Almost 300 new COVID-19 cases were reported yesterday after a relatively massive day of testing. Photo from ABS-CBN News
Culture Spotlight

While 8,000+ tests led to a jump in new cases overnight, recoveries are up

The number of tests done yesterday was far higher than the weekly average—a good sign that might mean better patient care and contact tracing. BY BENJAMIN CO MD
ANCX | May 11 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.

We’re back to the rollercoaster ride of data. This can be attributed to the higher number of people getting tested lately. As mentioned, the more testing done, the higher the number of cases we expect. We’ve had an average of 6,700 tests done daily in the past week with more than 8,000 tests done overnight alone! Hopefully, the “mass testing” now translates to better patient care and contact tracing in the community.

Testing capacity from April 4 to May 9, 2020

Number of tests conducted, individuals tested, positive and negative individuals.

Of the 173,352 total tests done so far in 158,384 individuals only 9 percent yielded positive results. The remaining 91 percent tested negative. 

The DoH reported 292 new cases, 75 new recoveries and 7 new deaths. Compared to the global confirmed cases, the Philippines contributes to 0.26 percent of the cases and 0.26 percent of the deaths from COVID-19 in the world.

Two things to consider: 

(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. Deaths and recoveries are on the average, announced publicly eight days after the event. 

(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 by at least 48 hours (the earlier the better). However, the test results released from government facilities range from 3-14 days, probably due to an overwhelming number of tests being conducted when compared to private hospitals where fewer number of tests done.

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

Comparison of daily new daily cases, deaths and recoveries. There are now 2,725 closed cases

Instead of using a linear graph to determine if we are “bending” the curve, a logarithmic scale can best illustrate whether the mitigations we have put in place are actually bringing down the number of cases. The figure below shows that after more than 40 days since the confirmed cases reached 30 per day, we have begun to slowly bend the curve. 

Plateauing is not similar to “flattening” a curve. “Bending” the curve is the only indicative parameter that we’re winning the war against this virus. It provides a sense of closure to one of the most difficult wars we had to battle. Only when we bend the curve can we begin to look forward to some “normalcy” in our lives. In short, the numbers have to go down. 

Figure 4 below shows a clearer picture comparing Singapore, the Philippines and South Korea. Singapore and South Korea saw a sudden surge in cases after easing their lockdowns. The Philippines maintains its current trend.

Are we bending the curve? Data on the Philippines. X axis shows the number of days since confirmed cases first reached 30/day. Y axis is logarithmic scale. (Comparison with data from Singapore and South Korea.)

The case fatality is down at 6.55 percent (vs 6.77 percent world average vs 2.44 percent ASEAN average) and the recovery rate up at 18 percent (vs 35.7 percent world average vs 20 percent ASEAN average) for the day.

Doubling time lets us know the number of days it takes for the confirmed cases (or death rates) to double and can be determined linearly or exponentially. A logarithmic scale is the ideal graph to use. Figure 5 below shows that the doubling time in death rates is around 8.2 days. The growth rate of cases is now at its lowest at 2.25 percent (based on the seven-day average).

Logarithmic scale of fatality rate in the Philippines. Y axis is the exponential growth since the first 5th death (March 14, 2020) and the X axis shows the number of days since the first fifth case. The doubling time using logarithmic scale is ~7.5 days.
 

DOH Reporting

More than half (397) are posthumous results. This is the number of people who have passed away before they were declared positive for SARS-CoV-2.

On the average, it takes almost nine days before a recovery is announced publicly (almost 50 percent are reported after eight days).

On the average, it takes more than eight days for a death to be publicly announced as well with 43 percent being reported after eight days.

 There needs to be more timely reporting of all the data coming in because it now seems that information we may be getting today on deaths and recoveries is a reflection of latent data more than a week. 

 

New cases per day

Of the 292 new cases announced today, ALL had tagged with their residence information. One hundred sixty-two (56 percent) were from the NCR, 74 (25 percent) from Region VII and 56 (19 percent) from other areas. Region-level data is accurate but cases by city are reported only for those that could be verified. 

In the NCR, the breakdown is as follows: Parañaque (35), Taguig (23), Quezon City (22), Pasay (15), Makati and Pasig (14 each), Manila (13), Muntinlupa (10), Valenzuela, Las Piñas and San Juan (3 each), Caloocan and Marikina (2 each). There are six cases for validation in the NCR. 

Region VII reported 68 cases in Cebu City and 6 from Cebu province.

Other areas with reports include Rizal (1), Laguna (20), Cavite (4), Batangas (14), Quezon (4), Lucena (1), Bulacan (4), Bataan (1), Nueva Ecija (1), Zamboanga City (1), Isabela (1).

Overall trend from March 1, 2020 up to May 10, 2020

The DoH website update shows the bar graph (Figure 6) for daily cases, active cases, daily deaths and daily recoveries. While there has been a decline in the past 3 days on the new daily cases, there is a sudden surge in new cases today. Total deaths have declined while recoveries continue its upsurge. 

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

 

Global statistics

Update as of 9PM Monday 11 May 2020

TOTAL CONFIRMED CASES: 4,196,263

TOTAL DEATHS: 284,034 (case fatality rate: 6.77 percent)

TOTAL RECOVERED: 1,500,269 (case recovery rate: 35.75 percent)

 

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 has passed the four million mark as previously predicted. The average trend in the past week has averaged 100,000 new confirmed cases daily with more testing being done worldwide. At the current growth rate at least 1M new confirmed cases may be registered every 10 days. This means there is a high probability that the 5M mark will be reached on or before May 19, 2020. 

Total number of recoveries is nearing the 1.5M mark with significantly greater recoveries than deaths. 

The United States of America continue to lead globally in the number of total confirmed cases at 1,367,963 with a case fatality rate (CFR) of 5.9 percent with 80,787 total deaths recorded. The recovery rate for the US is up at 18.7 percent. Among the states, New York leads almost 345,406 total confirmed cases and 26,812 total deaths with a CFR stable at 7.76 percent. Testing done in up at 9.5 M tests yesterday (28,533/M population).

While the United States may have the highest number of cases and number of deaths in the world, Belgium (16.29 percent), Yemen (15.69 percent), and France (14.9 percent) have the highest case fatality rates. 9 countries with more than > 50 cases AND zero (0) fatalities reported from COVID-19 are: Vietnam, Cambodia, Uganda, South Sudan, Rwanda, Madagascar, Mozambique, Central African Republic and Nepal for more than two weeks. 

Iceland now has the highest case recovery rate with 98.45 percent recovered (1773 recoveries, 10 deaths in 1801 total confirmed cases). Cambodia’s recovery rate remains at 98.36 percent (120 of 122 cases) with no deaths reported since their first case of COVID-19. Cambodia has had no new case since April 13, 2020. 

The median average of case fatality rates worldwide is lower at 6.77 percent. From the current data for the past two to three months, around 80 to 90 percent of patients are either asymptomatic or recover unremarkably. Depending on the healthcare system of the country and the risk age group (older or younger populations), the fatality rate is anywhere between 5 to 15 percent on the average. Recoveries far outnumber the deaths with a ratio of approximately 5.3:1.