June 24, 2020

Cebu City's #COVID19 Crisis: A throbbing migraine for General Cimatu

Latest data shows Cebu City has 3,987 cases [1] against a total population of 922,961 [2], translating to 4,320 cases per million residents, i.e., between Italy’s 3,948 [3] and the UK’s 4,511 [4].

Oddly, Cebu City registered 64 total deaths [5], translating to just 69 deaths per million, way below Italy’s 573 [6] and UK’s 632 [7].

If there are about as many cases per capita in Cebu City as in Italy and the UK, why is Cebu City’s mortality rate drastically lower than the two?

A potential explanation would be underreporting (e.g., COVID deaths reported as just pneumonia deaths), but the disparity between Cebu City and Italy/UK is just so vast, underreporting alone won’t be enough to explain this phenomenon.

A possible additional explanation is that Filipinos are generally younger.

People age 65 years and up at significantly higher risk of mortality for COVID-19 [8] while the median age is 24.1 years [9] for Filipinos versus Italy’s 46.5 [10] and the UK’s 40.6 [11]. That is, Filipinos stricken with COVID-19 generally have more resilient bodies.

Note, however, that a young population is not necessarily a good thing.

Filipinos on the average live for 70 years [12], compared to Italy’s 82.5 [13] and the UK’s 81.1 [14], meaning Filipinos die over a decade earlier than Italians and Brits. Thus, it’s also possible that Cebu City has fewer COVID-19 DPM because many of Cebu’s elderly, who would have been at higher risk of dying from COVID-19, have already died over a decade ago from some other cause.

Moreover, the Philippine Healthcare System as a whole is indubitably inferior to Italy and the UK. Case in point, Cebu City ran out of hospital beds to accommodate COVID-19 cases on 11 June 2020 [15]. While DOH Cebu City requisitioned additional beds, the fact remains that its medical workforce remains the same, potentially translating to a generally lower quality of care, as doctors and nurses divide their attention among more patients.

Regardless, I think it’s reasonable to expect Cebu City’s DPM to remain relatively low and nowhere near those of the UK and Italy, which the Health Department uses to claim the effectiveness of its COVID-19 response.

And that’s a major problem because it doesn’t take into account that Cebu City’s recovery rate, along with the rest of the Philippines, is shockingly low.

However, a slightly closer look at the numbers reveals a bad sign: the recovery rate is too low.

The median length of hospital stay for COVID-19 patients outside of China is 4 to 21 days [16]. Generously assuming a 21-day hospital stay, Cebu City’s a vast majority 2,319 cases as of 01 June 2020 [17] should have already recovered 21 days later on 22 June 2020.

However, data shows only 278 recoveries out of Cebu City’s 3,987 cases, meaning Cebu City’s COVID patients remain very sick longer than other countries. These patients are likely to survive, but extended hospital stays imply more massive medical bills.

Such bills will be a burden for Filipinos because the Philippines has yet to fully implement Universal Healthcare [18], unlike Italy and the UK, that already have such systems in place since 1978 [19] and 1948 [20], respectively.

All in all, I think it’s safe to say that Cebuanos have a higher chance of survival compared to those in Italy and the UK. However, survivors may want to brace themselves for years or even decades of misery because they’re more likely to face massive medical debt as a result of their hospitalization.

Given the sheer number of COVID-19 cases in Cebu, this dark reality may significantly affect the level of support among Cebuanos for this administration, so the pressure is on newly-appointed IATF-Cebu head and former Armed Forces Chief of Staff Roy Cimatu [21] to salvage the situation. (RJ Nieto/ThinkingPinoy)


[1] DOH nCoV Tracker. Retrieved 23 June 2020. https://rjnieto.me/3cAy3IY

[2] Philippine Statistics Authority. OpenStat: Cebu City. https://rjnieto.me/2VawATg

[3] Worldometers 2019 Coronavirus Pandemic Tracker. Retrieved 23 June 2020. https://rjnieto.me/2U3u4h1

[4] Ibid.

[5] See [1]

[6] See [3]

[7] See [3]

[8] US Centers for Disease Control and Prevention. COVID-19: People Who Are at Higher Risk for Severe Illness. https://rjnieto.me/2AS2c9r

[9] CIA World Factbook. Country Comparison: Median Age. Retrieved 23 June 2020. https://rjnieto.me/2VezgiS

[10] Ibid.

[11] Ibid.

[12] CIA World Factbook. Field Listing: Life Expectancy at Birth. Retrieved 23 June 2020. https://rjnieto.me/2V72VKE

[13] Ibid.

[14] Ibid.

[15] Inquirer. Cebu City hospitals run out of beds for COVID-19 patients. 11 June 2020. https://rjnieto.me/37Ulff5

[16] Rees et Al. COVID-19 length of hospital stay: a systematic review and data synthesis. medRxiv. 17 May 2020. https://rjnieto.me/37WFHvP

[17] Sunstar. Cebu City logs 45 new Covid-19 cases, 18 recoveries. 01 June 2020. https://rjnieto.me/3drklIc

[18] Manila Bulletin. Go supports suspension of UHC implementation due to alleged corruption at PhilHealth. 01 June 2020. https://rjnieto.me/2Cu1wHv

[19] Signorelli et Al. Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary. January 2020. https://rjnieto.me/3hUzJR2

[20] The Commonwealth Fund. International Health Care System Profiles: England. 05 June 2020. https://rjnieto.me/2Zgm3Y7

[21] Sunstar Cebu. EXPLAINER: Worried over General Cimatu's coming to Cebu? Check out job description, marching order. 23 June 2020. https://rjnieto.me/2B1Zdv3


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