With 380 COVID 19 cases confirmed with 25 deaths in the Philippines, the first few cases were foreign nationals or locals with a history of travel to infected countries. Today as those who have died breached two dozens, medical personnel manning our hospitals are dying too. In Manila Doctors Hospital, husband and wife anesthesiologists both caught the virus most probably while attending to a patient. Greg has just died. Evalyn is still hospitalized. In the Philippine Heart Center, a 34 year old Internal Medicine graduate and Cardiology fellow also died. At least a half dozen other doctors are currently in very serious and critical condition, intubated and connected to a respirator.
Since Heart Center placed 39 of its staff on quarantine, the hospital would have to go about an increased workload with fewer doctors, nurses, med techs, rad techs, PTs, orderlies, aides, janitors, office personnel and security guards. How long can this situation keep up until a hospital or two are forced to close down further increasing the burden those that manage to stay open?
PHOTO: Greg (right) and Evalyn with their special child son
A March 15, 2020 blog post predicted 300 to 400 COVID 19 confirmed cases in the Philippines by the end of the week (March 21) and 1000 cases by the end of next week (March 28). The March 21 prediction has already happened with 307 confirmed cases reported by the Department of Health. Would the 1000 confirmed predicted also come true by March 28, 2020? We have to average 100 (a figure already mentioned in the March 15 article) new confirmed cases a day to reach the March 28 prediction. In all probability at this stage of the spread of the disease, the Philippines will be hitting 100 new cases per day. The mathematical model being used here is called doubling time. We are assuming that the spread of the disease will double every week. This simply means that if we get to the 100 cases per day level ending March 28, then the next week (ending April 4) we may be getting 200 cases per day. In terms of total number of cases to date, the week ending March 21 had 300 cases, the week ending March 28 will have 1000 predicted cases and the week ending April 4 will have 2400 predicted confirmed cases.
Using the same projection, we could be hitting 400 cases a day in the week ending April 11 and 800 cases a day in the week ending April 18. These would translate to roughly 5000 cases by April 11 and more than 10000 cases by April 18.
We can project the figures until a majority of the Filipino people have been infected, many have died and, hopefully, more have recovered. The end of the virus is when there are no more Filipinos to infect (many in the rural areas may be spared if they isolate themselves from the urban folks). Far flung cities and municipalities may also be spared due to lack of contact with the rampaging virus.
Now that we know the worst case scenario, what can stop the natural spread of the virus. For one, it is claimed that COVID 19 does not survive long in high temperature. Now that we are at the start of summer and things begin to heat up, we are hopeful that fewer infections would occur. Two, the full effects of the massive Metro Manila lockdown or community quarantine has already reduced people to people contact which should result in lower new cases per day reported.
So the question is will things get worse before they get better? Probably. The number of new cases confirmed per day is the best indicator. If it keeps rising, then we are in big trouble (as if we are not there already). No huge growth for a few days may signal stabilization while smaller numbers per day compared to the previous high may indicate some sort of control (unless it explodes in another part of the country).
With the number of Philippine COVID 19 cases breaching the 100 mark (140 at latest count) and the number of deaths at 11, a disturbing development has now happened. The Philippine Heart Center had a COVID 19 mortality and as a result 39 of its staff are under quarantine. The PHC Medical Director announced that no new patient admissions would be entertained until the hospital gets back into full (or at least more manageable) personnel strength. Considering that in the past 24 hours, there were 47 announced new confirmed cases (from 64 to 111), today the Department of Health added another 29 confirmed cases bringing the total to 140, it is very clear that more cases are now being diagnosed per day. Should this 50 something new cases per day persist for next week then it would be easy to calculate a 200 confirmed cases level at the start of the week and possibly 300 to 400 confirmed COVID 19 cases at the end of the week. This level is bound to take its toll on the big Metro Manila hospitals when their own physicians, nurses, med techs, rad techs, physical therapists, aides, orderlies, janitors and security guards begin (as it has already begun) to become patients themselves. Should the Philippine confirmed cases growth curve follow those exhibited by China, Italy, Iran, South Korea, France and Spain then we may be seeing 100 new cases confirmed per day starting 7 days from today. In other words, we could just be 14 days away from reaching the 1,000 confirmed COVID 19 cases level.
What would be the implication of this to the average Metro Manila citizen? One, the National Capital Region health care delivery system could be SWAMPED with cases. Some hospitals, as already implemented by the Philippine Heart Center, may not take in new admissions. More hospitals may limit admissions. The idea of total closure is beyond imagination because at a minimum, patients already admitted would be allowed to heal in the normal course of their disease and would be discharged upon completion of the medical treatment plan. Only a MAJOR BREAK in protocol wherein all confined patients would have a high risk of getting infected with the corona virus would an emergency transfer of all patients to other facilities be done. This would happen when patients previously admitted for other conditions (normal delivery, elective surgery and other non-respiratory admissions) SUDDENLY and UNEXPECTEDLY develop flu like symptoms with the more serious cases testing POSITIVE for COVID 19. This could only mean that those patients got the COVID 19 during their hospital stay for non-COVID infirmities. A massive transfer of these patients would also put other hospitals at risk thus possibly crippling the hospital operations of more health facilities.
At this time Metro Manila is now on COMMUNITY QUARANTINE which would hopefully prevent, reduce or at least delay the rate of transmission of the dreaded disease. It may take at least a week or two before we may see the full (hopefully positive) effect of this emergency measure. Thus Metro Manila is in a RACE against TIME, meaning we are all banking on the community quarantine to FREEZE the spread at the same time that we know that there could be dozens (or, heaven forbid hundreds) of positive cases (but still undetected) that could be spreading COVID 19 at this very minute and the cases would only manifest in a week or two.
A new source of test kits from the University of the Philippines is in the works and would increase the number of test kits necessary to diagnose every individual with the COVID 19 disease.
Vaccines are being tested which would be the true game changer in stopping the spread of COVID 19. Various medicines are also being tried out (mainly those that have shown stopping power against the other corona viruses).
The Department of Health confirmed 140 COVID 19 cases with 11 deaths. DOH called on the public to be vigilant and practice personal preventive measures such as proper hand hygiene, social distancing, and cough etiquette.
DOH also called on people to refrain from visiting public places and/or attending mass gatherings.