Cebu Update on Cases and Deaths

Last reported C-19 attributed death (1) on 4th May, after only 3 deaths in April. As the non-masking standoff Continues with Governor Garcia, it is timely to update Cebu's provincial C-19 situation.

I used the Philippines Department of Health latest public domain Covid-19 Tracker data as of 11 June 2022. This provides data from March 2020 through to 9th of June 2022.

Cebu cases, deaths, and combined cases and deaths are set out in the 3 following figures. Overall death reports represent about 3.6% of all cases. Deaths as % of cases in 2022 (1.7%) are considerably lower than in 2020 (7.6% of cases) and 2021 (4.9% of cases). This shows that the virus has become far less pathogenic; improvements in treatment and management may also be contributing to improved outcomes.

It is interesting that Cebu's vaccine rollout was slow and late. Compared with NCR which just had one big delta spike with a few higher superimposed peaks, they have a low delta peak that was well on the way down, before it rose considerably in unison with the vaccine rollout.

Here deaths and cases are plotted on the same scale to give perspective.

It may also be observed that the most affected age groups for cases are young to middle-aged adults.

Deaths are very much skewed to older age-groups; which likely have the multiple comorbidities that contribute to poor outcomes with this virus.

There does not seem to be any cause for alarm given these data for Cebu, which as of the present has few cases and far fewer deaths associated with a virus which thankfully has become mild. Taking an endemic, live with it approach, would seem rational.

To dive a little further in the data, I decided to look at the time between the date of collection of a positive specimen and date of death. This could help with identification of of data anomalies.

This data shows:-

• Some cases where the test specimen was taken after death (the longest after death 82 days – encoding error?).

• The most common date of test sample was the same day as death.  I.e. People were dying (of something else?), were tested and reported as positive.

• Most deaths (80%) occurred between - 3 days (i.e. posthumous testing) and 14 days following specimen collection.

• There were some cases where death was more than 1 year after the positive test! Coding error, OR is any death post a positive test regarded as covid-19 caused regardless of the timescale?

I had noticed a standout spike in deaths from 19 to 22 October 2021.

It looked unusual because:-

• It showed a sudden standout peak of deaths at a time when both cases and deaths were dropping.

• It was an unusual pattern of deaths with the peak occurring discretely from a Tuesday to a Friday.

• A sudden out of pattern spike would hint at a trigger / external cause.

For all the deaths from 18 to 22 October 2021, I plotted the date of the sample collection against the date of death. Just for reference of the low background cases, I also input the cases that tested positive on the same date.

Instead of following the overall pattern for Cebu with most deceased having been tested within -3 to 14 days prior to death, few of these people who had died had been tested close to the time of death (average nearly 2 months between last test and death). Were they using old tests as cover to claim a covid-19 death? Curious, there were even 5 of the deceased tested more than 200 days earlier.

Could there have been a trigger for these out of pattern deaths? Could it have been the mass vaccination drive (including 7,000 people in custody) that started on 18th October 2021?

Was there a bad batch? Covid-19 attributed deaths in the Philippines are immediately cremated and no autopsy is permitted.

Needs an investigation! Governor Garcia, I hope this can be brought to your attention!