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Policy Note No. 2 03 May 2020

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Policy Note No. 2 03 May 2020 PUBLIC HEALTH DATA ANALYSIS AND RECOMMENDATIONS FOR COVID-19 IN WESTERN VISAYAS AS OF 30 APRIL 2020* Helena Marie Lagon Alvior, MD1, Mary Camille Samson, RMT1, Joseph Arbizo, RMT, MoS2, and Philip Ian Padilla, MD, PhD2 1 ThinkWell Philippines, Iloilo City 2 University of the Philippines Visayas, Miagao, Iloilo *Based on the data available on 30 April 2020. I. CURRENT COVID-19 SITUATION IN WESTERN VISAYAS Extension of enhanced community quarantine in Bacolod City, Iloilo City, and the Province of Iloilo is imposed until May 15, 2020 while other provinces (Aklan, Antique, Guimaras, Capiz, Negros Occidental) in the region are placed under general community quarantine. Decision for the lifting of ECQ in selected provinces are supported by IATF-EID Resolution No. 30 and was announced by Presidential Spokesperson Harry Roque in a press briefing last April 30, 2020. Imported Local, linked Local, unlinked Cumulative total 10 70 9 60 8 7 50 6 40 5 4 30 3 No. Cases New of 20 2 10 1 Total No. Confirmed of Cases 0 0 1-Apr 3-Apr 5-Apr 7-Apr 9-Apr 11-Apr 13-Apr 15-Apr 17-Apr 19-Apr 21-Apr 23-Apr 25-Apr 27-Apr 29-Apr 20-Mar 22-Mar 24-Mar 26-Mar 28-Mar 30-Mar Figure 1. Trend of COVID Cases in Western Visayas (DOH6 and Provincial/HUC Data) Local transmission is present in Region VI – Western Visayas and community transmission is increasing. Since April 20 when policy note 1 was shared, there have been 14 new confirmed cases in the region, bringing the total number of confirmed cases to 66. Three out of the fourteen are imported cases, two of which are repatriates. Seven of the fourteen are local and linked transmissions, while the remaining 4 are cases with no known contacts or importations. The provinces of Aklan and Capiz have no new confirmed cases while the island province of Guimaras remain COVID-free (Fig 1. and Table 1). Local transmission is present in the provinces of Antique, Iloilo, Negros Occidental, and the highly urbanized cities (HUCs), Iloilo City and Bacolod City. Community transmission is increasing, and this is contributed to by Bacolod City, Iloilo City and the province of Iloilo (Fig. 1) 1 Province/HUC Imported Local, linked Local, unlinked TOTAL Aklan 6 - - 6 Antique 1 11 1 13 Capiz 5 - - 5 Iloilo 3 12 5 20 Negros Occ 3 1 - 4 Iloilo City 5 3 1 9 Bacolod City 6 1 2 9 WESTERN VISAYAS 29 28 9 66 Table 1. Total number of COVID-19 cases in Western Visayas as of April 30, 2020 (DOH6 and Provincial/HUC Data) Local incidence and daily incidence rates are low: The incidence for COVID-19 in the different provinces and HUCs of Western Visayas has a range of 0.16 (Negros Occidental) to 2.23 (Antique). Guimaras Province has been excluded already in the data set due to its zero incidence. The daily transmission rates are also notably very low (Table 2). Incidence proportion per Daily Incidence Rate per Provinces 100,000 susceptible persons1 100,000 susceptible persons2 Aklan 1.04 0.01 Antique 2.23 0.05 Capiz 0.66 0.02 Iloilo 1.03 0.02 Iloilo City 2.01 0.04 Negros Occidental 0.16 0.003 Bacolod City 1.60 0.03 1 Incidence proportion during the period from day of first case to May 1, 2020 2 Daily incidence from day of first case Table 2. Incidence proportion and daily incidence rate for COVID-19 in Western Visayas Asymptomatic cases are detected by active contact tracing and testing. Comprising 41% of the COVID-19 cases in the region are asymptomatic and most were tested because they are close contacts of index cases. Critical 0% Severe 38% Asymptomatic 41% Mild 21% Figure 2. Confirmed cases by degree of infection (DOH6 Data) The detect/trace-test-isolate/treat pathway is indicative of the health system and public health capacity of an area. Only 23 of 66 confirmed cases (35%) in the region have data on number of contacts traced. More than half of confirmed cases in the region have either no published data on contact tracing (39%) or still in initiated/ongoing status (26%). Annex A shows a detailed presentation of the data per province/HUC. 2 For the 66 confirmed cases, the total number of contacts traced is 840. Almost 71% of traced contacts identified in the region have no data published on their testing status. The province of Iloilo and Iloilo City continue to have no published data on the contact tracing and testing status of their confirmed cases. On the other hand, Bacolod City has started to share data for transparency on their efforts. The rest of the provinces have testing results but are not disaggregated to the cases. RT-PCR test result turn-around time ranges from a minimum of two (2) days to a maximum of thirteen (13) days (average of 6, mode of 4). The Western Visayas Medical Center Sub-National Laboratory started testing on March 26. Prior to which, test specimens were sent to RITM and turn- around time was 6-7 days. From March 27 to April 11, test results are announced within 2-7 days, with 4 days being the most frequent count. After the Holy Week, turn-around time for the results ranged from 3-13 days, with a mode of 6 days. The data in Figure 3 is based only on the dates of specimen collection and confirmation of COVID-19 cases. Factors of delay are multi-faceted (i.e. supplies shortage, personnel/machine fatigue, invalid results) and further discussions with the SNL team may shed light on the bottlenecks that need to be addressed. Result turn-around time (number of days) 14 12 10 8 6 4 2 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 WV CONFIRMED CASE Figure 3. Testing result turn-around time by confirmed case (DOH6 and Provincial/HUC Data) The WVMC SNL has been designated to test specimen from Region 4B and Region 6 as per DOH Memorandum 2020-0188. The facility has already conducted a total of 4,130 tests and remaining available test count is 2,640. According to the UPV Philippine Genome Center Visayas, a third PCR machine has arrived at the SNL. It can be assumed that the maximum testing capacity per day has increased from 200 tests per day to 400 tests per day. Available data shows that the highest number of tests conducted in a day is 287, while the average is about 123 tests. Given the sample calculation below (Fig. 4), testing capacity can accommodate all specimens (persons under monitoring, suspect cases, probable cases and those pending) in 6 days, provided WVMC SNL is maximizing capacity. PUMs+Suspects+Probables+Pending = 2,442 cases WVMC SNL max testing capacity = 400 tests/day Number of days to accommodate all specimens = 6 days Figure 4. Testing result turn-around time by confirmed case (DOH6 and Provincial/HUC Data) 3 For Region 6 - Western Visayas, a total of 2,823 specimen have been submitted for testing. An average of 2.4% turn out positive (range: 1.2-3.1%), negative results account for 84.8%, and 12.9% are still pending. In Western Visayas, there are 316 identified quarantine facilities with a total of 5,899 beds to accommodate COVID-19 related cases (Table 3). This statistic is inclusive of facilities intended for use by the repatriated Overseas Filipino Workers (OFWs). Most of the municipalities have identified at least 1 quarantine facility. However, considering the number of positive and COVID-related cases in the region, these facilities are not fully utilized since most probable, suspect, and asymptomatic cases are placed under home quarantine. The 41.73% bed occupancy rate of in Negros Occidental is the highest in the region but still low compared to the number of available beds. The underutilization of these facilities can strain healthcare resources. Province Total # of Total # of Facility Total Total # of Bed Facilities Occupied Occupancy # of Occupied Occupancy (Identified Isolation Facilities + other facilities Facilities Rate (%) Beds Beds Rate (%) for OFWs) AKLAN 17 0 0.00 150 0 0.00 ANTIQUE 23 5 21.74 1027 79 7.69 CAPIZ 72 1 1.39 856 9 1.05 GUIMARAS 6 0 0.00 112 0 0.00 ILOILO 144 8 5.56 1201 67 5.58 NEGROS OCC 41 19 46.34 1908 304 15.93 ILOILO CITY 6 6 100.00 518 145 27.99 BACOLOD CITY 7 2 28.57 127 53 41.73 TOTAL 316 41 12.97 5899 657 11.14 Table 3. Distribution of COVID-19 Quarantine Facilities in Western Visayas (DOH6 Data). There are 37 COVID-19 treatment facilities in the region where 21 (57%) facilities are government-owned and the other 16 (43%) are private facilities. Fifteen of these government facilities are classified as level 1 facilities while 3 other facilities are categorized as Level 2. Private facilities also account for the 10 other Level 2 facilities while all Level 3 facilities (3 government, 6 private) are in HUCs – Bacolod City and Iloilo City. 7 6 5 4 3 No. Facilities of 2 1 0 L1 L2 L3 L1 L2 L3 L1 L2 L3 L1 L2 L3 L1 L2 L3 L1 L2 L3 L1 L2 L3 L1 L2 L3 Aklan Antique Capiz Guimaras Iloilo Negros Iloilo City Bacolod City Occidental Government Private Figure 5.
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