Phl’s COVID-19 Death Rate Above World Average

Health Secretary Francisco Duque III admits that not enough testing has been done. A health expert warns that people without symptoms and are not being tested may be spreading the disease.

Motorcycle riders crowd the checkpoint set up at the boundary of Antipolo and Marikina cities along Marcos Highway on the second day of the enhanced community quarantine’s implementation in the entire Luzon on Wednesday, March 18, 2020. Photo by Walter Bollozos, The Philippine STAR

The inability to conduct enough testing for coronavirus disease 2019 (COVID-19) has been seen as the likely reason for the Philippines having one of the world’s worst death rates since the outbreak – in some days double that of the global average.

Health Secretary Francisco Duque III, in a March 16 press briefing at Malacañang, argued that the “mortality rate is… only high because we have not done enough testing.”

“We have limited testing capacities, especially the past several weeks,” Duque said.

But he added that when the country reaches its target testing capacity of 40,000 kits, “we will be able to pick up more (positive) but mild cases so that the number of deaths will be further diluted by the growing number of positive cases.”

Anthony Leachon, health reform advocate and former president of the Philippine College of Physicians, said the mild cases and asymptomatic persons – those who carry the virus without experiencing symptoms – were not being tested and “will definitely be the main drivers of the outbreak.”

According to the United States’ Centers for Disease Control and Prevention, “some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.”

“If we follow the (percentage) of mild/asymptomatic observed in other countries, assuming that all of them are not being detected currently, the 140 confirmed cases (as of March 15) may only be representing 20 percent of the true number of cases,” Leachon told The Philippine STAR.

According to the World Health Organization’s data as of March 17, the Philippines is one of the 12 countries with fatality rates above the global average of 4.15 percent (7,426 deaths against 179,112 confirmed cases).

In just the past three days, the Philippines’ death rate swung from 8.57 percent (12 deaths against 140 cases) on March 15, to 6.42 percent (12 deaths against 187 cases) on March 17, and then to 8.42 percent (17 deaths against 202 cases) as of last night.

The Philippines’ death rate was comparable to those in countries with large elderly populations such as Italy and San Marino (8.95 and 8.82 percent, respectively, as of March 17) or Arab countries Iraq, Algeria, Iran and Morocco (7.26, 6.67, 5.69 and 5.26 percent, respectively, as of March 17).

Italy and Iran are among the countries hardest hit by the pandemic, recording 27,980 and 14,991 cases with death tolls of 2,503 and 853, respectively.

The British territory of Cayman Islands and the countries of Guatemala, Sudan, Guyana and the Dominican Republic also have rather high death rates, but this is because there are smaller numbers of confirmed cases coupled with a few deaths. (Both the sole recorded cases in Cayman Islands and Guatemala died, leading to a 100 percent death rate.)

On the other hand, China’s death rate of 3.98 percent (81,116 cases and 3,231 deaths) as of March 17 was near the global average.

South Korea and Germany, two of the most hard-hit countries, even reported death rates of 0.97 percent and 0.22 percent (8,320 cases and 81 deaths for the former, 6,012 cases and 13 deaths for the latter). South Korea has been commended for its rapid testing capacities. Austria, Belgium, Norway, Sweden and Switzerland are other European countries that recorded more than a thousand cases each with death rates below 1 percent.

Meanwhile, Malaysia – the Philippines’ neighbor to the southwest – is the country with the highest number of confirmed cases (553) without any recorded death as of March 17.

The comparison of the Philippines’ situation with that of other countries led to speculation that local cases were confirmed only when it was too late to save the patients. There were even reports of persons under investigation (PUIs) dying before the results of their testing for COVID-19 could come out.

The DOH’s most recent guidelines as of March 16 state that persons who may have been exposed to infection but do not yet display symptoms will not be tested. Instead, such persons under monitoring (PUMs) will only be required to quarantine themselves at home or be placed in barangay isolation units for 14 days. “No need for testing,” the guidelines state.

Persons may display acute respiratory illnesses, fever with temperatures above 38 degrees Celsius, or cough, shortness of breath or other respiratory symptoms. But they will not be tested automatically either.

For such persons to be considered patients under investigation (PUIs), they must have traveled or resided in a country reporting local transmission of COVID-19 or must have been in close contact with a confirmed case. Persons in close contact are those who provided direct care without proper personal protective equipment, stayed in the same close environment, or traveled together within one meter or three feet of each other.

If a person shows only mild symptoms, is not an elderly patient or does not suffer from other “comorbid” medical conditions, there is “no need to test, too,” according to the guidelines. In other words, the only ones to be tested are those with “comorbid” conditions or are elderly.

President Duterte’s partner Honeylet and daughter Veronica got themselves tested even as they experienced no symptoms.

Even Senate Majority Leader Juan Miguel Zubiri, who announced on March 16 that he tested positive after being exposed to a resource person who fell sick after attending a March 5 committee hearing, did not display any symptoms. Senators Sherwin Gatchalian, Nancy Binay and Francis Tolentino also got tested and were found to be negative for the virus.

This led to criticisms that the few testing kits available are being used on politicians as a form of special treatment. A reporter posted on Twitter that Senate reporters who were exposed to Zubiri were not contacted by the DOH even after the senator tested positive for the disease.

Edsel Salvana, an infectious disease specialist who leads the technical advisory group of the Inter-Agency Task Force on COVID-19, said the politicians and their families were tested before the DOH came up with its strict guidelines. He said it was the people’s responsibility to stay home and avoid infection, given the lack of testing capacity.

"I do not agree with testing asymptomatics at this time. Except for healthcare workers who may need to return to work. DOH has discretion for critical government officials. I do hope it is handled properly," Salvana posted on Twitter on March 18.

“DOH will now prioritize severe and critical patients. This is a trying and dangerous time for humanity. Please cooperate and stay home. Otherwise millions will die,” Salvana said.

For his part, Leachon disagreed with the DOH’s tack of limiting testing to just the most serious cases. He stressed the need to prevent people with no symptoms, like Zubiri, from unknowingly spreading the virus.

“The virus is being spread from person to person locally, and many people are asymptomatic while still spreading the virus. If they were able to obtain a test, they would test positive and could self-quarantine. People with whom they have been in contact could be warned and also self-quarantine,” Leachon said.

He added that South Korea’s fatality rate may be the most accurate, since everyone is tested and not just the most severe, “hence the denominator actually reflects the true number of all cases.” He also cited the example of Singapore, which despite having 243 cases (but zero deaths) as of March 17 has not yet found the need to impose a lockdown or community quarantine.

“If you identify all cases, not just those with severe symptoms (elderly, those with comorbids), then we can implement immediate isolation and quarantine of contacts… And, of course, to identify all cases, we really need a lot more testing kits,” Leachon said.

“Again, this should have been planned for back in January, because cases are not a matter of if, but when,” he added.

The World Health Organization has also repeatedly decried the lack of urgency on the part of many countries when it comes to testing, isolation and contact tracing, such as the careful monitoring of people who are in close contact with someone who has been infected.



“The most effective way to prevent infections and save lives, is breaking the chains of transmission. And to do that, you must test and isolate”, said WHO chief Tedros Adhanom Ghebreyesus, at Monday’s COVID-19 press briefing, held at the UN health agency’s headquarters in Geneva: “Once again, our message is: test, test, test.”



In his Monday briefing, Tedros acknowledged the rapid escalation in social distancing measures worldwide, which include many more school closures, the cancelling of sporting events and, in some countries, the closure of businesses where people congregate, such as restaurants, bars, cinemas, and theatres.



However, simply following guidelines for personal behavior like social distancing, regular handwashing and coughing into your elbow are simply not enough to “extinguish the pandemic,” Tedros noted.



“You cannot fight a fire blindfolded” he said, underscoring the importance of testing every single case. “We cannot stop this pandemic if we don’t know who is infected.”

Around 1.5 million tests have been sent to 120 countries by the WHO to meet global demand, and the agency is working with companies to make them available to those in need.



