Nature has brought humanity to its knees through the unprecedented foe that is coronavirus. However, the answers to the problems at large may be uncovered by studying the virus itself. As Gove. Lou Leon Guerrero has said, our island is sick, and just like in the pathogenesis of Covid-19 itself, this sickness is beginning to cause complications in other components of our figurative body.
Through this allegorical analysis, I offer a comprehensive perspective on the parallels that can be drawn between the pathophysiology of Covid-19 and Guam’s pandemic response and mitigation efforts. While the issues and concerns with our current response strategy have been well illuminated by many cynics in the community, I hope to provide applicable solutions.
To avoid death, we must first know how the virus kills. Soon after Acute Respiratory Distress Syndrome has run its course, it is only a matter of time before Multisystem Organ Dysfunction sets in. This fatal chain of events is preceded by a hallmark characteristic of Covd-19, the cytokine storm. This is a massive proinflammatory response in which multiple inflammatory mediators signal the immune system to initiate an aggressive attack on the infection. (Yuki et. al) The body believes that the aggressive deployment of immune cells is what will quell itself of the virus, but it is this very response that may be the cause for its fatal demise.
Analogously, Guam, as a community, has become infected with Covid-19. The virus has successfully eluded our public health system and made its way into the homes of our people, offices of our government, and the wards of our hospital. Its crafty deceptiveness lies not in its robust pathogenic character, but rather its inconspicuity.
With a serial interval that may be longer than the incubation period, infections may occur before symptom onset. In fact, this was determined by Xi et al. in their article published in Nature Medicine where they determined that 44 percent of infections occur before symptom onset.
By the time that patients are aware of their sickness, the virus has already made its way to other hosts. By the time our public health system was able to detect a concerning amount of cases, the virus has already made itself prevalent within the community. Just as inflammatory mediators do in the cytokine storm, our public health system has sounded the alarm to exercise a strict lockdown.
Further parallels can be drawn between our community pandemic situation and the disease of Covid-19. I aliken sustainable mitigation strategies like contact tracing and widespread testing to T cells in the adaptive immune response. Community lockdowns are like neutrophils which are innate immune cells that are able to hinder genetic replication of the virus, but can induce injury to lung tissue. In order to live with the virus, we must build more T cell immunity. (Cox and Brokstad, 2020) In the same way the body will be adversely affected by the oxidative stress caused by overemployed neutrophils, our community cannot rely on lockdowns to solve our issue of losing track of the virus. We must build a more efficient and robust test and trace strategy.
Our current strategy relies on techniques that are not proactive enough to safely liberate ourselves from overwhelming amounts of community transmission, so therefore, we are forced to compensate with an abrasive response such as a community lockdown. We must enact substantial changes to our strategy that goes beyond telling people to wash their hands and stand apart.
These changes must prioritize efficiency and cannot tolerate delayed notification of positive cases and identification of close contacts. With infections able to happen as early as two days before symptom onset and peak infectiousness occuring at 0.72 days prior to symptom onset, an infection surveillance strategy must be able to identify and immobilize infected individuals even before these individuals become aware of their sickness. (Xi et al. 2020)
With this type of data, restricting individuals who are asymptomatic from testing continues to enable community transmission. Our current method of contact tracing relies on the memory and more importantly, the integrity of community members to accurately identify all significant exposures. With only one third of confirmed cases being properly contact traced, we must increase human resources as well as digital platforms for this effort.
It would be prudent to adopt a test and trace strategy that utilizes accessible and frequent testing methods as well as contact tracing resources that may be more accountable. I have been able to identify the E25bio Direct Antigen Rapid Test. The Abbott BinaxNOW is also a respectable alternative as a lateral flow fluorescence immunoassay antigen testing strip, but is secondary in my perspective to E25bio because it requires a machine to process the sample whereas the latter simply uses an eluent on a paper strip in a process similar to thin layer chromatography.
To improve tracing efficiency, supplemental tools such as apps may reduce the amount of human resources necessary to effectively identify cases and more importantly, any presymptomatic contacts. Guam Department of Public Health and Social Services has reportedly created an avenue for the usage of an app called SafePlaces from the PathCheck foundation, but has yet to inform the people of how exactly they will utilize this. This app would be best served to use anonymized Bluetooth Relative Signal Strength Indicators to report any proximally and temporally relevant interactions from a confirmed positive case. With strong community participation in this type of contact tracing program, halting of community transmission may be much more attainable.
To conclude the parallel drawn from the pathogenesis of the virus at hand, this lockdown plays the role of the aggressive immune response that is responsible for the subsequent Multi Organ Dysfunction. While we will be able to reduce the amount of confirmed cases and halt community transmission of Covid-19, other facets of our society will have perished.
A quarter of our island’s population has become unemployed due to a stagnant economy. An observable increase in stillbirths can be attributed to a decrease in accessibility of prenatal care. Since the first cases of Covid-19 were confirmed, there have been 19 recorded suicides and whether that is due to pandemic fatigue or not, it is still just another point on the list of issues in our island that are illuminated by the pandemic.
Our island is sick, but we have been sick. All of these structural issues serve as comorbidities that are further complicated by the COVID-19 pandemic. Rather than blaming our cultural practices, it is these structural comorbidities that must be addressed in order to minimize the adverse effects of future waves of infection. Blaming our culture and people for the spread of the virus is like attributing adverse respiratory infections to simply having lungs. The people do not want to endure another lockdown, our society may die because of it. So, we must not yield to the virus, but rather adapt and build a robust immunity against future waves of infections that will keep our island safe while protecting our cultural values.
Kai Akimoto is a junior biology major at Macalester College. He is from Tamuning. Send feedback to firstname.lastname@example.org