It’s a Tuesday, and as expected, the new cases reported are lower at 7,379, pushing our total cases past 950,000 and the Philippines displacing Belgium for the 26th rank in the world. We remain on track to the 1 Million mark before the end of April and there is no stopping the country from reaching this milestone.

The good news for the day are the 21,664 new recoveries (they don’t wait for the weekend haul anymore), which brings down the active cases to 13.3 percent. Nevertheless, the 127,006 active cases is still quite a surmountable number considering that the cases reported are those where only PCR tests have been done. Patients who have symptoms and not tested using PCR are not reported. Patients who have symptoms and do not undergo any test at all are also not included in the daily count.

The positivity rate is slightly higher today than yesterday at 17.9 percent.

Total new deaths today was 93, bringing the estimated case fatality ratio to 1.95 percent (lower than 1.99 percent recorded yesterday) as there are more recoveries reported daily.

The sad news is that the health system continues to be overwhelmed as the intensive care units in the NCR and ward beds are past the critical level of 70 percent. Majority of the hospitals do not have space for patients requiring critical care already.

The NCR continued to lead the tally but the Rt is now down to 1.01 in Mega Manila (based on todays data) where it reported 2,784 new cases or 37% of the total in the country. While CALABARZON remains in second with 20% of the share of total cases, it is Cagayan Valley that shifted position with Central Luzon with 739 vs 692 new cases respectively.

In Mega Manila, Quezon City continued to lead but Taguig overtook the City of Manila for most cases. Eight cities reported only double digits. Twelve of the 17 LGUs in NCR were among the top 20 cities with most cases.

Among the provinces, while Cavite continued to lead, Isabela was in second spot with 406 new cases.

The Health Agency reported 9,628 new cases today, highly off-tangent from the usual Monday report. The good news is that it concomitantly reports 9,266 additional recoveries keeping the number of active cases stable at < 15 percent. The total number of cases for the Philippines is now close to 950,000, which we will inevitably cross tomorrow.

Daily positivity rate is significantly lower at 15.4 percent, but tomorrow is a Tuesday and there are likely less tests done on a weekend. We will most likely see less cases again tomorrow and hopefully Wednesday. If we are able to sustain reporting less than 10,000 new cases daily over the week, then we most likely will have lower new cases in the subsequent week. Note, however, that these daily reported cases are based on RT-PCR test results and not rapid antigen tests.

There are 88 new deaths reported today, bringing the estimated national CFR (based on outcome of those who had COVID-19) to 1.99 percent.

Hospital occupancy for intensive care is still at the critical level including the ward beds.

Even the NCR reported significantly less cases today at 3,848 (40 percent) of the total cases. CALABARZON came in second with 2,088 and Central Luzon with 1,334 new cases. Triple digits continued to be reported by Cagayan Valley, CAR, Western Visayas, Central Visayas, Bicol Region and Zamboanga Peninsula. There were 38 cases with NO known location on a regional level.

In the National Capital Region, the numbers are also seeing lower cases today. Even Quezon City had half the cases only compared to yesterday. Remarkable data came from Pasay City which saw only 87 new cases reported. Thirteen of the 17 LGUs were among the top 20 cities with most cases.

Among the provinces, Cavite continued to lead with 730 new cases, followed by Bulacan, Rizal and Laguna. All provinces in the top ten reported triple digits.

The Health Agency reports 10,098 new cases and in the weekly recovery haul, 72,607 recovered this week (based most likely on a time-based recovery status). This leaves 15.1 percent active cases or 141,089 who have still neither recovered or resulted in demise. This brings the case fatality ratio based on outcomes to 2.0 percent, with the DOH reporting 150 new deaths.

The positivity rate is slightly lower now at 17.2 percent but may not be an actual reflection of everyone getting tested by RT-PCR. Evidently, because of the increase in number of daily cases, there are those that may have shifted to using rapid antigen swabs when they are symptomatic. These reports are not generated or reported to the Health Agency.

The NCR continued to lead on a regional level with 46 percent of the total. CALABARZON was in second with 2,174 cases (22%) followed by Central Luzon with 960 (9.6%). Triple digits were seen in the following regions: Cagayan Valley, CAR, Central Visayas, Ilocos Region, Western Visayas, and Zamboanga Peninsula. There were 47 individuals with no location on a regional level.

In Mega Manila, Quezon City led the haul with 26 percent of the total cases. Manila had 513 new cases. Eleven other cities had more than 100 cases. Thirteen of the 17 LGUs in NCR were among the top twenty cities with most cases for the day.

On a provincial level, the provinces of Cavite, Rizal, Batangas, Bulacan and Laguna were the top five. Of these provinces, 4 of the provinces were from Region IVA (CALABARZON).

With a 7-day moving average of 10,406 new daily cases for the country, the Philippines had 72,842 total cases for the week April 11-17, 2021, and 1,071 new deaths for the same week (7-day average of 153 deaths/day).

While it is a fact that the world is seeing a rise in new cases, the infographic below provides an overview of the current situation in select Asian countries, with Indonesia seeing declining trends compared to the rest. The daily new confirmed COVID-19 deaths per million population has also astoundingly increased for the Philippines making the case for using deaths/cases an implausible estimation for case fatality ration.

Testing capacity among the same select Asian countries above show that while the Philippines is testing more people per 1,000 population, the share of the daily COVID-19 tests that are positive are highest for the country with a current positivity rate averaging 20 percent (1 in every 5 tested will likely test positive).

The Philippine Genome Center has released its latest biosurveillance report with 752 samples sequenced nationally. Notice the significant increase in B.1.351 (South African variant) compared to the UK (B.1.1.1.7) and the P.1 (Brazil). Based on the report, where 6,423 cumulative samples were sequenced nationwide, 21 percent were attributed to variants of concern, with more than half from the B.1.351 variant.

Today was a typical day. The Health Agency reported 11,101 new cases and 72 new deaths bringing the adjusted case fatality ratio now to 2.19 percent in the Philippines. Note that the computation of this case fatality rate is based on deaths/(deaths + recoveries). This was used in this blog (as based on the World Health Organization) because of the very high number of active cases. The current active cases is at 22 percent or 203,710. Removing the active cases provides a more or less realistic indicator of how the Philippines is doing in terms of mortality due to COVID19, instead of using total cases (which is at 926,052) as the denominator. The method of deaths/total cases assumes that all active cases will result in good outcome and no additional deaths would occur among these active cases. When the DOH reports its weekend recovery haul tomorrow, the CFR will slide lower than the past days.

The National Capital Region healthcare capacity remains critical as ICU beds are at more than 85 percent utilized, and ward beds at 72 percent utilization.

The pandemic is not only taking a toll in the Philippines. There is a significant jump in total number of new cases in the world, with India reporting more than 200,000 new cases daily (7-day average of 189,000 cases/day). The case fatality ratio for India is at 1.37 percent, with 88.4 percent of the over 14 million total cases now resolved (resulting in either deaths or recoveries).

Brazil, on the other hand, is seeing more deaths relative to new cases. The estimated CFR for Brazil is at 2.91 percent, with only 9.2 percent active cases.

The global case fatality ratio stands at approximately 2.48 percent, as there are still more than 18 million active cases as of this report.

The Health Agency reports 10,726 new cases today. While the cases are still above the 10,000 mark, there has been a slowing down in the increase of cases. The reproduction rate needs to go down lower and faster so that the we target a Rt of <1.0 in order to achieve an actual decline. More testing has been performed in the past days with a 19.7 percent positivity rate.

There were 145 new deaths reported and again, I will reemphasize that the case fatality ratio is more accurately computed with deaths/(deaths + recoveries) because this is a more realistic CFR than using death/total cases. Why? Because the active cases are large – more than 21 percent (193,476)! Active cases will have two outcomes – recoveries or deaths. We cannot presume that the active cases will all end up as recoveries. With the 145 deaths, our actual CFR is at 2.18 percent and not 1.72 percent (which is a highly biased percentage with too many positive assumptions).

The latest OCTA Monitoring Report on the Philippine COVID-19 update shows that the Reproductive number in the NCR has improved to 1.16 for the week of April 9-15, but is still above 1.0. The average new cases for the NCR daily was 5,085 in the past week and a one week drop in growth rate to -0.4%.

Mega Manila accounted for 47 percent of new reported COVID-19 cases over the past week. The rest were divided as follows: CALABARZON 20 %, Central Luzon 11%, Cagayan Valley 5% and Western Visayas 4%. The one week growth rate of new cases in CALABARZON and Bulacan was 14 percent, while the one week growth rate in Western Visayas was highest at 97%. Cagayan Valley had a decline in the growth rate of -14%.

The table below shows the downward trends in many cities in NCR. “But while the trend has slowed in NCR, the region will continue to have a high number of new COVID-19 cases for the next weeks, which means demand for hospital care in the NCR will not ease very soon. The largest one-week growth rate in the NCR plus was in Kawit, Cavite which had 83 new COVID-19 cases per day over the past week, an increase of 417 % compared to the previous week.” In Mega Manila, it was the city of San Juan that continued to have the highest growth rate of 76%.

We were headed to break 900,000 cases today. It was inevitable. With 11,429 new cases reported (yes, we’re back to the real numbers as more samples are tested). This pushes the active cases past 20 percent (183,527). As the reproduction number is still > 1.0 the average daily cases will continue to increase (albeit slightly slower than the steep trajectory seen last month). The positivity rate still hovers close to 20 percent in spite of more tests being done. The healthcare capacity in the National Capital Region continues to rise. Note that more cases will also mean a troubling increase in the number of deaths eventually, as critical care units become inundated with the increase in numbers.

The case fatality ratio is NOT 1.72 percent. While the Health Agency arrives at this number by computing the number of deaths divided by the number of cases. A better way to compute for CFR is to use the formula [deaths/(deaths + recoveries)] x 100 = CFR. This latter formula mitigates the bias due to delays in case resolution during an ongoing outbreak by restricting the analysis to resolved cases. This is particularly important at this time because the number of active cases is now more than 20 percent. Hence the denominator cannot be the total number of cases as it is presumptuous that the active cases will all recover. The denominator that should be used should be the deaths plus the cases that have recovered. These are the resolved cases. While this method does not eliminate all biases related to delayed reporting, it is a better formula for computing deaths due to COVID-19, as we still do not know the outcome of the active cases. [For further information on this, kindly refer to the link https://www.who.int/news-room/commentaries/detail/estimating-mortality-from-covid-19 .]

With the 148 new deaths reported today, the actual national CFR is 2.16 percent.

The National Capital Region accounted for 5,317 or 46.5 percent of the total cases today. CALABARZON and Central Luzon complete the triumvirate, where these three regions account for 76 percent of the cases in the country. CAR, Western Visayas and Cagayan Valley are the other three regions with more than 400 cases today. There are 82 cases with no known location on a regional level.

In Mega Manila, Quezon City accounted for the majority of the haul with almost 1/4 of the total cases. Manila was second with 623 cases. Pasig and Caloocan had more than 400 but less than 500 cases. Only Muntinlupa and Pateros reported double digits for new cases. Fifteen of 17 LGUs in NCR were among the top 20 cities with most cases for the day.

On a provincial level, Rizal overtook Cavite for the top spot. Bulacan was in third with 461 cases. All top ten reported more than 200 cases.

On a lighter note, the DOH has reported that as of April 13, 2021, more than 1.25 million doses of a COVID-19 vaccine has been administered. The 7-day average of vaccinated individuals is close to 50,000. Of the vaccines that have been distributed, 64 percent (1,093,651) have received at least the first dose, while 162,065 individuals are fully vaccinated (have completed the second dose). In the infographic below is the information from the Health Agency.

The table should be interpreted cautiously as people may think that more than three million doses have been given. Of the over 3 million doses of the vaccines the Philippines has, 93 percent have been distribution and less than half of the total doses at hand have been administered.

In the table one will see the number of doses received. This indicated the number of doses appropriated for that particular region. Beside the region are the number of first and second doses administered from that appropriated number. While the National Capital Region received the chunk of the vaccines (1,158,470), less than 500,00 have been given a first dose, while around 56,000 have been used for second doses.

The Health Agency reports 8,122 new cases and 162 new deaths for today. We will most likely breach the 900,000 mark tomorrow as there are more tests done and the positivity rate is at 19.5 percent. The unfortunate news are the ICU bed capacity in both the national level and in the National Capital Region. For the national level, it is now close to the critical level of 70 percent, while in Mega Manila, it is alarmingly high at 88 percent.

The increasing death reports over the past week is expected as the cases have averaged more than 10,000 daily in the country. In the National Capital Region alone, where close to 50 percent of the cases in the country is recorded, the OCTA Monitoring Report showed that “the CFR due to COVID-19 in the NCR from March 28 to April 13, 2021 is 5.36%, nearly three times higher compared to the CFR of 1.82% from March 1, 2020 to March 27, 2021. While the more recent CFR is based on a much smaller sample size of 284 deaths, and the CFR may still decrease as more data comes in, the possibility of an increase in CFR should not be ignored. The reasons for the increase in CFR may be due to an overwhelmed hospital care system, the presence of SARS-COV2 variants which may be more lethal, or both. Comparing the CFR before and after March 28, 2021, there was an increase from 11.8% to 28.6% for the 65 and up age group, an increase from 5.7% to 16.4% for the 60-64 age group, and an increase from 2.7% to 8.7% for the 50-59 age group.”

In todays data drop, NCR owned 3,753 or 46.2% of the total cases. CALABARZON was in second with 1,831 cases followed by Central Luzon with 811.

In the National Capital Region, Quezon City led the haul with close to 1/3 of the cases in the NCR. One can see the significantly decline in cases in the various cities in Mega Manila, but this is not reflective of the actual numbers as the reports are from lower testing on a Monday. Thirteen of 17 LGUs in NCR were among the top twenty cities with highest cases.

On a provincial level, Cavite continued to lead. This was followed by the province of Rizal and Pampanga.

You know that the data of the Health Agency is consistent (although not necessarily accurate) when they report lower numbers on Tuesdays and Wednesdays. The data for Tuesday are collated from tests done on a Sunday. As we all know, not all testing facilities are open daily or 24/7 and are usually closed on Sundays and holidays. This is true as well in other parts of the world. Because the data in other countries in the world are mostly real time, you will notice that the global cases are always lower on Mondays and Tuesdays (because most of the European and North American countries are a day back with respect to Philippine time). The bottomline is – COVID19 testing is not a medical emergency.

The DOH reports 8,571 new cases or almost a 25 percent drop from the cases in the previous days. This is the usual trend prior to the surge. Tuesdays and Wednesdays would see around 20-25 percent less cases than the average high days from Thursday to Monday. There is a slowing down in the increase of cases but we need to work at bringing down the reproduction rate to not only 1.0 but less than 0.7 (and even lower) in order to provide some order to the chaos we are current experiencing.

There were 137 new deaths reported. Positivity rate is at 18.3 percent (appreciably lower than the previous days) but the hospitals are inundated with patients where ICUs are now filled to the brim in many public and private hospitals in the National Capital Region. Isolation facilities have been added in some cities, but not enough for the rising cases in those localities.

The distribution of the “ayudas” and reports of some disorganized vaccination sites should be addressed by the individual local government units because these propagate super spreader events. While the intention to provide assistance and immunization is vital, it should be a well thought of plan (I thought that there was enough time to practice this while they were all waiting for the arrival of the vaccines), ironically is such a mess in some areas with people jockeying to get vaccine slots or hoping to be part of the QSL (quick substitution list). These two super spreader events need to get addressed promptly in order not to affect the gains of the current quarantine status.

In todays data drop, NCR reported 3,949 new cases or 46 percent of the total cases in the country. Region IVA has 1562 cases and Central Luzon with 1,116 cases. These three regions alone account for 77 percent of the total cases in the country. Cagayan Valley hauled 556 new cases, while CAR contributed 282.

Quezon City owned 1,053 of the 3,949 cases in NCR or 27 percent of the total cases today. The City of Manila was in second with 596 cases. Pasay City, Marikina, Valenzuela, Malabon, Pateros, and Navotas reported fewer cases today than the previous days. Thirteen of 17 LGUs are among the top twenty cities with most cases.

On a provincial level, Cavite continued to lead with 539 cases followed by Rizal with 511. Pampanga, which is in GCQ status has 462 cases today, higher than erstwhile leader Bulacan that reported 397 cases which is in MECQ status.

There is good news and there is bad.

Let’s start with the good. With a reproduction rate of 1.2, it means that the growth of cases has slowed down significantly. Slowing down does not mean declining cases. It means, that instead of multiplying to more than twice the number in the previous week, there will still be minor increases and seems to be headed to plateauing. The positivity rate has also declined from a week high of 25 percent to 19.5 percent today.

The bad news is that while the case fatality rate nationally is 1.73 percent, it is much higher in the National Capital Region at 2.1 percent. This finding is not unexpected. Note that the NCR + bubble, which is current riddled with an overload of critical patients is a reflection of what happens when the healthcare facilities are overwhelmed. Medical care is compromised, better healthcare access is limited, patient care is delayed, and patient outcome is poorer. The total number of deaths has passed the 15,000 mark.

The Health Agency reports 11,378 new cases but 204 new deaths. Healthcare facilities continue to be burdened with the rising cases. The active cases have continued to rise and is now almost 160,000.

Based on the yesterdays data from the Department of Health, the following top 5 regions account for close to 80 percent of the total cases of the Philippines. So far, these are the total cases based on regional breakdown with NCR, CALABARZON, Central Luzon, Central Visayas and Western Visayas having the most cases in the country.

Todays data drop showed that NCR, CALABARZON, and Central Luzon continue to bring the haul for the day with 76 percent of the total cases. Cagayan Valley, Western Visayas, CAR, Ilocos Region, Central Visayas and Bicol Region report triple digits. There were 67 cases with no known location on a regional level.

In the NCR, 15 of the 17 LGUs reported triple digits with Quezon City reporting 940 new cases. Manila and Pasig reported more than 600 but less than 700 cases. Thirteen of the 17 LGUs in Mega Manila were among the top 20 cities with most cases, with rank 1-12 all from NCR.

At a provincial level, Cavite, Bulacan, Rizal and Laguna report more than 500 cases today.

The Health Agency reports 11,681 new cases today pushing the total cases of the Philippines to 864,868. Sunday serves as the day when the recovery haul is reported, with 55,204 recoveries reported today. While this brought the total active cases to 16.9 percent, the number of reported active cases are still high at close to 150,000.

New deaths were reported at 201 for today.

Positivity rates for tests are still past 20 percent and ICU beds and isolation beds based on reports by the DOH is at past critical levels. Reports, however, from respective hospitals are more grim where many private and government hospitals in the LGUs in Mega Manila have passed the brink of despair.

While the reproductive number of the NCR is now lower at 1.24, this should not make the government and the people complacent as the IATF now lowers the quarantine restrictions to MECQ in spite of the high numbers we are still recording. For the week of April 4-10, 2021 alone, the Philippines had almost 70,000 new cases and 1,323 new deaths.

The Health Agency releases the report of the Philippine Genome Center Biosurveillance Report (batches 12-14) based on 1,361 samples sequenced nationally. While most the variants are B.1.1.1.7 (UK variant), it is quite alarming that there are more B.1.351 (South African variant) as additional cases in the latest batches. Data as of April 9, 2021 showed both the UK and SA variants dominating the type of variants that are present. Note, that not all samples swabbed undergo genomic sequencing.

The following regions continued the daily haul today: NCR, CALABARZON, Central Luzon, and Cagayan Valley. NCR owned 48 percent of the cases in the country. But these four regions accounted for 84 percent of the total cases for the day. Six other regions reported triple digits.

Fourteen of 17 LGUs in the NCR were in the top 20 cities with most cases.

Quezon City continues to dominate among the cities with most cases, Muntinlupa City is seeing a rise in its new cases. This is in relation to the population size of Muntinlupa compared to other LGUs. One must look at the numbers based on a per capita (or population size) and not simply the number of cases alone.

On a provincial level, Cavite continues to lead followed by Rizal and Bulacan. All the provinces in the top 10 report triple digits.

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With cases averaging 10,000 daily in the country, the Philippines displaces Sweden and is behind Iraq, which is experiencing a difficult second surge as well but has an average of 7,000 new cases daily. Lower than the 7-day average of the Philippines.

The weekend summary shows the current testing capacity of the Philippines. Note the fewer daily COVID-19 tests conducted within the week interval because of the Holy Week holiday and the share of COVID-19 tests that are positive has skyrocketed past the 5 percent acceptable mark.

On cases and deaths from COVID-19, the Philippines also sees a large sudden peak for deaths and cases. Cases, however, see a tinge of decline, again due to the fewer reports due to the fewer testing done during the Holy Week holiday.

The graph below provides an overview on how select Asian neighbors are faring compared to the Philippines in the COVID19 pandemic.