Bohol and Negros Oriental, both with populations of about 1.3 million in the 2015 census, have seen increasing numbers of SARS-CoV-2 infections in recent weeks. The seven-day daily average from June 11 to 17 was 106 and 155 for Bohol and Negros Oriental, respectively. Compare this to the 35 daily average number of new cases during the same period in Cebu province whose population is about 3 million (2015 census).

One explanation for Negros Oriental’s triple-digit daily cases is that the province is testing more people than ever; 89.1 percent of the 1,085 cases reported in Negros Oriental from June 11 to 17 are asymptomatic suggesting that infected individuals were identified through contact tracing or other compulsory testing. The same is the case for Bohol with 89 percent of 743 cases being asymptomatic. In Cebu province, only 38.2 percent of 246 cases reported from June 11 to 17 were asymptomatic. In absolute numbers, Cebu has the most number of symptomatic cases among provinces, but fewer than Cebu City. The Department of Health Central Visayas (DoH-Region 7) reported 359 new cases in Cebu City from June 11 to 17; 52.8 percent of which were symptomatic. All data used in this article are lifted from DoH-Region 7 Covid-19 tracker.

As for positivity rates, since the numbers of test results released by Bohol’s and Negros Oriental’s local reverse transcription polymerase chain reaction testing facilities are posted in the daily DoH-Region 7 Covid-19 bulletin, determining their respective positivity rates is easy: they are high these days. The remaining tests cover Cebu province and three highly urbanized cities, but no breakdown per area is provided.

There are several factors to consider when adopting a specific testing strategy. For one, testing alone will not lead to control of the virus. Effective contact tracing and isolation of infected persons or suspected cases must follow. Limited available resources at LGU level and differences in prioritization play in. There is no right or wrong. In rural areas, transmission is slower due to lower population density and absence of workplaces with large number of employees, making surveillance seem less urgent. Speaking of workplaces, many companies do regular testing of employees to reduce the risk of major office, plant or project site outbreaks, which would negatively affect production. Recently, about 50 employees of a construction project in Cebu City tested positive. All were asymptomatic.

Obviously, simply counting new cases or active cases doesn’t give the whole picture of the situation on the ground. We have the healthcare utilization rate, itemized by types of rooms and equipment. But how do we factor in that rural areas usually lack critical care units and trained medical staff? There could be an emerging health crisis in a remote locality and we wouldn’t know about it.

As for case fatality rate, or CFR, in Central Visayas, Cebu province’s 4.58 percent is the highest as of June 17. Bohol’s and Negros Oriental’s CFRs are 0.81 percent and 1.65 percent, respectively.

Cebu City’s CFR is 3.46 percent, pulled up by the large number of Covid-related deaths that occurred a year ago: 500 of Cebu City’s 867 Covid-related deaths were reported from May 30 to July 9, 2020. The city has more Covid-related deaths than Cebu province despite its much smaller population.

But CFR is like infections and positivity rates, a relative number that depends not only on Covid response but on how many — or few — tests are administered.

At the end of the day, it will be the number of deaths relative to population that will tell us who had the better pandemic response. But how deadly Covid actually is, we will likely only have an idea once we know the total deaths from all causes and can compare this number with the expected number of deaths.

The polio outbreak that was declared by the DoH in September 2019 has officially ended with no new cases detected in 16 months. The outbreak, caused by low levels of immunization, came after the Philippines having 19 years of polio-free status. In the commentary “Polio Eradication at the Crossroads” published in The Lancet on June 9, Konstantin Chumakov, PhD, and colleagues argue that the “only sustainable solution to eliminating paralytic poliomyelitis is to indefinitely maintain the highest possible rates of population immunity through quality immunization programs.”

“Hunting down the virus,” through acute flaccid paralysis surveillance and environmental surveillance, have proved to be no guarantee for eliminating the dreaded paralytic poliomyelitis. Points to ponder in this pandemic age.