Meaning of COVID Numbers Lost in DOH Bulletins
AS THE number of COVID-19 cases rise and fall, the bulletins released by the Department of Health (DOH) no longer have real value. Sharp spikes and slides are left largely unexplained except to point out the failure of laboratories to turn in their test results on time.
The DOH holds more data including the breakdown of cases according to geographical areas. But this is not incorporated in the daily bulletin. Rather is it released as “Beat COVID-19 Today: A COVID-19 Philippine Situationer” at 8:30 PM. But the information lacks analysis that could be more helpful to policy-makers and the general public.
There is hardly any reference to this “situationer” in news reports. The media have mostly limited themselves to publishing the daily count from the DOH bulletins.
How useful are these numbers in themselves? The media audience will appreciate knowing about the record-breaking daily counts during a “surge” and may keep watch of the tallies in the hope for a steady decline.
But more important, DOH remains the only source of nation-wide totals and the distribution of cases around the country. Experts and other research groups are dependent on what DOH provides.
Currently, as Delta cases continue to surge, the numbers are a source of daily dread, a quick indicator of how government has allowed matters to slip into deeper crisis.
But DOH may have other intentions. The design of the bulletins suggests goals other than those that have to do with policy or public health. (See box)
Measuring the Impact of ECQs
Since August 12 this year, the country’s 7-day average of new COVID cases has not been lower than 10,000. As the count continued to rise, some experts earlier projected a peak in September. On September 9, the country’s 7-day average breached 20,000. The all-time high of 26,303 new cases was logged last September 11.
Government placed the NCR under Enhanced Community Quarantine (ECQ) from August 6 to 20, hoping to contain the spread and lower infection rates. But the case numbers continued to increase
Dr. Alethea de Guzman, director of the DOH’s Epidemiology Bureau, said on August 25 that new peaks would be reached “in the coming weeks.” She pointed out that a rise in cases was the reason ECQ was declared so that the continuing rise of cases would show new levels in case numbers. However, the increase was “not centered on [NCR Plus] alone” but was experienced “across all of Luzon and select regions in Visayas and Mindanao.”
The geographical distribution of cases provides the larger picture on the record-breaking increases that followed. But DOH has not shown this larger picture mapping the hot spots. ECQ was declared in NCR, Laguna, and Bataan in Luzon, in Iloilo City in Visayas, and Cagayan de Oro City in Mindanao. But no analysis was made before or after the lockdowns in these areas.
A breakdown of the numbers in these places post-ECQ could help assess the impact of lockdowns and develop a rational policy regarding area-focused, even “granular” ECQs.
It is part of the DOH’s systemic failure not to have examined and checked their data from the beginning. Media should recall that early in 2020 DOH failed to separate backlogs of cases and missing old and new cases as though the issue of time did not matter to understanding the viral spread.
The lack of analysis raises questions about the rationale of imposing or lifting ECQs. The same lack also gives rise to speculation that is not based on actual data.
Media need to do more on their own
Numbers need to mean something to their audience. Media, in close consultation with expert groups, data analysts and other stakeholders, should evaluate the information DOH provides, so they can avoid just recording what they are given without analysis. The exercise should also expand their own understanding of what the numbers are really saying.
Assoc. Prof. Peter Cayton of the UP School of Statistics and Dr. Jomar Rabajante from the UP Pandemic Response team helped CMFR identify values in presenting COVID-19 related data.
Transparency and Timeliness
The reference must be clear about source and the time frame of the data.
Time frames can present more clearly the actual progression of the disease. Viral effects can change within hours. Information on “long COVID” has not been studied enough to inform the public about how long these cases remain infectious.
The percentages of bed occupancy in hospitals, which is related to the severity of symptoms, also share the same unreliability and are of minimal relevance unless provided in “real time” – information tracking that has been done more effectively by LGUs.
Data used by media should be clear to a general lay audience. Its general purpose is to inform, not just to flag emerging threats/surges and otherwise provide guidance for public health, but also to indicate the appropriate policy response on the part of government and to provide guidance in protecting public health.
Terms used and categories provided must be explained fully and include interpretation of figures and their meaning.
Information over time or reflecting sequence of events and impact can map the virus spread and present a continuing chronicle of its virality or transmissibility at a specific time and over a time span.
A source can pile on percentages of positivity, transmissibility or severity of symptoms – but without context, comparative analysis and historical background, the numbers by themselves are without meaning.
Need for Context
Currently, DOH bulletins show up the dis-connect between the high transmission rates and government’s set policy to lower levels of restrictions.
“Scorecard” reporting covers up arbitrary standards and in the long run, conditions the public to think that these higher and higher counts are an expected norm. The information that the DOH puts out regularly must translate into policy and meaningful action to be taken seriously at all. Other countries have shown that zero new COVID cases is possible. Other countries in the region have dealt with the surge of the Delta variant with better success than ours .
The numbers are important. Case studies must be written up. But who is doing this job? Unfortunately, the DOH has not been a reliable custodian of these numbers. The daily bulletin alone is an example of how these numbers have been wasted as a basis for sound policies against COVID-19.
What’s in DOH’s Bulletins?
The DOH claims that it is releasing its data on COVID to the public so that anyone can make assessments of the situation. In the form of a daily bulletins headlined by three percentages:
* the total percentage of active cases,
* the total percentage of recovered cases, and
* the total percentage of those who died.
DOH used to provide notes to correct the numbers in the previous bulletin, stating failures of laboratories to submit their daily counts. But these corrections are no longer given regularly.
The daily counts of newly recorded cases, of recently recovered cases, and of the new deaths, are lined up in a separate row underneath these percentages. Below these numbers is the total number of documented cases the country has had of COVID (as of writing, more than 2.1 million).
Cluttered below these numbers are ratios:
*of persons who tested positive side-by-side the number
* of individuals tested;
* of hospital bed usage in Metro Manila and in the country as a whole;
* of the levels of severity of active cases.
There is a single-panel cartoon and an “Update and Message of the Day”, that are similar to the comic strips that come in candy wrappers and randomized advice from fortune cookies.
At the bottom are contact details to remember, including a call to download the StaySafe contact tracing app, which Health Secretary Francisco Duque III himself has admitted to have had “almost no impact.”
Fonts and sizes are used to give emphasis to certain numbers, suggesting the underlying intent of the bulletin. But the scorecards are laid out to highlight the small percentage of those who suffer severe bouts of COVID, the low death rate, altogether giving the impression that COVID-19 is less severe than it is.
Historicizing and contextualizing data are important for the audience to be able to make sense of them. The recent daily reminders of COVID enjoying high transmission rates can be difficult to understand in the lived context of government continuing to loosen restrictions without greater testing, without intensified contact tracing, and without upscaled vaccinations.
How numbers got to a certain point, whether they increased or decreased over a period of time, can provide audiences with an idea of which actions by government and citizens work positively and which ones do not. Given the relatively increased testing capacities that the country now has, the daily rates of infection would be easier understood by the public if these were contrasted with infection rates from earlier “surges” and periods when COVID-19’s spread seemed to slow. Media can do this guided by experts in the field.
If this kind of reporting is sustained, the public might be able to develop a fixed, quantifiable sense of how low is “low” for transmissions, or how high is “high” when it comes to active cases.
Photo from DOH website.