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Public Health Decision Making Needs Quality Source Data: Philippines DOH Death Data shows 35% of C-19 Deaths within -7 to 1 day of a Positive Test. This does Not Match C-19 Disease Natural History.
35.2% of covid-19 attributed deaths occurred within -7 to +1 day of a c-19 specimen being collected. Local hospital and mortuary practices may affect C-19 reporting and lead to deaths overestimation.
The natural history of covid-19 illness is an initial flu-like illness for the first week, that may progress to a serious and potentially fatal immune-mediated over-response in the second and subsequent weeks in some cases. In a population that has ready access to testing I would expect that there should be a time gap between a positive covid-19 test and reporting of fatal outcomes due to people getting tested fairly early in the illness and before sequelae develop.
I wanted to see time frames being presented in the covid-19 cases in the Philippines. To do this I took a dive into the DOH Covid-19 Tracker data released last 23 April 2022. I wanted to determine 1. How long after a positive test victims of the illness died, and 2. How long it took to get test results back after testing.
I downloaded the 4 DOH covid-tracking cases and deaths data sets as of 23rd April 2022 and extracted the death data. There were 59,884 death reports in this data set. I looked at the data sets under DateSpecimen, DateResultRelease, DateRepConf and DateDied.
There were some data discrepancies as follows:-
3,574 cases (5.97% of the total cases) had no specimen (test data) and only had DateRepConf and DateDied. The reported date of death of 96.2% of these was AFTER / LATER THAN the date of Report confirmation. The biggest gap between DateRepConf and DateDied was 606 days. I excluded these cases from my analyses.
There were 351 cases (0.59%) where the date of death was more than 7 days before DateSpecimen, or DateResultRelease (if there was no DateSpecimen input). Were these people tested posthumously, long after their death? I excluded these cases from my analyses.
I also excluded 418 deaths (0.7%) which were reported to have occurred later than 120 days after the specimen date / result release. The duration of these ranged from 121 up to 602 days post specimen.
After excluding these discrepancies, I was left with 55,540 data sets which I analyzed. 1947 (3.5% of 55,540) of those who died, died in the 7 days prior to their test specimen being collected? These people are apparently being tested and declared as covid-19 cases after they had already died!!
11,516 (20.7% of 55,540) died on the day that their specimen was collected, and another 6,071 (10.9%) died the day following their specimen collection.
Thus, 35.2% of the deaths occurred either before a test was done or within 1 day of a test being conducted. What does this mean? Filipinos do not present to the hospital or for testing until they are about to die from covid-19, or could it be that these positive test results are coincidental findings in people who are already dying from something else.
This analysis has found that approximately 1/3 of deaths occurred within -7 to 1 day of an official covid-19 test being positive. Such a short time between test and death is not congruent with c-19 natural history, which is a progressive illness occurring over several weeks, particularly for severe cases with fatal outcomes.
I would suggest that c-19 was likely an associated finding, and not the cause of death in at least a good portion of these cases. This is further supported by local practice where all hospitals have been requiring c-19 testing prior to admission. Further, anyone who died during the pandemic has also been required to get a c-19 test before the body could be buried. If it was found to be covid-19 positive it would be compulsorily cremated.
The turnaround of testing was typically rapid, with the majority of test results being returned within 4 days of specimen collection. I excluded negative durations (75 sets with results returned before the input specimen date), and durations longer than 31 days (142 sets with durations from 32 to 529 days) from this analyses.
Covid-19 Case Fatality Rates have been used drive fear and in turn acceptance of vaccination.
In the Philippines, to date, nearly 60,000 deaths have been attributed to C-19. Are these really due to c-19, or are the numbers possibly (likely) inflated as implied by this discussion?
A closer examination of cases in light of known covid-19 infection natural history, and local practices affecting reporting of cases WITH covid-19 as opposed to deaths FROM covid-19 would be well warranted now that we are now more than 2 years into collecting data, assessing outcomes from the pandemic, and determining future direction.
It will be very reassuring if we can confirm that c-19 deaths were lower than has been reported.