Looking into the FASSSTER Data: A Case Report of COVID-19 Cases in Caraga from April – December 2020

Figure 1. Screenshot image of the homepage of FASSSTER COVID-19 v4.0 (http://fassster.ehealth.ph/covid19/)


The spread of SARS-CoV-2, the strain of coronavirus that causes COVID-19 disease, has reached all throughout the regions in the Philippines, affecting all individuals without discrimination of age and weather. This has greatly affected the public health status of the Philippines in which it created a domino effect, compromising all aspects including the economic sector. The first two confirmed cases in the Philippines was a Chinese couple, a 39-year-old female and a 44 year-old-male. The male patient was the second reported case and also the first confirmed death due COVID-19, declared expired last 1 February 2020. For Caraga region, the first COVID-19 case was reported on 6 April 2020, a 68-year-old male from Butuan City with a pre-existing medical condition, suffering from diabetes with chronic obstructive lung disease. The said patient has a travel history from Manila and arrived in Butuan last 12 March 2020. The region declared its first local transmission in Butuan City last 19 June 2020 thru the Department of health Center for Health Development (DOH CHD) Caraga, following the first 3 cases that has no travel history in areas with community-wide transmission.

In this report, we will look into the details of the COVID-19 cases in Caraga as of 31 December 2020 through the Feasibility Analysis of Syndromic Surveillance using Spatio-Temporal Epidemiological Modeler for Early Detection of Diseases (FASSSTER) v4.0, a web application and repository of epidemiological data developed in partnership with the Department of Health (DOH), Department of Science and Technology – Philippine Council for Health Research and Development (DOST – PCHRD), and the Ateneo de Manila University. We will be looking into speed of the outbreak which is interpreted as the case doubling time, as well as the mortality rate interpreted as mortality doubling time. Growth factor of the cases through 7-day moving average (7DMA) and capacity utilization rate (CUR) will also be discussed.

The case doubling time (CDT) measures the speed of the outbreak. The speed of the outbreak tells how effective the outbreak control and preventive measures are. CDT influences decisions on case finding, testing, contact tracing, isolation, and quarantine. High numbers of CDT indicate a slow outbreak while low numbers indicate a fast outbreak. On the other hand, mortality doubling time (MDT) is a measure of the rate of death. The rate of mortality measures the effectiveness of clinical care. MDT influences decisions on compliance with clinical practice guidelines, hospital surge capacity, and infection prevention and control measures. High numbers of MDT indicate low death rate while low numbers indicate high death rate. The 7DMA is the average of the numbers of new cases, based on report date, over the last 7 days up to the current day. And the CUR is the rate at which equipment and bed capacity are being utilized for the entire region.

Figure 2. Graph showing the speed of the outbreak since the first reported case in Caraga as of 11 October 2020.

The speed of the outbreak (Fig. 2) shows the doubling time for Caraga Region corresponding to the reported number of cases as of 11 October 2020. The horizontal axis corresponds to the number of days since the first event (Day 0) and the vertical axis corresponds to the quantities in logarithmic scale with base 10. The blue, red and green graphs represent the cumulative number of cases, deaths and recoveries in logarithmic scale, respectively, on each particular day.

Figure 3. Graph showing the epidemic curve base on report date in Caraga from April 2020 – December 31, 2020.

In between the months of April to December 2020, the highest number of new cases was reported on 11 October 2020 (fig. 3) accounting to 122, although the speed of the outbreak is far from and in between the 7-day doubling time and 30 day doubling time (fig. 2). However, the capacity utilization rate (CUR) at this time is 75% (fig. 4) in which it exceeded the danger zone (intensive care units and isolation beds are at full capacity). This means that as of 11 October 2020, though the speed of the outbreak is relatively slow in respect to the 7-day case doubling time, hospital capacity are at risk to which if not resolved, would later speed up the case doubling time, given if quarantine measures will not be strictly imposed for the succeeding days.

Figure 4. Graph showing the Health Capacity Utilization Rate in Caraga as of 11 October 2020.
Figure 5. Graph showing the speed of the outbreak since the first reported case in Caraga as of 31 December 2020.
Figure 6. Graph showing the Health Capacity Utilization Rate in Caraga as of 31 December 2020.

Since 13 October 2020, the speed of the outbreak is decelerating. Deceleration of speed was recorded up to 31st of December 2020 which is still far from the 7 day doubling time threshold (fig. 5). Case and Mortality doubling time as of 31 December 2020 was 21.00 and 19.11 respectively (fig. 7), both showing increasing trends. This just indicates that there is a relatively slow outbreak and a very low death rate of COVID-19 cases in Caraga as of 31 December 2020.  The health capacity utilization rate as of 31 December 2020 has already dropped down to 37.36 % which is below warning zone (fig. 6). This means that the CUR has significantly improved since that of 11 October 2020 wherein it has the highest reported daily cases. Also, despite the deceleration, data shown is still far from the target threshold of the 30-day doubling time (fig. 5). This means that much effort is still needed to slow down the spread of the virus for it to reach or exceed the target threshold.

Figure 7. Case and Mortality Doubling Time of COVID-19 Cases in Caraga as of 31 December 2020.
Figure 8. Growth Factor and the 7-day Moving Average as of 31 December 2020.

The growth factor as of 31 December 2020 is 0.9125 (fig. 8). This is 0.314424 lesser than that of the growth factor of the highest recorded daily case on 11 October 2020 which accounts for 1.226744. Similarly, the 7MDA of 31 December 2020 is 31.28571, which is 29 lesser than that of 11 October 2020, accounting for 60.28571 (fig. 8). This means that there is a relative decrease of reported daily cases since the day at which daily cases were reported the highest in Caraga (October 11, 2020).

Generally, COVID-19 Cases in Caraga, based on data provided by FASSSTER through case doubling time, growth factor, and epidemic curves, suggest that the spread of cases are relatively low and highly manageable. However, there is a need to drastically improve COVID-19 facilities and hospital capacities to ensure that the CUR will be within the safe zone, thereby preventing overload and overuse of resources, and ultimately providing optimal care to all the patients in need of proper medical attention. Also, cases not reaching to the 30-day doubling time, suggests that there is still a need to strengthen non-pharmaceutical interventions (e.g quarantine protocols) in order to significantly slow down the spread of the virus in the region.

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