CARLA ELIZE DERAIN YL3 

1.     Establishing the existence of an outbreak

The several COVID cases in barangay starting 1 week ago represent a cluster. The first
step is to determine whether or not the cluster of cases is an outbreak. Note that the
expected number in Manila is 50-150 per day and assuming that the target barangay
contributes to 1/3 of these cases. To determine whether an outbreak is actually
occurring, data from accessible existing sources such as locally reported disease
registries, population surveys or healthcare records must be collected. Next is to
compare whether observed number cases exceed the expected number (16-50 cases
daily). Data such as disease onset, demographic variables, number of cases and
population at risk reflects the severity and potential spread of illness. Assuming that
there are 60 daily reported cases in the barangay exceeding the anticipated number of
cases, thus, occurrence of outbreak is now established. 
 

2.     Creation of working hypothesis

Hypothesis is generated through baseline knowledge of investigators or by an interview.
The baseline knowledge about COVID-19 includes SARS-COV2 as etiologic agent,
respiratory droplets and fomites as modes of transmission, and advanced age and
comorbidities as risk factors. Hypothesis-generating interviews must also be conducted
to provide further information, not only confined to the known sources and exposures,
which generate null or alternative hypotheses. Let’s assume that index patient along
with other patients who had and had not contact with him in the barangay presented
COVID-19 symptoms such as high fever, cough and fatigue. Since, there are
unexposed patients who became ill, a hypothesis that patients displaying flu-like
symptoms are infected by other respiratory infections, can be inferred. Thus, the
outbreak is not related to COVID indicating null hypothesis.
 

3.     Collecting data
A retrospective cohort study is the design of choice for an outbreak in a small population
applicable to the target barangay. The initial step is to contact the residents of the
barangay, determine their exposure to an index patient and compare the exposure of
the case-patients with the exposure of persons without the COVID symptoms as
presented by the table.
Next, the attack rate of exposed persons to the index case (74.7%) is calculated by
dividing the number of persons who develop symptoms (56) by the total number of
exposed persons that had contact with the index case (75). This formula is also used to
compute the attack rate of unexposed persons. 

4.     Data analysis

The risk ratio is calculated to determine the measure of association by dividing the
attack rates of the exposed over unexposed group which equals to 6.9. This indicates
that exposed persons were 6.9 times more likely to become ill than those who were
unexposed, thus, there is a strong association between exposure and disease. The
population attributable risk percent indicates that 79.9% COVID in the barangay can be
attributed to the exposure to an index patient. Afterwards, statistical analysis using a
chi-square test would be done to obtain the p-value which supports or rejects the null
hypothesis. Assuming that the p-value is less than 0.001, thus, the null hypothesis was
rejected and alternative hypothesis was accepted (exposure to index patient was indeed
associated with COVID).

5.     Initiate supporting investigation

The flu-like signs and symptoms of COVID may be similar to those of other respiratory
infections. Hence, coordination of epidemiologic findings with the laboratory and
environmental studies providing an unquestionable conclusion must be established. To
achieve confirmation of SARS-COV2, medical records of each patient including
smoking history, comorbidities, radiological findings, laboratory findings and RT-PCR
assay results on admissions and throughout the progression of the disease of the case-
patients must be obtained from hospital. Once the findings have been collected, the
cases will be diagnosed based on WHO guidelines on COVID-19.
 6.     Communication of results

Once the findings have been summarized and concluded, an effective communication
to the local authorities must be conducted by oral presentation and written report. An
oral briefing should be held with local authorities to present the study findings and
recommendations in order to implement measures for control and prevention. The
written report should be available in scientific format, and be used as a record for the
Health Department in that locality if a similar situation arises in the future. 

REFERENCES:
Centers for Disease Control and Prevention (2006). Principles of Epidemiology
in Public Health Practice. An Introduction to Applied Epidemiology and
Biostatistics. 3rd edition. Retrieved May 27, 2021 at
https://www.cdc.gov/csels/dsepd/ss1978/lesson6/section2.html#step6