62 new Covid-19 cases reported; Legislative hearing bares continuing struggle with data
The Joint Information Center reported 62 new Covid-19 positive cases out of 434 samples tested on Wednesday, 26 of which were identified through contact tracing. One case reported recent travel from the U.S. and was identified in quarantine.
To date, there have been a total of 2,550 officially reported cases of Covid-19 with 49 deaths, 635 cases in active isolation, and 1,866 not in active isolation. Of those cases, 2,277 are classified as civilians and 273 are military service members.
As the community continues to learn how to adapt to life with Covid-19, Sen. Therese Terlaje, the oversight chair on health, continues to monitor progress with the Department of Public Health and Social Services (DPHSS) to get a clearer picture of the trajectory of the reopening of Guam businesses, tourism as well as restoring some semblance of normalcy for residents.
“Since the first oversight on contact tracing held in May through today, these hearings have been essential to getting information to the public when there has been so much uncertainty. Hearing that there is progress is encouraging and lets everyone in our community know that DPHSS is working hard to keep them safe, while also considering their need to get back to work,” Terlaje said.
The third in a series of oversight hearings, which took place on Oct. 1, sought update on the progress of Covid-19 response measures including the contact tracing and Investigations capacity, implementation and results of Covid-19 tracing apps, public disclosure protocol for case investigations and contact tracing information, status of the CARES Act funding request and other federal funding, and Public Health Authority Powers under Chapter 19, Title 10, Guam Code Annotated.
The DPHSS workflow has been streamlined for contact tracing and containment, and they can now contact a positive case, close contacts, plan isolation, and instruct on quarantine for family members within 5-8 hours of test results.
According to Dr. Chima Mbakwem, projects coordinator for the Office of HealthCare Associated Infections Epidemiology, the new strategy is a time-saving mechanism where the containment team identifies family members and close contacts and immediately hands the data to the contact tracing investigation team who completes their investigation within 1-2 days while those identified are already under quarantine and are being monitored for 14 days.
Annette Aguon, Covid-19 Epidemiology/Surveillance Branch Lead, also updated the Oversight Chair on contact tracing investigation resources stating that there are currently 22 investigators, 25 contact tracers, plus 3 contact tracers with Dr. Mbakwem’s team. Also assisting in this effort are approximately 42 DOE nurses, 38 existing Public Health staff, among others.
In addition to public and private partners, a pilot project has started at UOG which will augment the investigation team at a separate site. Santos and Mbakwem attributed the increased staffing, household contacts in multigenerational homes already under quarantine, and the current lockdown in assisting them to complete investigations sustainably until Guam starts reopening and shifting gears.
Although the Guam Covid Alert App has only seen a 19.6 percent adoption rate, short of the recommended 60 percent gold standard, efforts are still ongoing to increase the levels through various outreach and incentive programs. Public Health also launched the SARA Alert technology which will eventually replace most of the manual monitoring, allowing a more robust way for patients and close contacts to report their symptoms daily via telephone, email, smartphone, or text messaging.
Though much progress has been made regarding containment and contact tracing, Dr. Ann Pobutsky, Guam’s territorial epidemiologist, advised that they are behind on data management and migration, stating that it will be at least another month until we get more robust weekly surveillance reports, which will break down community spread by activity categories.
The categories are a work in progress but could contain the information that the community has been pressing for, to make well-informed decisions about what activities could be riskier for them and their families and to help the government determine what businesses could be classified as lower or higher risk.
Terlaje stated, “I continue to urge the Department to provide more data to the public to help them understand what information is driving the decisions so that they have confidence in this process going forward.”
Acting Director Art San Agustin updated the Chair on the latest changes to quarantine protocols, noting that those who wish to test on day 6 and test negative, can opt to fulfill the remainder of their 14-day quarantine at home.
Dr. Mbakwem clarified that these individuals are on restricted movement, which means they can go to the store for essential items and exercise because they have a lower probability of testing positive. This is different from quarantine for close contacts who have been exposed to Covid-19.
Although the ongoing community positivity rate averages approximately 8 percent according to the JIC, Aguon advised that DPHSS is still confident in their ability to adequately trace contacts and control the spread of infection, especially with the recent adjustments made with the isolation and quarantine team and updated internal protocols with the trace investigation team.
“I am optimistic about the progress made in just the past few months regarding containment and contact tracing, however, I cannot stress enough about the importance of transparency in the process and data-driven decisions being the key to public participation,” Terlaje said.
In addition to adopting the Guam Covid Alert App last month, public health officials will also be using Sara AlertTM, an open source tool that automates monitoring and reporting of individuals exposed to or infected with the coronavirus.
With Sara AlertTM, individuals will be able to update the Department of Public Health and Social Services on their health status on a daily basis during the period of time they are participating in public health monitoring. The tool provides real-time insights and increased reporting capability to support containment of the virus. It also enables hospitals and health systems to conduct contact tracing for their own employees. Sara AlertTM will be especially useful as DPHSS implements Guidance Memo 2020-11 Rev10, the latest quarantine protocol guidance.
“As further restrictions are relaxed, we need to ensure our Public Health containment and isolation team has the resources they need to keep this virus in check and prevent another surge of confirmed cases,” said Governor Leon Guerrero. “By deploying the new Sara AlertTM system, we can improve our efforts to mitigate the spread of COVID-19, protect the health of our people, and support our goal of safely opening up our community.”
Unlike Guam COVID Alert, users will not have to download a smart phone application to access Sara AlertTM. Instead, they will communicate directly with DPHSS officials to report daily symptoms through web, SMS text, email, or phone call. Sara AlertTM does not collect or ask for other personal identifying information like social security numbers, bank account numbers or other financial information. Sara AlertTM will only ask individuals to report symptoms they may be experiencing. The Sara AlertTM system is already in use in several other states and territories.
“DPHSS remains focused on its mission to reduce the number of Covid-19 cases in Guam,” said DPHSS acting Director Art San Agustin. “Digital tools like Sara AlertTM are useful for quarantine management and help us improve our response and transition to recovery. This will increase our ability to track potential cases and contain cases more efficiently.”
Sara AlertTM is free for use by federal, state, territorial, tribal, and local governments, and regional health organizations. It was developed by MITRE, a not-for-profit organization that works in the public interest, in close collaboration and partnership with national public health organizations, including the U.S. Centers for Disease Control and Prevention, Association of State and Territorial Health Officials, National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and other local and state health departments. Sara AlertTM has enabled public health workers to monitor and respond to the coronavirus pandemic and to coordinate and direct care where it is needed most.
“We developed Sara AlertTM with public health for public health,” said Dr. Paul Jarris, Chief Medical Advisor of MITRE’s Health Transformation Technical Center, and former Vermont Commissioner of Health. “Sara AlertTM has the potential to modernize the public health management of individuals in quarantine and isolation to protect communities from further spread of disease in this and future pandemics. As the pandemic evolves and stay-at-home measures are relaxed, states and localities can use it to strengthen efforts to control outbreaks in less affected areas, and to mitigate future waves of illness and possible rebound effects.”