Friday, May 7, 2021

In daily Covid report, precise meanings of technical terms are critical; DoH must share them


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First word
THE Department of Health has made its daily report on the Covid situation in the country so bland and cut-and-dried, it emits no light on the nation’s travail. Health Undersecretary Maria Rosario Vergeire herself looks a little bored by her daily media briefings.

Last Saturday, she intoned: “The Philippines reported 9,226 new coronavirus disease 2019 (Covid-19) infections, bringing the total tally to 1,046,653 as four laboratories failed to submit data on time. According to the Department of Health (DoH), this brought the active cases in the country to 72,248. Of this, 94.9 percent are mild, 1.7 percent are asymptomatic, 1.4 percent are severe and 1.1 percent are in critical condition.”

The DoH also announced that total recoveries climbed to 957,051 after 10,809 more patients recovered from the illness while the death toll increased to 17,354 with 120 new fatalities.

No doubt, yesterday’s report was more of the same.

The daily briefing has been reduced to a formula now: total tally of confirmed cases, number of new infections, number of active cases, number of deaths and number of recoveries.

There is no breakdown of the cases by geographical area, or an indication of which age groups are being hit. No perspective on the national situation.


The assumption is that after one year of the pandemic, we, Filipinos, should know by now what the terms “active cases,” “recovered cases,” “confirmed cases” and “new infections” mean.

The truth is these are technical terms and concepts of a complex reality, and they are critical and useful in understanding what we are living through and where we stand.

Active and recovered Covid-19 cases
There is a lucid article by Ms. Lisa Cornish in the Devex website that explains what we need to know about “active” and “recovered” Covid-19 cases. She wrote:

“Globally, the number of confirmed Covid-19 cases has passed 50 million, according to Johns Hopkins University’s Coronavirus Resource Center, with over 1.2 million deaths. But the data also shows that 65 percent of confirmed cases have recovered to date, with 32 percent remaining ‘active.’”

In assessing the global situation, active and recovered cases appear to provide a more accurate picture to understand the current crisis. In India, reporting on the recovered cases — including 1 million recoveries within 13 days — enables the conversation to move beyond the alarming totals.

More than 8.5 million cases have been confirmed in the country, impacting 6 out of every 1,000 persons. But just 6 percent are active, according to official national statistics. Indonesia is also promoting recovered statistics as part of media engagement, highlighting “cumulative cures” that continue to increase daily.

The challenge of reporting on active and recovered cases becomes immediately evident while reviewing the Covid-19 dashboard created by the World Health Organization (WHO) — active and recovered cases are missing from country and global reports.

“WHO is monitoring the pandemic at global level via the number of cases and information provided by [member-states] themselves,” a WHO spokesman told Devex. “The number of cases who recover after the disease is assessed differently in every country. (Member-states) are using different and complementary information systems to monitor the epidemic and the data quality might have been assessed in [member-states] for in-country use and is not systematically shared with WHO.”

“[Recovered cases are a] more important metric to track than confirmed cases.”

Inconsistencies in methodologies exist in reporting these figures both between countries and even between jurisdictions within a country creating a challenge when reporting at the global level.

When is a patient considered recovered?
Tom Duszynski, director of epidemiology education with the Indiana University-Purdue University Indianapolis, explained that a patient is considered medically recovered from Covid-19 after antibodies fighting the infection have successfully contained the virus, preventing the virus from replicating and supporting recovery. When they have no long-term health effects or disabilities, they are considered recovered.

Defining that in data, Duszynski said, is more challenging. Some health agencies are more cautious than others in defining a recovered patient.

In May, when the US state of Arizona sought to release information on recovered cases, officials faced challenges with no standard definitions of recovered — an ongoing challenge. The sheer numbers of cases also meant that automation was required to define this based on knowledge of the virus and its impact rather than medical tests confirming the patient had recovered.

In Alberta, Canada, Alberta Health has defined a recovered case as one where 14 days have passed between a confirmed case and no required hospitalization or additional treatment, 10 days since a hospital discharge, or two negative tests at least 24 hours apart.

In Australia, definitions between internal jurisdictions can differ. “States and territories are providing the Department of Health with a daily figure on the number of cases that they have assessed as having ‘recovered’ from their Covid-19 infection,” a spokesman for the Australian Department of Health informed Devex . . . .

High-income countries are more likely to make their definitions available. In low- and middle-income countries, including Papua New Guinea, statistics on Covid-19 recoveries may be published but there is no publicly available information on how it is defined and tests required to confirm recovery.

Where active cases are highest, recovery is not reported.

Creating an even bigger challenge is the reporting of active cases where there is no, or questionable recovery data.”

What does a case of Covid-19 really mean?
More important, Carl Heneghan, professor of evidence-based medicine at the University of Oxford, has raised a fundamental question on what countries mean when they talk of “a case of Covid-19” within their territories.

In an article in the Spectator magazine in the United Kingdom last year, he wrote: “What’s in a name? That which we call a rose by any other name would smell as sweet,” wrote the Bard. He was referring to a rose which is a rose, instantly recognized by its fragrance and its appearance. But a case of Covid-19 does not fit the metaphor, because it differs wherever you look.

In the course of our evidence-gathering activities, we have gone through a few thousand papers reporting studies on all aspects of Covid-19 spread. We found that not very many defined a case of Covid, which is a sign of sloppiness when that is what you are looking for. Those that did, reported different definitions and ways of ascertaining what they meant by a “case.”

Now, this may seem a pedantic academic remark, but in reality, it underlines the chaos, which has crept into Covid-19 science and decision-making. After watching a briefing by the UK Chief Medical Officer Chris Whitty, where he described his worry about the increase in cases and compared the situation in the United Kingdom to other countries, we asked the question: What does a Covid-19 case mean and how do different nations define a case?

We looked at the definition of a case given by the WHO, the United States and European Union Centers for Disease Control, China, Italy, Spain and France. We only tapped official websites and what came out was a concoction that did not smell like the Bard’s rose.

The UK government definition is based on clinical symptoms and testing is recommended for cases who are well enough to remain in the community . . .

We have already written about the inappropriate use of the PCR test as currently used, which is pregnant with consequences. Arbitrary thresholds may be so high that the United Kingdom may be heading for perpetual lockdown, as every minute fragment and debris of the coronavirus will count as positive. We deduce that a reported “case” is most probably simply the result of a positive PCR test. The new guidance is meaningless unless it provides a clear threshold for the limits of detection . . .

France, on the other hand, has an emphasis on clinical signs and symptoms.

Enter Spain with a layered definition. A confirmed case may have an active infection (a clinical diagnosis backed up by PCR or antibodies) or be asymptomatic (based on positive PCR). No definition of PCR thresholds is reported.”

Clearly, Philippine health authorities have to study and learn more about SARS-CoV-2 and the pandemic that it has ignited. National communications at this point is rudimentary and shallow. There are plenty of articles and studies on the pandemic available online, but no one in our health bureaucracy has risen to the challenge.



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