35 LGUs showed increasing cases. The ADAR (average daily attack rate or incidence rate) is now critical in Cebu City, Makati City, Lapu Lapu City, Pasay City, Navotas, Malls, Laoag, Tuguegarao, Mariveles and Manolo Fortich (Bukidnon).

ICU capacity is critical in 9 LGUs, high in 10, and moderate in 4.

Shockingly high with more than 50,000 tests done on August 7, 2021 is the positivity rate of 21.3%.

The shock here is that the Health Agency reported only 8,900 new cases today and miraculously 6 new deaths. That pushes the active cases now close to 80,000. The major problem is the hospital utilization in the National Capital Region which is up, with the ICU utilization at 67% or a tad shy of the critical mark of 70%.

It is likely that the 8,900 new cases announced are those that have been validated for now. The health agency has been erratic in announcing the cases for the day. For example, yesterday’s data did not tally – the total announced by the government was 9,671 but during the data drop of the DoH, there were 9,753 actually recorded.

While the province of Cebu had 1,352 cases reported for 08.08.2021, the major cities Cebu City, Lapu Lapu and Mandaue had around 750 cases only. Where did the 600 cases come from? And that becomes a problem when we just rely on data without being able to scrutinize it. It makes the modeling and prediction bad.

How did the province of Cebu end up with this data? Well let’s start off with the fact that 903 of the reported cases on August 8 were from specimen collection dates August 4-6, 2021. Four hundred and forty five (445) were from August 1-3, one was from July 31 and 1 all the way back from February 11. The right question to ask is WHY is the data (and reporting) in such disarray? The Health Agency needs to provide more transparency on how it collects data and what it announces for the day, because all projections and modeling highly depend on the data the health agency gathers and reports.

The NCR continued to dominate the day, followed by CALABARZON and Central Luzon. The share of Mega Manila for the total cases in the Philippines is up at 27% (and climbing).

Cavite is back on top among provinces with most cases, followed by Cebu and Laguna.

Among LGUs, Quezon City maintains its lead. The City of Manila, Cebu City, Cagayan de Oro and Dasmariñas (Cavite) are the others in the top five. Twelve of 17 LGUs in NCR are among the top twenty cities with most cases for the day.

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.

More cases today as the Health Agency reports 11,021 new cases for more than 56,000 tests done August 5. The positivity rate is one of our highest at 19.1%! And the active cases are up at more than 76,000 or close to 5% of the total proportion of cases with COVID19. And these are just those that are reported and recorded from RT-PCR tests done in the country.

Number of new deaths today is 162 – bringing the case fatality ratio for outcomes to 1.83%.

On the second day of ECQ in Mega Manila, we will not expect the numbers to change until 2-4 weeks later. Hopefully, it does not last longer than expected.

The NCR is front and center in today’s numbers accounting for more than 25% of the total cases for the day. Followed by CALABARZON and Central Luzon, these three regions alone comprise 53.7% of the cases for the day in the country.

Cebu province returns with the highest cases on a provincial level. Cavite and Laguna report more than 600 cases apiece and Rizal has close to 300 cases.

Among LGUs, Quezon City ran away with more than 540 cases. This city alone contributed to almost 5% of the total cases in the Philippines today. Eleven of 17 LGUs in NCR were in the top twenty, all of them having triple digits reported.

OCTA MONITORING REPORT

The weekend report for the period July 31-August 6 is not good news.

The sudden ‘surge’ in the reproduction number in the National Capital Region to 1.74 is quite disturbing. But it was expected, as the Health Agency reported the presence of the delta variant in every LGU in the region.

The top 40 LGUs in terms of 7-day average for new cases are provided in the infographic below. All data are obtained from the Data Drop of the Department of Health.

In terms of percent change, those that have seen significant (critical) rise in cases from the previous week are: Santa Maria (Bulacan), Cabuyao (Laguna), Parañaque, Pasay City, Mandaluyong, Valencia (Bukidnon), and Taguig at over 100%. Others in the critical zone include: Pasig, Imus, Muntinlupa, Dasmariñas (Cavite), Bacoor (Cavite), and Kalibo (Aklan).

The incidence rate or ADAR is critical in Cebu City, Makati, Laoag, Mariveles, Tuguegarao and Kalibo.

ICU utilization is critical in Makati, Iloilo City, San Pedro, Calamba, Tuguegarao, Cabuyao and Meycauayan. However, the ICU utilization is not real-time and does not reflect the actual situation on the ground where most of the private hospitals in the capital now filled up with sadly having to refer patients to other facilities outside of their LGU.

Here we go again.

On the first day of ECQ, the Health Agency reports more than 10,000 cases today for tests done August 4 in close to 60,000 tests done with a positivity of 18.4%. This would be tantamount to having 1 in every 5 people testing positive in the country. Active cases are up at more than 74,000. This is the highest number of active cases recorded,

A total of 247 new deaths are reported today, which puts the case fatality ratio for outcomes to 1.82%.

Hospital utilization is also rapidly increasing, with the NCR rising 2-3% on a daily basis this week.

Both NCR and CALABARZON report more than 2,000 new cases each. Central Luzon and Central Visayas reported more than 1,000 but less than 2,000 cases apiece. Note that NCR, CALABARZON, and Central Luzon alone comprised almost 50% of the total cases in the country today. Unlike the previous surges, however, the current one is now scattered all over the country with four regions reporting quadruple digits and almost all the rest triple. Three regions report more than 500 cases today – Western Visayas, Davao Region and Ilocos Region.

In a day marred by more than 10,000 cases, Cavite province takes the lead on a provincial level. Three provinces in the CALABARZON area are among the top ten provinces for the day, which, aside from Cavite, includes Laguna and Rizal. All annexed closed to the border of NCR.

On a LGU level, 11 of 17 LGUs in NCR are among the top 20 cities/municipalities with most cases. All these 11 LGUs had more than 100 cases each today. Two LGUs in Cavite – Bacoor and Imus – make it to the top twenty cities with most cases in the Philippines.

The Health Agency releases an updated information in a single day. It has also announced that all 17 LGUs in the National Capital Region have cases of the delta variant. On August 5, the Philippine Genome Center Biosurveillance Report reported 119 additional delta variant cases. This means that the percentage of delta cases did not differ yesterday and today.

With 116 new cases of delta variant added today, and the Health Agency reporting that the variant has been located in nine regions in the country, the public is expected to practice minimum health standards professed by the Department of Health.

Reports on genome sequencing are not real-time. Reports are also random and not done in all RT-PCR swabs. With a rise in positivity rate over the past days, we really need to keep an eye on making sure that the delta variant is contained, and contained quickly.

Today, the Health Agency reports 8,127 new cases for more than 56,000 tests done last August 3. Notice how the positivity rate continued to climb in spite of slightly more tests done. The active cases are also up at more than 66,000 (4.1%).

Healthcare capacity utilization is also up, both nationally and in the National Capital Region. And what a difference a week made in the number of new cases alone.

New deaths are at 196 today, with the case fatality ratio for outcomes now at 1.82%.

Today, the NCR claims 25% of the total cases for the day with more than 2,000 cases – its new high for this surge. Two regions saw quadruple digits while ten saw triple digit counts.

Cebu province had most cases on a provincial level, but oddly, Cavite, which has been in second spot for a week is is a less strict lockdown status.

Among LGUs, NCR has 12 of its 17 LGUs in the top 20 cities with most cases. Cebu City came in second among LGUs on a national scale. However, today’s numbers belong the Mega Manila. Four LGUs in NCR had more than 200 cases.

The Philippine Genome Center releases its bio surveillance report updating the previous report. This is as of August 4, 2021. Notice that of the 374 sequenced on this date, 116 (31%) were delta variant. This is an increase from the previous report on July 28 where 96 of 373 sequenced (25.7%) were delta.

Reminder in interpreting this report is that this is based on random sample collection as the center does not sequence all PCR swabs.