Relative Joy

As more countries report Omicron in their shores, the world is at pause mode on how to approach the new variant of concern. To date, almost 40 countries have accounted for Omicron.

The Health Agency today reports 543 new cases for more than 32,000 tests done on December 4, 2021 with a positivity rate of 1.7%. With slightly more recoveries, the active cases hover at 13,500 with more than 50% of them being moderate to critically ill. Notice that this sizable amount have a lot of backlog for outcome which have not been reconciled.

There are 113 deaths added today.

NCR continues to lead among regions with 102 cases today. This was followed by CALABARZON with 76 cases and Cagayan Valley with 69. The rest of the regions had less than 50 cases with 4 regions reporting single digits.

Cavite topped the provincial list followed by provinces in the north.

Among LGUs, it was Zamboanga City that had the most cases in the country for the day with 28 cases as all LGUs in the NCR see less than 20 cases. Only 4 LGUs in the NCR reported double digits, while all reported single digit cases. The fewest cases in the top twenty LGUs for the day was 5.

The Health Agency reports 603 new cases based on 35,950 tests done last December 3 with 1.8% positivity rate. The active cases are now less than 14,000 but more than half of them are moderate to critically ill.

The Health Agency adds 156 deaths today, as the number of deaths approach the 50,000 mark.

NCR had 121 cases today or 20% of the total cases in the country. Western Visayas and Cagayan Valley reported more than 50 cases apiece.

On a provincial level, all provinces reported less than 30 cases, with Negros Occidental, Negros Oriental and Isabela having 27 cases each.

Quezon City was the only LGU that reported more than 20 cases, while all the rest of the LGUs in the top 20 report less than 20 cases. Only seven LGUs report 7 digits, while the rest report single digit cases. The fewest cases today for an LGU in the top 20 was 6.

THE WEEK IN REVIEW

The past two months has been a good one, as the numbers showed a sustained decline in new cases in the Philippines. And that’s the good news. This is our best sustained decline in the pandemic. And it is worthy to give credit where credit is due. This is a story of how vaccines are able to bring down a surge and with the limited vaccines the country received at the beginning of the two surges this year, the tactical approach to covering NCR, the densest city in the country (and one of the most dense in the world), and the nearby regions and other highly urbanized regions was truly remarkable.

The drop in cases was so significant that from a 7-day average of a little over 1,000/day last week, the PH now has a 7-day average less than 500 daily new cases. The deaths remain an unresolved problem as backlogs in accounting for the outcomes of those moderate to critically ill cases still hound the agency.

Nevertheless, here is a snapshot of the summary of cases (per capita), testing and reproduction number in the country. The current 7-day average is 4.48 cases/million population, with 3 tests per 10,000 population and a positivity rate that is at its lowest at 1.9% since the start of the pandemic. This puts our reproduction number down to 0.55 (+/- 0.05), our lowest since the start of the pandemic in 2020.

Even when compared head to head with select Asian nations (the data below is on a per capita or based on the population of each country), the Philippines has single digit case per million. Indonesia has 1 per million population, while Japan has 0.8 per million population. Deaths are a different story, however, but this time, the burden is shifted to Vietnam and Singapore with more than 1.5 deaths/million population. Only Japan has <0.01 death/million population due to COVID-19.

Reproduction number in the same select countries shows that the Philippines is continuing the declining trajectory (but I feel it will plateau around this point soon), as it has the lowest reproduction number among these select nations. Note that South Korea and Vietnam continue to have R>1.0 as the former sees its highest cases since the beginning of the pandemic with more than 5,000 cases/day. Singapore has significantly and rapidly slowed down the reproduction number as the cases drop to 700 plus within a month from seeing more than 2,000 new daily cases. But that should not be a difficult task for Singapore because the country of less than 6M people have more than 90% vaccinated (>85% fully) and are able to manage the cases because of the smaller population size.

The Philippines is seeing a 7-day average of 514 new daily cases and 138 daily deaths reported as of December 3, 2021. This brings the weekend to a lower daily average than the previous weeks in terms of cases, but the backlog in outcomes among those moderate to critically ill needs to be reconciled sooner and announced in one blast.

The Health Agency announces 517 new deaths today and with more than 1,100 new recoveries, this leaves the active cases down to a little more than 14,000. Half of the active cases are moderate to critically ill. Notice that the severe to critical account for more than 3,200 of the active cases. This does not correlate with the ICU utilization rate, both nationally and in NCR.

There are 243 deaths added today.

NCR accounted for almost 1/4 of the total cases today with 121 reported. All other regions report double digits.

CALABARZON ranked second among regions, with Cavite leading the top ten provinces together with Negros Oriental. All provinces reported 25 cases or less, on a day with very low positive patients.

Among LGUs, it is Quezon City that reports the most cases with 31 new cases. All other LGUs report 15 or less cases, with 5 cases as the fewest number for an LGU to be included in the top 20 list.

The Philippines continued to report cases averaging 700/day as all areas in the country are declared Alert Level 2. In spite of the second to the lowest alert level imposed nationwide, the government (and this writer) encourage everyone to get vaccinated and to make sure that in spite of vaccination, to follow minimum health standards of wearing a proper fitting mask, avoiding crowds and congested places, avoid unnecessary gatherings, and continue to wash hands and practice proper cough/sneeze etiquette.

Today, the Health Agency reports 544 new cases today based on close to 33,000 tests done last December 1 with a positivity rate of 1.8%. The active cases are down to less than 15,000. Almost half of these are moderate to critical.

There are 235 added deaths today.

NCR accounted for 20% of todays cases, while the Zamboanga Peninsula has 78 new cases (a mix of backlog reports and recent ones). All the rest of the regions saw less than 50 cases, with two regions reporting single digit.

On a provincial level, no province saw more than 50 cases with Zamboanga Sibugay claiming 43 cases.

Six LGUs report double digits as Quezon City was the only city that had more than 20 cases at 21. All cities and municipalities had less than 20 cases and majority reported single digit with the least number of cases today at 5.

As more countries are now reporting Omicron (24 as of this writing), we need to remain vigilant on the situation as there is still paucity of data on transmissibility and severity of this new variant of concern. We probably will know more information in two weeks.

The Health Agency reports 564 new cases today based on 34,918 tests done last November 30 with 1.7% positivity rate. This is one of the lowest (if not the lowest) positivity rates the country has recorded. This also drops the 7-day average to 600 cases/day. Almost half of the active cases are moderate to critical.

There are 40 additional deaths today.

The NCR reports 104 new cases with Quezon City accounting for almost 1/3 of the total cases in Mega Manila. Central and Western Visayas are in second and third rank today with 69 and 57 cases, respectively. Cases in Central Visayas are driven from the province of Negros Oriental, specifically Dumaguete City.

It’s relatively a benign day as 7 LGUs report double digits with less than 30 cases (except for Quezon City), while the remaining in the top 20 LGUs are all single digits, with 5 cases as the least number.

The first day of December looks promising as the Health Agency reports 500 new cases based on a little over 30,000 tests done last November 29 with 2.1% positivity rate. And with slight more recoveries than new cases, the active cases drop to around 15,000 for the country. But this is still an over estimate because almost half of these active cases range from moderate to critical cases. If you look closely at the infographic below, you can see that almost 25% of the active cases (>3,500) are still either severe or critical. All these cannot be accounted for the ICU bed utilization both nationally and even in the NCR. These outcome of many of these cases have not been accounted for and the reporting on deaths is NOT real-time.

There are 167 new deaths announced today.

NCR reported 110 cases today, with Quezon City accounting for close to 30% of the cases in the region. Almost all the other regions report double digits, while four regions report single digit cases. It is important to note that there are still backlogs in the data and it is strongly advised that the agency report all the backlogs sooner than later. This is important because of the threat of the new variant. Any sudden artificial uptick in cases due to backlog can be mistaken for a ‘surge’ of unnecessary concern.

Isabela is the lone province that had more than 50 cases today.

Among LGUs, only 5 LGUs report double digits while the rest in the top 20 had single digit reports.

The last day of the month of November 2021 has the Health Agency announcing 425 new cases today – our lowest since June 02, 2020 when we had 359 cases.The Philippines now has a 7-day average of less than 750 new cases/day (this including backlogs). As reported yesterday, the data in NCR is real-time and is the reason why Mega Manila data is reliable.

The data today is based on 24,442 tests done last November 28, with 2.1% positivity rate. Active cases are at 15,800 with almost half of them moderate to critically ill.

There are 44 additional deaths announced today (with a lot of backlogs in outcome of active cases still being unaccounted for).

The NCR reported its lowest number since the pandemic with 66 cases today, or 15.5% of the total cases in the country. This was followed by Cagayan Valley and CALABARZON with 48 and 46 cases respectively. Five regions reported single digit cases.

On a provincial level, all provinces in the top 10 had less than 30 cases, with Zamboanga del Sur and Benguet in the lead.

Zamboanga City led on an LGU level with 24 cases, while Quezon City had only 18. Eight of 17 LGUs in NCR were in the top 20. Notice that the fewest cases in the top list today is 3 and there are multiple cities from North to South of the country with very low single digit cases. In NCR, 4 LGUs reported zero (0) cases – Malabon, Parañaque, Marikina and Pateros.

The week begins with 665 new cases, an all time low. The last time we saw cases this low as July 13, 2020 when the country recorded 653 cases. Today’s data is based on over 32,000 tests with 2.1% positivity rate (also an all time low). Active cases are slightly down to 16,289, but more than 46% are still moderate to critical. The analysis for this is in the white paper below.

There are 141 newly announced deaths.

NCR led today’s numbers with more than 25% of the total cases or 164 of the 665 cases today. It is also NCR that is real-time while the rest of the regions have delayed reports. The data today for NCR is accurate, but cannot be said with all the regions.

Zamboanga del Sur had the most cases on a provincial level, with all provinces in the top 10 having less than 50 cases.

Even if Quezon City takes back the lead among LGUs, none of the top 20 cities/municipalities had more than 50 cases. Only 6 LGUs reported double digits while the rest of the LGUs in the top 20 were all single digit cases, with 5 cases being the least number for the day.

COVID RESEARCH WHITE PAPER

This white paper most likely has been shared several times on social media (Twitter or Facebook) since yesterday. It’s an analysis of the active cases of the Health Agency as of November 27, 2021. There are a few things that the reader is advised when going through the data provided. (1) This is data from the daily Data Drop of the Department of Health. (For those knowledgeable about the Data Drop, it provides the whole excel data sheet of the cases including whether they have been resolved or not.) (2) The Health Agency will most likely need to depend on the Local Government Units for information on the outcomes of the active patients. Patients who may present initially as asymptomatic or mild can progress to more critical states or recover spontaneously. There is no way we can track that unless the patients are followed up on a day to day basis – something that is apparently not seen on the Data Drop. Remember, the classification of the condition of the active case is at the time of testing. (3) Backlogs in unresolved cases go way back to 2020. While it is understandable that more severe or critical cases (at the onset) may have longer hospital stays, it is highly unlikely that their outcomes would remain unresolved after 30-60 days.

As provided in the table below, there are over 1,200 cases in 2020 that have had no outcomes yet. We do no know if they are dead or alive. For the 2020 data, there are still 294 patients initially tagged as asymptomatic or mild who have had no resolution on outcome. For the moderate to critical, 1,124 cases remain in limbo.

The same interpretation can be made for the data in the first half of the year and from the third quarter (July to September 2021). The third quarter has the largest bulk of unresolved cases classified under moderate to critical. These remain unreconciled as of the publication of the white paper.

The Health Agency announces 863 new cases today as the number of deaths continue to record triple digits at 156 for the day. This is based on more than 34,000 tests with a positivity rate of 2.4% on November 26.

Number of active cases are down to a little more than 16,000 with close to 45% moderate to critical in status.

While the NCR continued to record the highest cases among the regions (it is after all the densest in the country) accounting for almost 20% of the total number in the country today, other regions continued to report double digits. Only BARMM reported single digit cases.

Even on a provincial level, none of the provinces reported more than 50 cases, with Negros Oriental having the most cases.

Zamboanga City continued to lead among LGUs with highest cases, while 8 of 17 LGUs in NCR were in the top 20 cities/municipalities with most cases for today. The fewest cases in the top 20 was 8. With LGUs reporting less than 40 cases and many LGUs reporting 10 cases and less, will we touch the 500 mark this coming week?

THE WEEK IN REVIEW

It wasn’t a bad week for the Philippines and many Asian nations. In spite of the news of Omicron as the new variant of concern emanating from Africa and now found in other parts of Europe and Hong Kong, here’s a run down on the week that was.

The 7-day average is down to around 1000 cases/day while deaths are still in the three digit numbers due to the backlogs and late death reports from the Health Agency. Many of these deaths were still months back and not real-time.

Over-all, was a good week as the positivity rate and hospital utilization rate continued to drop. The reproduction number stayed at a decent 0.7 (+/- 0.05), and has been <1.0 for the past month. As long as there is no rise in this number, we will continue to see triple digit trends in cases for December (sadly, as well as deaths because of the backlogs).

The country is faring incredibly well compared to select Asian countries. Although Singapore is seeing a large dip in its reproduction rate from 0.9 to 0.76, the slight increase in Ro of other countries just points to the fact that low numbers are stable (and will stay that way hopefully as long as we continue to accelerate vaccination and observe health protocols in spite getting vaccinated).

On a per capita basis (cases and deaths per million), Singapore continues to take the lead (but there are more cases reported for Vietnam one should remember that Singapore is a tiny nation with less than 6M people). The Philippines joined Indonesia in reporting single digit cases per million population as it recorded 9 new case/M population for its 7-day rolling average.

Unfortunately with the backlogs, the Philippines continued its lead on death reports in these select Asian nations with 1.70/M deaths.

With the global reaction to Omicron, it is best that we remain vigilant and not get too excited at reopening the borders too broadly. There will be some sacrifices we will need to make, and some of them will need to weigh benefits over risk. For now, because of the many unknowns on Omicron, erring on the side of caution is the way to go.

Preparing for a storm – whether it arrives or not – will always be the most prudent action.

Get vaccinated. And keep practicing minimum health standards.

The situation may look safe now, until you test positive.

It’s another straight day for triple digits, in both cases and deaths, as the Health Agency reports 899 new cases based on more than 37,000 tests done last November 25 with a 2.4% positivity rate. The active cases are still around 17,000 with close to 45% of them being moderate to critical. And as the announcement for deaths continues to come in aliquots, there are 188 new deaths announced today, bringing the case fatality rate for outcomes to 1.71%.

Today’s number of cases brings the 7-day average to around 1,000 (or less) new cases/day.

Hospital utilization rate both nationally and in Mega Manila are now below 27%.

The NCR owned 161 of the 899 or 17.9% of the total national cases. Two other regions reported triple digits – Zamboanga Peninsula and CALABARZON. However, the data from Zamboanga Peninsula were actually late reports. More than 60% of the data from Zamboanga were from September 2021.

This accounts for why Zamboanga del Sur was number one among provinces and Zamboanga City reporting 105 cases today, when in actuality, there were only 37 recent positive patients from November 14-25.

Nine of 17 LGUs in NCR were in the top 20 LGUs with most cases. With 7 cases as the least number of cases in the top 20, this means that if your LGU had 7 cases, it would be in the top 20 list.