37 new Covid cases reported; Physicians advisory issued for additional dose of mRNA vaccine



Thirty-seven new cases of Covid-19 were identified out of 560 tests performed on August 17. Thirteen cases were identified through contact tracing. To date, there have been a total of 9,118 officially reported cases of Covid-19 with 144 deaths, 412 cases in active isolation – inclusive of 16 hospitalized cases with five hospitalized cases receiving ICU-level care, and 8,562 not in active isolation. The CAR Score is 9.2.


As of Aug. 17, a total of 106,108 (77.85 percent) of Guam’s eligible population (residents 12 years and older) have received either both doses in the two-dose series (Pfizer-BioNTech and Moderna) or the single-dose series (Johnson & Johnson/Janssen) of the Covid-19 vaccine. This percentage includes 8,444 fully vaccinated residents between the ages of 12 – 17, as well as Guam's fully vaccinated adult population of 97,664.


Today, the Guam Department of Education (GDOE) confirmed five separate cases of Covid-19 involving students at Adacao Elementary School, Machananao Elementary School, Agueda I. Johnston Middle School, George Washington High School and Okkodo High School. In collaboration with the Department of Public Health and Social Services (DPHSS), GDOE has identified and notified teachers as well as parents of students who may have been in contact with the index cases to schedule testing.


Tested individuals will remain in quarantine until they are cleared by DPHSS to return to campus. Cleaning and disinfecting of areas of the campuses are taking place to ensure schools are ready for regular hours of operation on Thursday, Aug. 19.


Today, DPHSS issued Physicians Advisory No. 2021-009 advising Guam licensed physicians and providers of the guidelines for administering an additional dose of U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA)-approved mRNA Covid-19 vaccines.


The Physicians Advisory was issued at the recommendation of the Vaccine and Antiviral Prioritization Policy Committee (VAPPC).


Late last week, the FDA and U.S. Centers for Disease Control and Prevention (CDC) recommended that people who are moderately to severely immunocompromised receive an additional dose of an mRNA Covid-19 Vaccine (Pfizer-BioNTech or Moderna) at least 28 days after the completion of the initial mRNA Covid-19 vaccine series.


The Physicians Advisory notes that there is some clinical subjectivity that surrounds the definition of someone with a moderately to severely immunocompromised status. The CDC has stated that this includes people who have:

Active treatment for solid tumor and hematologic malignancies


Receipt of solid organ transplant and taking immunosuppressive therapy Receipt of CAR-T-cell or hematopoietic stem cell transplant (within two years of transplantation or taking immunosuppression therapy)


Moderate or severe primary immunodeficiency (e.g., DiGeorge syn

drome, Wiskott-Aldrich syndrome) Advanced or untreated HIV infection


Active treatment with high-dose corticosteroids (i.e., ≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis blockers, and other biologic agents that are immunosuppressive or immunomodulatory.


Chronic medical conditions such as asplenia and chronic renal disease may be associated with varying degrees of immune deficit.


The Physicians Advisory cautions that even with this provided list to serve as a guideline, there is still clinical subjectivity at hand. Therefore, the VAPPC has recommended that persons receiving additional doses come at the recommendation of a licensed physician or mid-level provider.


This can be in the form of a physical or a verbal prescription that must include the qualifying diagnosis/condition, which will be documented in the recipient’s immunization record.


Per recommendations from the CDC, anyone who believes they meet the criteria can present to a public vaccination clinic and self-attest as to their eligibility. This will be subject to the clinic provider’s review.