Is Guam’s health care system heading for collapse?
With the spike in Covid cases, governor expects 20% hospitalization
Combat Medics from the Guam National Guard's 1-294th Chamorri Battalion assist the Guam Department of Public Health and Social Services with the testing of 156 personnel at the Department of Corrections in Mangilao on Aug. 13. Photo courety of GUNG
The number of Covid-19 positive cases on Guam mounts without letup and with 105 positives reported on Thursday, the island is bracing for scarier statistics.
As of Aug. 20, the total tally is 704— including six deaths—representing the largest number yet since the beginning of the outbreak on Guam.
Behind the skyrocketing number, local leaders and health industry stakeholders are confronted by the likelihood of the Covid-19 putting further strain on the island’s limited health care system—which for decades has been the subject of intensive scrutiny and at the center of political bickering.
Currently, 14 are hospitalized and four are at Guam Memorial Hospital’s ICU unit, which has only five beds.
GMH administrator Lilian Posadas said three are on ventilators. “These are young people; they are in the 30s, so this is a scary situation,” she said.
Guam has 79 available ventilators, which local officials hope will not have to be used. But the current predicament nudges local leaders and health officials to brace for the worse.
“Statistically speaking, we can anticipate that 20 percent of these cases will end up in the hospital, which is already reaching its capacity,” said Gov. Lou Leon Guerrero, who herself is just recovering from the Covid-19 infection.
More people who come to GMH with respiratory conditions need a higher level of critical health care. Photo by Mar-Vic Cagurangan
“I must remind the public that this pandemic will either accelerate beyond the capacity of our healthcare system or decrease to containable levels—we are dangerously close to the former,” she added.
Posadas said more people who come to GMH with respiratory conditions need a higher level of critical health care.
In anticipation of more Covid-19 patients, GMH begins to realign its resources by assigning more beds for coronavirus patients.
“We have 14 beds available (for Covid cases) but we are using eight of these for non-Covid patients,” Posadas said. “We have an additional six ICU beds. We partition the ICU area for Covid and non-Covid cases so that non-Covid will not mix with the Covid patients. We will use the six for Covid if needed.”
On the third floor, the telemetry unit has 26 beds that will be allocated for Covid-19 cases. “We are moving non-Covid telemetry patients to another area,” Posadas said.
But a source in the medical community has raised concern about the staff limitation, especially in ICU. The Skilled Nursing Unit in Barrigada, which was previously assigned as a Covid-19 facility, is currently unusable due to a lack of air-conditioning system.
“Guam needs to reduce or flatten the daily increase of new cases to only 16.5 percent, otherwise there will not be enough ICU to handle the number of seriously ill patients,” a source in the medical sector said. “Those projections assume 20 percent of Guam’s Covid-19 patients and will require hospitalization, with 20 percent of those requiring intensive care bed.”
Guam's test positivity rating -- defined as the seven- day average of positive-- is 6.8 percent of testing performed.
"Our case doubling rate, defined as the estimated number of days in which our total number of positive cases will double if we continue at the same rate, is an alarming 17 days,"the governor stated in her executive order.
If worse comes to worst, Guam will turn to the military for emergency medical assistance.
Leon Guerrero said the Joint Region Marianas has assured her that the military will extend medical resources if Guam’s health care system is maxed out.
She said the tents installed by the Navy for the sailors at the coronavirus-stricken USS Theodore Roosevelt remain on the island and will be made available for Guam’s emergency need.
“We are prepared,” the governor said. “But I hope we don’t get to that point where we have to use tents and use all our ventilators.”
However, officials and medical professionals acknowledge that the reported numbers do not reflect the real picture of the Covid-19 situation on Guam due to testing impediments.
The Guam Department of Public Health and Social Services is shifting its efforts to target testing and has postponed the community testing. Test results will also be delayed, due to the large number of samples submitted for Covid-19 testing to the Guam Public Health Laboratory.
The Joint Information Center said DPHSS is reaching its capacity for storage space for specimens and will need more time to be able to run the remaining tests as efficiently as possible.
Tents were set up at the Naval Hospital for sailors at the Covid-19-stricken USS Theodore Roosevelt, which docked in Guam during the outbreak in May. Photo courtesy of US Navy
Based on the current scenario, the actual number of Covid-19 positive cases on Guam could be as high as more than 2,000, according to a statistical model followed by the Centers for Disease Control and Prevention, which also predicted that the island will have a cumulative total of eight coronavirus-related deaths by Nov. 1.
The Youyang Gu forecast said the true number of infections is many times greater than the reported number of cases "because the majority of infected individuals do not get tested due to several reasons: 1) they are asymptomatic, 2) they are only mildly symptomatic, 3) they do not have easy access to testing, or 4) they simply do not want to."
At this point, the government is relying on fresh attempts to contain further spread of the coronavirus by imposing more stringent restrictions including the reinstatement of the business shutdown.
“It is my hope that this escalation will last only a week—just long enough to flatten our rising curve,” the governor said.
“ Based on what we know about COVID-19, to prevent the collapse of our healthcare system, we need to take drastic steps and we need to take them immediately. I know this is extremely difficult, but the good of all depends on the sacrifices of many. More than ever before, we need unity, hope, compassion, and the political will to see this crisis through.”