[THREAD: #COVID19PH Epi Surveiallnce]

A lot of people have asked very valid questions as to why the DOH national case counts take a while to update vs the LGU or even CHD (Regional Offices of the DOH).

Let me try to explain as best as I can in this thread.

RT everywhere

1/ First of all, let me refer you to Annex F of DOH Administrative Order 2020-0013. This AO is famous because this is the AO revising the PUM/PUI classification to suspect/probable case.

Read in full here: https://www.covid19.gov.ph/wp-content/uploads/2020/04/DOH-ao2020-0013.pdf

2/ Every suspect case (formerly PUIs awaiting testing) comes into contact with the health system, specifically with a disease reporting unit (DRU). This can mean a hospital, a health center, or any of the sentinel sites built specifically for COVID19.

3/ Ideally, each case is interviewed by a health worker and their details are written (yes, paper) into a case investigation form (CIF). (PS - efforts are underway to transition to a fully electronic CIF system). CIF is important because it contains important details that can...

4/ guide contact tracing efforts by the LGU - namely the city/municipality/provincial epidemiology & surveillance unit (CESU/MESU/PESU) in close coordination with the CHD. It also contains medical information that can guide in clinical case management.

5/ Another copy of the CIF is transmitted to a DOH-accredited COVID19 lab, usually bundled together with the boxed sample of the suspect case for testing. For RITM and its subnational labs (SNLs), specific samples are now sent to the assigned zone. See Annex D of AO 2020-0013.

6/ For all other labs, as far as I understand, they are not bound like RITM/SNLs to receive specific samples, which is why we see certain LGUs partner with private labs for widespread testing in their LGU.

7/ Which brings me to the DOH official tracker. A lot of people have asked why there is such a huge discrepancy in the totals between the total confirmed cases and the testing capacity table. The official press release is that case validation is ongoing, and that is the truth.

8/ The official, national case counts come from the DOH- Epidemiology Bureau (EB). As you saw in the first figure in this thread, EB gets two sources of counts: one from the regional epidemiology & surveillance units (RESU) housed in each CHD, and the DOH accredited labs.

9/ Labs report daily to the DOH aggregate values of tested positive, negative, equivocal, and invalid individuals. There are efforts underway to integrate the reporting system of all labs into one platform so that they are near real time for the line list, not just aggregates.

10/ The line list of case information takes a while to come in. Paper backlogs (10,000+ CIFs of + and -) were mentioned by DOH before Holy Thursday, and that backlog has been significantly addressed since. But paper forms are still used for new cases, so encoding takes a while.

11/ The LGUs report earlier as they have their own reporting systems (our health system is devolved after all) as they are furnished copies of the lab test results. But designation of case numbers (PH-XXX) are assigned by EB, and careful steps are taken to ensure that...

12/ the case designated with a number is really a confirmed case. Alignment of case totals is also done constantly between EB, RESUs, PESUs, and CESUs/MESUs to ensure the case is really located in that area, not in the permanent residence indicated in the CIF.

13/ A lot of LGUs &CHDs have issued public statements clarifying the discrepancies in the tracker, and rightly so - any discrepancy is going to be met with some (or maybe a lot of) level of skepticism from the public. I love this press release from CHD-V as it is honestly nuanced

14/ Now, when will we expect the cases in the Cebu prisons to come? Probably tomorrow. The Sitio Zapatera numbers came in a day after it was reported in the LGU.

Is this too slow? Perhaps. Ideally, we want it as quick as possible, while still making sure the data are correct

15/ Will things be better? Yes! While it would have been ideal to set these systems up beforehand (Taiwan prepared for 15 years!), multiple encouraging efforts are underway to integrate all information systems and improve timeliness of reporting.

16/ The fact that the public is having a conversation on discrepancies is such a HUGE deal for health data transparency in this country, because even to some people in the health sector, health data can be a black box.

17/ So as a public health professional volunteering all my time to DOH, I'm happy that we are in the growing pains phase of open data in health.

What I can assure you is that:
1. No one is faking the data
2. Efforts are underway for real, structural change in health data infra

18/18 So keep those constructive feedback coming towards DOH's way. They are listening intently, and working their best to win the public's trust again.