Public health director Linda Unpingco-DeNorcey
Guam’s Covid-19 number continues to look good, with zero positive cases consistently showing in the past four days and keeping the tally at 136.
But tests in the community will continue, according to government officials. On April 25, the Guam Department of Public Health and Social Services, along with the Mayor’s Council of Guam, will launch a pilot program in the Astumbo Housing Area in Dededo, where individuals with mild to moderate symptoms of Covid-19 will be tested. The purpose of this pilot is to identify vulnerable groups with whom testing is not readily available or accessible.
“Our measures were implemented early, aggressively and very proactively guided by science and a sound medical advice, and what we learned from other countries,” Gov. Lou Leon Guerrero said.
Over the next few weeks Leon Guerrero hopes to test 258 individuals per day using Guam’s FDA approved machines and test kits. “This level of testing is one of the conditions needed to safely begin to lift some of our current restrictions. Remember a single case can quickly lead to large clusters,” said the governor.
Another issue addressed during the conference was the change in Covid-19 trajectory on island. “The doctors have been working with FEMA to readjust the trajectory. Based on our mitigation efforts, which I’ve said we’ve done early, early on, first week, second week of March and aggressively done initiatives and directives to improve and increase social distancing, staying at home, hand washing—all those measures that are mitigation measures to decrease the risk of exposure,” Leon Guerrero said.
“FEMA recognizes our efforts and so they readjusted our trajectory to saying at the peak we’d need about 40-bed capacity and we can meet that now. As far as the 14-day, if we start looking at April 10-11, where we’re seeing mostly zero positive cases, then maybe one or two, we can say that for the 14 days we sustained that slow spread of the infection.”
Gov. Lou Leon Guerrero
With six machines on island, the governor hopes that Public Health can secure 200 tests each week moving forward. “Linda is being assured by CDC and also the World Health Organization that we’ll be getting 200 tests this week,” she said. “[FEMA] is saying if we have the capacity of 258 tests a day, that that’s a trigger to start lifting things.
The Rapid ID Now can test 124 a day, the BD Max at GRMC can perform 220 tests a day, and the GenExpert can test 284 a day at Public Health and at GRMC. “My advice from Dr. Mike Cruz is that we need to target more of the people who are at a higher risk, for example those who live in a multigenerational home, those who are healthcare front liners, by the way the tag is going to be also doing testing for her soldiers,” she said. “And we’re also going to include the Guam Fired Department and GPD in that testing. So we’re going to start testing the population of first responders.”
Leon Guerrero believes that Guam does have the testing capacity and once the government has the data, once their recovery plan is approved by the recovery panel, that the whole of next week Guam will do more testing.
The governor also clarified on the initial trajectory shared weeks ago. “Those were done with little history and data,” she said.
“Now that we have actual data for over the last five, six weeks, we can now better adjust our trajectory. I also understand that that data was done without the mitigation measures in consideration.”
The governor stated that even as Guam moves forward, the government will still do testing. “If there’s the need to assure the public that restaurant worker is a high-risk area, we’ll certainly look at testing them. right now, because we’re not still fully at the capacity because of test kits, we’re gradually bringing out the tests with targets of selected groups of populations that we feel are a higher risk.
Dr. Michael Cruz, of GRMC and the head of the governor’s medical advisory team, said public and private clinics have been receiving testing kits. “We should a plan for the wider testing of the community as a whole hopefully in the next couple of weeks,” he said.
On the FEMA capacity plan, Cruz said the government will be sharing reconfigured models of the projections. “With FEMA’s model’s and putting in the full mitigation efforts that the governor has within the last several weeks, it shows there has been a significant decrease in the actual bed cap,” he said. “We’re pushing a peak and flattening the curve significantly over a longer period of time so that our healthcare resources will not be overwhelmed given the current FEMA modeling that allows for the full mitigation efforts that we’ve been doing here on Guam.”
Cruz said John Hopkin’s model showed a 60 percent decrease in spread rate, which flattens the curve so that any peak that Guam may actually happen in September or October. “That allows us to meet the needs as far as our hospital resources.
The governor said that while there are only 17 active Covid19 cases on island, the government is still reluctant to lift restrictions. “Any plan to lift restrictions must be slow and happen over time,” she said. “Much of our recovery depends on getting it right. Opening too soon can mean a resurgence of new infections. In that event we must be ready to identify, test, and isolate all new cases and trace every contact they make.”
Leon Guerrero also announced that Public Health, with the Mayor’s Council of Guam, would launch a pilot program in the Astumbo Housing Area in Dededo on April 25 from 9 a.m. to noon. “They will be testing individuals with mild to moderate symptoms of COVID 19. The purpose of this pilot is to identify vulnerable groups with whom testing is not readily available or accessible,” she said.
Cruz said the Astumbo testing will be the start of a larger community testing protocol. “We want to make sure that the vulnerable populations, as the governor has stated—multigenerational, multifamily homes, end stage renal patients, those with significant comorbidities, frequent flyers to the hospital that we know are coming back and forth to either GRMC or GMH,” he said.
Cruz said if the government does not test these vulnerable populations that they may overwhelm the healthcare system.
Public Health Director Linda Unpingco-DeNorcey said the pilot program will start with a small sample size. “These pocket areas we’re identifying, we’re working with the Mayors Council and we’re looking at representatives of all this area.”
“We’re starting at that area because they’re the most vulnerable and they’re the most high-risk,” she said. “Why that area in particular, because a lot of them don’t have access to care and some of them also have barriers to care. I.e., they just don’t have transportation, or they have cultural barriers, or it could be a case where they have illnesses, but they don’t seek medical care due to lack of insurance. We also identified that this is an area that we can examine.”
Another issue brought up during the conference was how to test people who are reluctant to get tested. “Public Health, we try to encourage them, we try to give them some counseling, some education,” DeNorcey said. “We try to tell them the benefits of getting tested and how it would help us not only identify if they’re ill but also protect their other family members, their loved ones, and their friends and their families. If it comes to the point that we try and try with whatever educational intervention we’ve implemented and they still say no, the best that we can do is to just document that in our medical record and also closely monitor if there are other members of their family that could be at real great risk.”
DeNorcey mentioned cases in the quarantine sites where individuals were unhappy to be quarantine but started to show symptoms and being tested positive. “There’s that change of behavior that occurs (when) they realize they’re positive. That attitude and behavior now shifted totally 360-degree turn,” she said. “This is what we’re trying to do at Public Health. It’s very difficult to try to change behavior. We can only do that through education, knowledge, attitude, but the most difficult part is changing the way they behave.”
The director said that Public Health even hopes younger family members can encourage their elders to get tested. “And if we have to educate the child so the child can be the one to be instrumental to their parents or even their grandparents to change their attitude, that is what it’s going to take,” she said.
Leon Guerrero also discussed a phone call she had at 1am with Vice President Mike Pence, Dr. Deborah Brix, FEMA’s Peter Gaynor and his group of experts. “They talked some more about testing capabilities. They talked about if we’re going to be reopening the states and the territories, we need to make sure we have testing capabilities. They talked about their ability on a national level to provide those capabilities and working very closely with commercial laboratory,” she said.
Leon Guerrero also mentioned that the president’s experts talked about the importance that test kits and machines be FDA approved. She said, “They have relaxed their regulations a little. Meaning that if you are a commercial lab that is FDA approved and manufactures the squabs, the test kits and so forth, and there’s an alteration of the squab or test kit, they can go ahead and do their own manufacturer’s validation.”