As stores reopen, on-site work continues, and people return to the streets, we are made to think that the country has braved a wave of infections, that the spread of COVID-19 has been successfully mitigated, and that all that is left to do now is to prevent a resurgence of cases. Yet one should not be too confident—if they should be at all—about such an impression. For around three months after a wide-scale lockdown, there is still so much we do not know.
While I may not have extensive knowledge on Epidemiology, I can at least raise a few questions that I believe are critical points for understanding the state of the nation amid the current pandemic. These are ones that ought not to just be matters of discussion; these must also be addressed by a government trying to create an appropriate public health response and understood by the public whose confidence in the former must be secured given all uncertainties.
The first is perhaps the most obvious: what is the actual extent of the spread of the virus in the country? It may be easy to cite the tally of cumulative cases reported by the Department of Health (DOH), but the limited rate at which tests are conducted render the official statistics insufficient to answer the said query. For instance, after about 10 percent of the population in each of three Cebu cities had been tested, barangays with zero reported cases were found to have persons with past or active infections.
Particularly worrying is that 80 percent of cases discovered by the Cebu mass testing scheme showed no symptoms of the disease. And because the Philippines’ testing strategy targets only “suspected” individuals—that is, those that are symptomatic—it may be plausible that the actual count of positive cases is significantly higher than what we are detecting. But we may never know that for sure if the DOH continues with its current limited testing protocol.
However, more than just the gathering of adequate data, the timeliness of their presentation must now also be considered. Seemingly, we get a sense of how we are progressing based on the trend of new cases reported daily. Thus, for over two weeks, there appeared to have been a steady pace of between 100 to 300 announced new positives each day—that is, until this number started rising and eventually soared to over 1,000 new cases last May 29, when the DOH introduced the concept of “fresh” and “late” cases, attributing the latter to backlogs in the validation queue.
This leads me to ask about the reliability of the trend of new daily cases given by the Health Department, particularly in its use as an indicator for the effectiveness of government response measures and the easing of lockdown restrictions. If officials need numbers to tell them how their decisions could impact either the containment or the further spread of COVID-19, then it is contestable to use panel data based on the date of public announcement since a significant chunk of the cases reported thereby are apparently “late” and thus do not reflect the actual time of when samples were collected, much less of the time of infection. As such, it is dubious to draw correlations between an implemented intervention and its supposed outcome from this sort of information, rendering it next to impossible to determine the efficacy of the programs and the best courses of action moving forward.
Further, what the DOH has not addressed is how long this has been going on. Though they only made the distinction between “fresh” and “late” recently, I doubt there were no backlogs before, thus calling the whole set of figures, and whatever curve we were trying to construct, into question.
Nevertheless, I am not claiming that it is impossible to graph the numbers in a way that better reflects the actual rise in cases—as opposed to their mere date of announcement—but I do find that doing so may be more difficult due to the country’s testing limitations. Whether this problem is unique to a situation such as ours or whether it is inherent in epidemiological data gathering, I maintain that it is still a valid inquiry.
Hence, the inadequacy of and discrepancy in data could spell trouble for those tasked with steering national efforts, but they are ultimately more dangerous for us, the stakeholders of their decisions, who may bear most of the consequences thereof. If we are to be assured that the government has done the best it can, then the questions presented above should be answered, and the problems they imply must be resolved. Until then, we will all remain in the dark about how the country is actually doing.