DOH explains COVID-19 cases reporting after data mix-up

By Joseph B.A. Marzan and Emme Rose Santiagudo

Concerns were raised about the reporting of confirmed coronavirus disease 2019 (COVID-19) cases, particularly the data gap between the Department of Health (DOH) and figures from local government units.

The latest was when the DOH reported 111 cases on April 22 while Cebu Governor Gwendolyn Garcia, told CNN Philippines on the same day that there were 139 new COVID-19 cases in Cebu City alone.

Cebu City Mayor Edgardo Labella confirmed Garcia’s claim in another interview.

But in its health bulletin and virtual presser, the DOH only reported 111 cases on the same date.

During the virtual presser, DOH Undersecretary and spokesperson Dr. Maria Rosario Singh-Vergeire said that the cases in Cebu were not included in their report as the numbers were still under verification.

The numbers were eventually added to the DOH’s confirmed cases on Thursday, April 23.

 

DOH’s COVID-19 REPORTING SYSTEMS

The first reporting system used by the DOH was implemented through Memorandum Circular No. 2020-0006, which organized the flow of information from DOH to the public.

The old reporting system follows the classification of the World Health Organization (WHO) and the United States’ Centers for Disease Control and Prevention (CDC), which classified unconfirmed patients into two categories: Persons Under Investigation (PUI) and Persons Under Monitoring (PUM).

PUIs are those with symptoms of COVID-19, have travelled to places with previously confirmed cases, and/or have had prior contact with confirmed cases.

PUMs, on the other hand, have no symptoms but have had contact with PUIs and confirmed cases and/or have travelled to places with previously confirmed cases.

Under the old reporting system, the DOH’s Epidemiology Bureau (EB) would send surveillance reports to the office of DOH Undersecretaries Dr. Eric Domingo and Dr. Myrna Cabotaje, who will then inform DOH Secretary Francisco Duque III.

At the same time, the Research Institute for Tropical Medicine (RITM) in Alabang, Muntinlupa City would send laboratory reports to Sec. Duque.

The RITM was previously the only laboratory to conduct testing of PUIs and suspect cases, but the DOH has since accredited other hospitals as Subnational Laboratories.

The Office of the Secretary would then forward these reports to the Health Promotion and Communication Service and the Media Relations Unit for drafting of press statements and eventual dissemination.

Sec. Duque would then appear through a daily press briefing at 1 p.m. to announce updates.

The daily press releases and updates will then be posted on the DOH website and on its official social media platforms, right after the press briefings.

Copies of the press releases and updates will also be sent to the DOH Centers for Health Development (CHD) for dissemination to provincial governors and city mayors and local media.

On April 9, 2020, DOH released a new “Surveillance Notification System” through Administrative Order (AO) No. 2020-0013.

Under the new system, non-COVID-19 patients who were neither PUIs nor PUMs will not be taken into consideration.

PUMs have also been scrapped under the AO’s new classification system.

Several local government units, however, such as Iloilo City, still obtain PUM data and include them in their reports.

PUIs were also divided by the new AO into two classifications: suspect cases and probable cases.

Suspect cases are those:

              – with COVID-19 symptoms;

              – who have travelled or have been residing in areas with confirmed COVID-19 cases or local transmission of the disease;

              – who are either 60 years of age and above, or with other grave illnesses, or with sensitive pregnancies, or health workers; and/or

              – with inconclusive results and need immediate hospitalization.

Probable cases are those who are suspect cases who have already tested and have had inconclusive results or awaiting results.

COVID-19 positive cases are simply renamed as confirmed cases under the new classification.

The new reporting starts with case identification on suspect cases by Disease Reporting Units (makeshift clinics, hospitals or health centers).

Reports will then be given to city, municipal, and provincial health offices, the RITM which is the National Reference Laboratory, and Subnational and other DOH-accredited Laboratories.

The local government units (LGUs) will then cluster cases and send their reports to the Regional Epidemiology and Surveillance Unit of the DOH-CHDs in the regions, which will transmit these clustered case reports to the EB.

The RITM, the Subnational and other DOH-accredited Laboratories will both conduct confirmatory testing on the samples collected from suspect cases, who will now be considered as probable cases.

The results of the tests will be released to the DOH Executive Committee, the EB, the RESU and the DRU.

The Subnational and other DOH-accredited Laboratories will also send results of their tests to the RITM for coordination.

At present, the DOH-CHDs in every region conduct daily virtual pressers online with the local media starting at around 2 p.m.

The DOH Central Office conducts its virtual pressers online and through national media at 4 p.m.

 

COVID-19 TRACKER

Another mishap the DOH has had in reporting is the COVID-19 tracker available on their website (https://www.doh.gov.ph/covid19tracker).

In Western Visayas, Iloilo City is placed under statistics for Iloilo province, Bacolod City is under statistics for Negros Occidental, and statistics for Guimaras are not available under their drop-down box, despite previously having a PUI.

This led to confusion and even caused CNN Philippines to misreport Iloilo City as having 25 confirmed COVID-19 cases in its April 22 article on the reinstatement of the city’s liquor ban. 

Daily Guardian has learned that this also seems to be the case in other regions of the country, where independent component cities, or chartered cities, with low number of confirmed COVID-19 cases will be joined with the province of their location, while provinces with no confirmed cases, despite previously having either PUIs or PUMs, don’t have their own statistical set.

The only regions that have different presentations of these sets are the National Capital Region and the Davao Region, where Davao City is presented separately from its once-province, Davao Del Sur.

Dr. Renilyn Reyes, DOH-CHD 6 spokesperson, said that this may be because of the DOH’s continued confirmation on the permanent residences of the confirmed cases.

“We’ve tagged more cases in Western Visayas because  it is their area of residence, but it turned out, after validation that their current residence is in either NCR or other regions, so [it is different] in the national tracker,” she said.

According to data by the DOH-CHD 6, as of 8 a.m. of April 23, Western Visayas has 55 confirmed COVID-19 cases, with 36 active cases, 11 recoveries and eight deaths.