‘Patients who die with COVID symptoms should be tested’

CEBU, Philippines —  A Cebu-based epidemiologist has recommended swabbing patients who have died with coronavirus disease 2019 (COVID-19) symptoms.

Dr. Kathrina Saavedra Perez-Catingub said the collection of postmortem nasopharyngeal (NP) swab specimens from a deceased person suspected of COVID-19 should be done.

It was also recommended by the Centers for Disease Control and Prevention (CDCP).

It said postmortem NP swab specimen for COVID-19 testing and separate NP swab for testing of other respiratory pathogens shall be done if an autopsy is not performed for a suspected COVID-19 case.

“We are not capable of doing autopsies at this time due to lack of a facility with sufficient safety and environmental controls. Epidemiology is what guides the government’s decisions and getting true numbers is the key here,” said  Catingub.

Also, she said the results of the test are needed for contact tracing.

“Unsaon man ang pag-trace sa contacts kung blind ang doctors to the status of patients who presented with symptoms before they died?” she said.

Dr. Narciso Tapia, an expert on public health, also said it would be of big help to analyze the profile of the deaths.

 “Let us not turn a blind eye on the deaths. It would be helpful to analyze the profile of the deaths. It’s not true that dead men tell no tales. At this time, they can tell a lot and may save lives,” he said.

Fatality, Mortality rates differ

Meanwhile, Tapia yesterday said that just because Cebu City’s COVID-19 case fatality rate (CFR) is low does not mean the actual number of deaths is also low.

“The more COVID-19 cases, the more chances of having deaths,” he said.

He made the statement after Mayor Edgardo Labella lobbied for the reimposition of less strict general community quarantine for the city citing 1.08 percent fatality rate.

The mayor said the city’s fatality rate is way lower compared to the national average of 4.16 percent. The city’s death toll is now at 64, including six deaths yesterday.

Also, Labella said the city’s recovery rate is higher compared to the national average of 23.66 percent despite the high number in cases here.

Tapia pointed out that the case fatality rate is different from mortality rate, making the numbers look vastly different.

He said the case fatality rate is the proportion of people who die who have tested positive for the disease, while mortality rate is the proportion of people who die after having the infection overall.

He said CFR is mistakenly identified as the mortality rate.

“Case fatality rate is the proportion of people who died out of those positive for COVID. COVID Mortality rate is the number of people who died from COVID out of the total population in Cebu City at a specified time (usually expressed as per 100,000).

“So, CFR of 1.07 percent means out of 100 COVID positive, there is one death. CFR of 1.07 percent does not mean one with COVID died out of 100,000 Cebuanos at this time,” Dr.Tapia said in his Facebook post.

To see what a difference this makes, consider 100 people who have been infected with COVID-19. Ten of them have it so severely that they go into hospital, where they test positive for the virus. The other 90 are not tested at all. One of the hospital patients then dies from the virus. The other 99 people survive.

That would give a case fatality rate of one in 10, or 10 percent. But the infection fatality rate would be just one in 100, or 1 percent.

In other words, the case fatality rate describes how many people doctors can be sure are killed by the infection, versus how many people the virus kills overall.

Contain COVID

Tapia said it is important to arrest the rising number of cases now before it will become unmanageable and prevent the new cases from coming up, not just detect the new cases with testing.

“For us healthcare professionals including those voicing out here on Facebook, each life matters. We do not see deaths as numbers or cases (borrowing Patch Adam’s line). We treat each one as a person who could be anybody’s loved one, a parent, a sibling, a mentor, a business partner, a dear friend, a spouse, a child. So a case fatality rate of 1.07 percent matters especially with increasing cases,” he said.

The Inter-Agency Task Force on the Management of Emerging Infectious Diseases reverted the city to the stricter enhanced community quarantine status earlier this week.

The IATF based its decision on these conditions: the COVID-19 cases in the city have doubled in 6.64 days or less than week which is considered as high risk; out of the 80 barangays in the city, 61 are affected with active cases; the city logs testing positivity rate of 33-36%; and as of June 14, the critical utilization rate stood at: 60 mechanical ventilators (45%), 27 ICUs (100%), 399 isolation beds (90%), 133 bed wards (93%). KQD (FREEMAN)