A member of the Philippine Coast Guard guides OFWs as they arrive from Hong Kong at the Ninoy Aquino International Airport. Photo by Basilio H. Sepe, ABS-CBN News
Culture Spotlight

The DOH attributes the swell of new COVID cases to returning OFWs and repatriates

The Health Agency announced 380 new cases today, and said that we should “expect an increase in numbers in the coming days.” But our resident expert believes that pinpointing a reason is challenging given that data is late and erratic. BY BENJAMIN CO MD
ANCx | May 27 2020

Infectious diseases and clinical pharmacology expert Dr. Benjamin Co has been thankfully breaking down coronavirus numbers in his personal blog since the outbreak started. The perspective he provides is informative, and comforting in those who are craving for a clear picture of how we are faring against the virus. Dr. Co will share daily updates and analysis of the Department of Health reported numbers with ANCX. 

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Refer to the link DOH.gov.ph  or up-to-date data or to COVID19.gov.ph. (The latter is not a secure site.) The new site for the Department of Health is user friendly, provides more information where a COVID19 tracker is seen. Readers can check their official site where Data Drop for raw data can be found. 

One useful site is COVID19stats, where one can see most of the DoH data in graph format.

 

Another surprise, and confusion over numbers

We have had more cases yesterday and today compared to the declining trend last week. The DoH reported overnight 380 new confirmed cases, 94 new recoveries, and 18 new deaths. While there is an increase in new confirmed cases, this may be attributable to the backlogs in the reporting system (and I believe it’s difficult to correlate it statistically because of latent data). The erratic numbers today, according to the spokesperson of the agency is “attributable to some of the OFWs and repatriates, and to expect increase in numbers in the coming days.”

And while we’re at this topic on shifting the burden of added cases to this subpopulation, it was no surprise that of the 350 cases reported last night (a jump from the previous day of 258 cases), there was inconsistency in why the numbers suddenly went into fluctuation mode once more.

Last night, of the 350 new cases announced, only 295 had tagged residence information. This meant that 55 had unknown locations. Of those with tagged residence information, 276 were reported in Luzon (247 from the NCR), 3 in Visayas and 16 in Mindanao (with 10 cases coming from Davao City). 

After all the perplexity in the data for the last two and a half months, the DoH announced tonight over their Viber group that:

And we’re praying that this migration of datasets will provide a clearer picture of what’s really going on and how the pandemic is being handled in the Philippines. 

Communication efforts should aim at minimizing public confusion because no one knows the source of all these frustratingly obfuscated data. Everyone is trying to make heads or tails of a never ending saga of spikes and waves in a country that has been in the longest lockdown in the world. 

 

How we are doing compared to the rest of the world

Trajectory of several countries in days since the confirmed cases first reached 30 per day. (The Philippines is in pink.) 

Daily new confirmed COVID-19 deaths. (The Philippines is in pink.)

Daily new confirmed COVID-19 tests.(The Philippines in pink.)

The figures above show the rolling seven-day average for confirmed cases, deaths and testing done in various countries. (The Philippines is in pink.) Notice that while there are more tests being conducted in the Philippines over the past weeks, we have more or less maintained a plateau in daily confirmed cases—until yesterday when we have that uptick in the curve. The conjecture that the ECQ was helpful in not increasing the numbers, while plausible, is also questionable. If the ECQ was indeed helpful, why did the number of confirmed cases not see a decline? 

The answer—the backlog. 

While there is a noticeable bending of the curve in deaths, there still remains a significant proportion of deaths, recoveries, and test results that have yet to be reported. Nevertheless the total deaths in the country due to COVID-19 are a small number compared to deaths from non-COVID cases, which have taken a back seat ever since the start of this pandemic. 

Interestingly, while France has done less testing than the Philippines, it has managed to turn around the number of cases in their country with a lockdown that lasted less than two months. 

In spite of the varied daily reports that show an increase in the number of cases, the doubling time for cases and deaths remain low in the Philippines. As a matter of fact, based on the graphs in the figures below, our doubling time approximates every 10 days for cases and deaths, respectively.

How rapidly are the cases increasing in the Philippines?

How rapidly are the deaths increasing in the Philippines?

It is important to bear in mind that the Philippines contributes to only 0.25 percent of the total confirmed cases in the world and 0.25 percent of the total cases of deaths attributable to COVID-19. A very low number considering that other nations that have more resources are faring less better than us. Deaths due to COVID-19 in the Philippines make up 0.00082 percent of the total population. Total confirmed cases make up 0.013 percent of the Philippine population.

The global picture for COVID-19 deaths per million people as of May 27, 2020. 

 

Good news and bad news

The announced new cases, recoveries, and deaths are the tally of reported cases for the day. 

Case fatality rate is lower at  6.0 percent (vs 6.18 percent global average, vs. 2.46 percent ASEAN average) and recovery rate is steady at 23.3 percent (vs. 42.9 percent world average, vs. 47.2 percent ASEAN average) for the day. 

While we aim to target more than 10,000 tests a day, we’ve actually gone down in numbers for patients being tested. On May 25, the figure below shows that 315,363 total tests were conducted, up from 307,000 cases the previous day.

Total Tests Conducted as of May 25, 2020

To say that we are controlling the pandemic will require fulfillment of two parameters. The number of confirmed cases and the number of deaths must have the same trajectory. As long as there are active cases in the community, there will be ongoing transmission of the virus and the potential to cause disease. 

Whether we like it or not, the prolonged lockdown has affected not only the economy, but other health issues of Filipinos. We have bought enough time to be ready for a “new normal.” The question is, are Filipinos socially responsible enough to live differently moving forward? 

We look forward to the COVIDKAYA system tomorrow and hope that with the transition to the new site, we will be excited to provide better and more understandable information to the public.

To get in touch with the Department of Health, the COVID hotline is (02)894-COVID loc 1555.

Disclaimers on the data: 

(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 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 percent reported after eight days and more) and deaths averaging almost 9.5 days (with around 46 percent being reported after eight days or more). 

(2) Depending on where testing is done, RT-PCR test results take an average of one to two days to process. Barring any delays, all tests done should ideally be released within 48 hours (the earlier the better). However, the test results released from government facilities range from three to 14 days, probably due to an overwhelming number of tests being conducted when compared to private hospitals.

 

Global statistics

Update as of 8PM 27 May 2020 (Wednesday)

TOTAL CONFIRMED CASES: 5,704,077

TOTAL DEATHS: 352,669 (case fatality rate: 6.18 percent)

TOTAL RECOVERED: 2,447,424 (case recovery rate: 42.9 percent)

https://www.worldometers.info/coronavirus/

Total cases worldwide

Note that every reference has its own cut-off time for reporting. For the global data, WorldOMeters is used as its reference.

The total confirmed cases is close to the 5.5 million mark. The trend in the past week has begun to average 120,000 new confirmed cases daily with more testing being done worldwide. At the current growth rate, at least one million new confirmed cases may be registered every eight to nine days. The six million mark is projected to be breached on or before May 30, 2020. 

Daily confirmed cases since December 31, 2019. The last time we looked back at the lowest numbers was on February 24, 2020. It has been an upward trajectory since and has plateaued at >80,000 confirmed cases per day since April 5.

The United States of America continue to lead globally in the number of total confirmed cases at 1,725,808 with a case fatality rate (CFR) of 5.83 percent after surpassing the 100,000 mark with 100,625 total deaths recorded. The recovery rate for the US is up at 27.8 percent. Among the states, New York leads with 373,622 total confirmed cases and 29,451 total deaths with a CFR of 7.88 percent. 

Brazil remains in second with a CFR of 6.23 percent. Russia is in third with a CFR of one percent. India remains in the 10th spot with 151,876 total confirmed cases, but a low CFR of 2.86 percent.

As countries ramp up testing in various degrees, more new confirmed cases are being reported. This means that with more testing and aggressive contact tracing, we are now able to identify patients who are asymptomatic or pre-symptomatic and are potentially infective to the vulnerable population. This explains why, with more testing, we now see a better picture of the extent of the pandemic. With more testing, the death rates go down. 

The median average of case fatality rates worldwide has declined further to 6.18 percent. (It was 6.21 percent yesterday.) For the past two to three months, around 80 to 90 percent of patients are either asymptomatic or have mild disease and recover unremarkably. 

Recoveries far outnumber the deaths with a ratio of approximately 7:1. (The ratio of recoveries continues to increase, and will reassuringly do so, over the deaths because of increased testing.)