AT A GLANCE
Recommendations based on the data
- Testing should be expanded at the soonest possible time and should be more targeted.
- Special attention should be given to the elderly and immunocompromised who appear to be the most vulnerable group.
- While the role of asymptomatic cases in transmission is not yet clear, they should not be taken for granted since they could be spreading the disease unknowingly.
- Physical distancing should be strictly enforced.
- To date, Quezon City, San Juan, Makati, Pasig, and Manila show the highest number of cases. Testing should therefore be given priority in these areas with clear protocols, as chances of a faster spread of infection are higher. Extended community quarantine and strategic lockdowns should also be considered for identified hot spots. The importance of prompt reporting and transparency cannot be understated.
- Given limited resources, hospitals that will be used exclusively for COVID-19 patients should be given full support – personnel, funds, medical equipment, PPEs, and other critical resources.
- Intelligent decision-making should be evidence-based and guided by data. The more transparent government is, the better for all stakeholders.
MANILA, Philippines – The coronavirus outbreak has affected over a hundred countries around the world, including the Philippines. It has sparked alarm and caused governments to declare lockdowns in certain areas in an attempt to contain the exponential spread of the coronavirus.
The Department of Health (DOH) has released data which we spliced and diced and converted into maps and charts that could help authorities shape more targeted responses.
People ask whether the requirement for everyone in Luzon, for example – an island group of nearly 57.5 million people – to stay at home for a month, possibly more, is justified. What else should local government units and the national government do to contain this deadly disease?
We looked at the data and drew a partial list of recommendations above based on hard data available and inputs from an epidemiologist. The data used in these graphs are as of Friday, April 17, 4 pm, unless indicated otherwise. This page is updated daily.
Who is vulnerable?
According to the US Centers for Disease Control and Prevention (CDC), the elderly are at higher risk for severe illness due to COVID-19, the disease caused by the coronavirus.
Among the positive cases so far, 1,803 (or 31%) are senior citizens, or at least 60 years old.
Data in early published papers also showed that elderly people are “at highest risk of dying” from COVID-19, according to Dr Maria Elizabeth Mercado, a member of the University of Santo Tomas faculty of medicine and surgery teaching clinical epidemiology, and an independent research analyst.
This is consistent with local data. “If we look at the data from DOH, the age group with the highest proportion of death in individuals with infection is the elderly which is consistent with the data released by researchers in China,” Mercado said.
Among the 387 deaths as of April 17, a total of 260 are 60 years old and above, 69 are in their 50s, 36 are in their 40s, 13 in their 30s, and 9 are below 30, including the youngest death at less than 1 year old.
The DOH data does not say whether a patient has underlying conditions upon testing positive for the coronavirus. But based on news reports and DOH statements about these deaths, almost all have underlying conditions or were immunocompromised. These are listed in the table below.
Meanwhile, 8 who have exhibited severe symptoms are above 50 years old. There are also 4 in critical condition who are above 55 years old.
In the US, the CDC has prepared guidelines to prepare nursing homes and long-term care facilities in taking care of seniors who are suspected or confirmed COVID-19 patients.
In the Philippines, however, most elderly people live with their families. Seniors are also advised to take extra precautions and stay healthy to minimize their risks.
But they should not be the only ones taking precautions to prevent acquiring the disease.
Why we need the quarantine right now
While the elderly and immunocompromised are those most at risk of severe illness, it does not mean that the rest of the population cannot be affected by the disease.
So far, the DOH data shows that those in their 30s and 60s have been the most afflicted age brackets. However, the cases are spread out, from as young as less than 1 year old to as old as 101.
Males make up over half (or 54%) of positive cases.
A bigger concern for epidemiologists is DOH data that also shows not all cases were symptomatic at the time they were tested.
So far, 24% of positive cases as of March 19 (or 52 of 217) were reported as asymptomatic, or did not exhibit symptoms when they turned out to be positive for the coronavirus. Of the asymptomatic cases, around 3 out of 4 (or 38 cases) were younger than 60.
The role of asymptomatic cases in transmission of this disease is not clear.
Meanwhile, 72 positive cases (or 33%) exhibited mild symptoms.
Mercado said it’s usually the severe cases that are always reported, but there are also mild and moderate cases where “they don’t really look any different from common colds, common coughs that most of the time people dismiss.” Add to that, she said, are the asymptomatic individuals who could be spreading the disease unknowingly.
Given this, the chance of undetected community transmission “is possible, given that currently we are unable to test everyone” she added.
‘Clusters’ show spread through social networks
(NOTE: Data for this section is as of April 3. The DOH has since excluded travel and exposure histories in its COVID-19 data releases.)
The data also indicated how some cases are connected with each other.
There are at least 16 clusters of relationships involving 51 positive cases. They were either family members, or were exposed to another positive case. The biggest network so far is connected to patient PH42, who is directly or indirectly linked to 7 others. PH42 had traveled to Japan and resided in Pasig City.
There are two other big clusters centered on patient PH9 (who had traveled to the US and South Korea, and directly connected to 5 others) and PH41 (who had traveled to the US, and directly or indirectly to 4 others).
Six other positive cases in the data indicate “exposure history to a known COVID-19 case.”
At least 50 positive cases have traveled to other countries with cases of the coronavirus. Two of these – who have since recovered – had been on the Diamond Princess cruise ship that was quarantined off Japan due to multiple cases of COVID-19 onboard.
Of the 155 who didn’t have travel history, 50 had contact or were related to someone who tested positive. They reside mostly in Metro Manila, especially in the cities of San Juan, Marikina, Makati, and Quezon City.
The remaining 105 are not linked to another positive case in the DOH data. A majority of this group reside in San Juan City and Quezon City, according to DOH data.
Meanwhile, the travel histories of 3,040 positive cases were being validated or were blank in the April 3 data.
The government had already placed the country under Code Red Sublevel 2, which signifies the presence of sustained community transmission that is beyond the government’s capacity to trace.
This also prompted a lockdown, or “community quarantine” first in Metro Manila then expanded to the entire Luzon. Cities in Metro Manila that are greatly affected – like Makati City and Quezon City – have already implemented different levels of community quarantines, for example, to stem the virus’ spread.
Of the reported cases nationwide, 3,823 of 5,878, or 65%, are residents of Metro Manila. All 16 cities and the municipality of Pateros in the national capital region now have confirmed cases.
Quezon City tops the count so far, with 1,016; followed by Manila, 487; Makati City, 332; Parañaque City, 331; Mandaluyong City, 271.
There are now 1,314 cases in the rest of Luzon. A big majority of the provinces there, or 28 of 38, have confirmed cases.
So far, 150 residents from 11 provinces in the Visayas (including the 77 cases in Cebu City) and 149 residents from 16 provinces and Cotabato City in Mindanao (including the 81 cases in Davao City) have reported testing positive.
Some of these cases were travelers from other countries or visited places in the Philippines affected by the coronavirus.
Meanwhile, the homes or locations of 442 positive patients (out of 5,878) are not yet indicated.
As of the April 5 data release, 3 foreigners who tested positive in the Philippines, marked as from China before, had their residence listed as “None” again.
Starting March 25, the DOH data made the cases’ residence data more specific to the town or city, not just the province.
Moving forward, DOH should use insights from their data to plan the stages of lifting the lockdown, said Mercado. For instance, the data could be used to determine where testing should be concentrated. “The idea is not to test the whole Filipino population or everyone living in NCR, but just to test the area with high secondary attack rate (number of people getting sick after exposure to a positive COVID case).”
Having good data on this “will allow us to plot area hot spots where we recommend extended quarantine for residents living there and advise the public to avoid going to that area,” she added.
(NOTE: Data for this section is as of April 5. The DOH has since excluded hospitalization data in its COVID-19 data releases.)
Government’s basis for imposing a lockdown was WHO projections indicating that the number of patients could reach 75,000 in 3 months.
This would be catastrophic since Philippine hospitals have a combined bed capacity of only around 100,000 or 9.9 beds per 10,000 people, based on available data from the Philippine Statistics Authority. The goal of physical distancing and community quarantine measures is to “flatten the curve” or slow down the spread into levels that the system can handle.
The positive cases are currently confined in at least 131 public and private facilities around the country as of April 5.
Of the number, 31 are hospitals under DOH, 3 are hospitals under the defense department, 19 are local government hospitals or health offices (including rural health units), and the remaining 78 are private hospitals.
The confinement of 1,955 cases (out of 3,246) is not yet indicated while it is blank for 321 cases in the April 5 data.
As of March 26, at least 4 private hospitals have said they are already at maximum capacity.
With the rising number of cases, the Philippines’ health care system would be put to the test, especially when it comes to bed capacity, medical supplies and equipment, and manpower. (IN NUMBERS: What hospitals need to treat COVID-19 patients)
On March 20, the DOH designated Dr Jose N Rodriguez Memorial Medical Center in Caloocan City, the Philippine General Hospital in Manila, and the Lung Center of the Philippines in Quezon City for exclusive use of coronavirus patients. This is after medical industry leaders appealed to the government to do so.
In addition, health experts and workers have said that the government should address long-standing problems in the Philippine health care system – from lack of basic medical supplies to understaffed health facilities – to be able to craft better responses to the coronavirus outbreak and even future health crises. (READ: Little protection for government’s coronavirus frontliners)
Most importantly, Mercado pointed out the importance of providing frontliners with personal protective equipment or PPE.
Managing tests, too
For tests to be conducted on more people, Mercado said that once the kits from the UP National Institutes of Health are approved, DOH should “advocate that the government covers the cost for testing” to aid Filipinos who might not be able to afford it.
With limited movement while in a lockdown, Mercado also suggested that people who transport food or those who still need to go to work to provide for their families be prioritized for the tests.
More data transparency
Mercado said that while the DOH shared enough data, it could help if the data is organized and structured better to minimize errors or deviations.
DOH “should ensure that the individuals who will be taking charge of reporting and coordinating with them are well-trained,” said Mercado. Hospitals “should be briefed and trained on how to handle the COVID cases so that there is only one standard operating procedure,” she added.
“It is also paramount that these data have a codex/codebook that explains what variable names (the headers) contain so that experts can use their data better,” she added.
For instance, she said, “If I wanted to see the average time it takes from initial symptom manifestation to death, or to check incubation period, I can’t do it with the current database” from the DOH’s nCoV tracker.
Information is a very powerful tool. We should use it, Mercado said. Data collection is critical, she pointed out, not just for operational guidance but also for historical purposes.
“We should record the measures we adopted, how effective they are. In so doing, we learn from it.” – story by Michael Bueza and visualizations by Akira Medina and Paul Fernandez/Rappler.com