CFR Varies Widely in the Philippines, and Internationally

Different reporting methods can give very different results: Philippines Statistics Office reports 2.6 x higher Deaths related to Covid-19 compared to the Department of Health.

Case Fatality Rate (CFR) is the number of cases of an illness that result in death divided by the number of cases of the illness that are reported, and presented as a %.

An infection with a high CFR will kill many people, while an infection with a low CFR will claim relatively few. Case fatality rates are not constant as they can vary between populations and over time, depending on the infectious agent, the susceptibility and overall health of the population being infected, and the efficacy and availability of quality treatments.

Accurate Covid-19 CFR can be hard to determine accurately because not only is the “gold standard” PCR test highly inaccurate giving high rates of false positives, the illness and its credited deaths has become so incentivized, and so politicized that the veracity of any reports may be questionable.

In the Philippines, the Philippines Statistics Authority is the official agency recording deaths, which they tally deaths based on received death certificates. They encode all cases where Covid-19 is listed on the death certificate either as “confirmed” or “probable”. For 2020 and 2021 the PSA document 83,324 cases with Covid-19 Virus Identified and 52,587 cases with Covid-19 Virus Not Identified, a combined total of 135,911 cases. Note that their latest 2021 Cause of Death Data was released on 29th March 2022 and is preliminary and may be updated with late death reports.

The PSA data is 2.64 x higher than that of the Philippines Department of Health, which uses a Covid-19 tracking app, includes only “confirmed Covid-19 cases”, and reported a cumulative death count up to 31st December 2021 of 51,504 cases.

The Philippines overall Case Fatality Rate is reported as 1.6% by DOH. However, the apparent case fatality rates by cities, as shown in the following table varies from 0.6 to 1.7%. Does this nearly 3x difference in fatality rates reflect demographics (aging or high comorbidity rates), access to medical care (affected by socioeconomic status), or reporting biases (reporting of both cases and deaths has been incentivized)?

Philippines is middle of the pack in terms of internationally reported C-19 CFR which currently have an average of 2%. This table from Our World in Data shows widely varying CFRs (grey lines). It is curious that the same infection will result in CFRs ranging from lower than 0.25% up to well above 5%, a more than 20-fold difference.

Changes in CFR will continue to give indication of the pathogenicity of the infectious agent and/or the ability of the population’s immune systems