By Mar-Vic Cagurangan
Cutting through the plague of confusion
By Mar-Vic Cagurangan
In these bizarre times, the only thing that is consistent is the inconsistencies of information that we have been receiving from the scientific and medical community— compounded by each government’s schizophrenic mandates and policies.
When the Covid-19 vaccine was first introduced, it was heralded as the beginning of the end of the pandemic. But the rapid resurgence of the virus, globally and locally, brings the question mark, even for medical experts who are now attempting to make sense of Guam’s perplexing statistics.
We all know now that there is no black-and-white explanation for how the vaccine works. It has medical nuances that health authorities bumble to spell out. You have to pay attention.
Information about the vaccine mutates as fast as the coronavirus does. The vaccine offers protection against Covid-19, world health authorities initially promised, sending people to complacency. A caveat came later. The vaccine is not a hundred percent effective, the Centers for Disease Control and Prevention later admitted.
While Covid-19 vaccination for adults aged 65 years and older remains effective in preventing severe disease, CDC said, recent data suggests vaccination is less effective at preventing infection or milder illness with symptoms.
CDC said emerging evidence also shows that among health care and other frontline workers, vaccine effectiveness against Covid-19 infections is decreasing over time. This lower effectiveness is likely due to the combination of decreasing protection as time passes since getting vaccinated (waning immunity), as well as the greater infectiousness of the delta variant, CDC said.
And then there’s a new layer of confusion as the Biden administration began rolling out booster doses of Pfizer's Covid-19 vaccine. While recommending an additional dose of Pfizer's vaccine for people aged 65 and older and nursing home residents, along with people between 18 and 64 with underlying health conditions, the CD panel grappled with the question of whether people in potentially high-exposure risk occupations should get a booster, but ultimately decided against recommending it.
Now we have a load of new information to process.
Guam is a particularly curious case. The island has one of the highest vaccination rates in the United States— 87.5 percent as of the last week of September. Yet, Guam has one of the highest breakthrough rates in the nation.
In August alone, 554 of 1,765 positive cases were identified as breakthrough infections.
Vaccinated and unvaccinated hospitalization cases show an equal proportion. Death reporting has become routine for the government again and hospitalizations have put a new strain on Guam’s frangible health care system.
Dr. Nathan Berg, who heads the governor’s physician advisory group, said Guam’s numbers should not be taken out of context. “It adds sensationalism to something that is not true,” he said. “To say that we have the highest positivity rate is not true.”
Berg said Guam’s high numbers are an indication of good things. “We have a high rate of testing, and that is a positive thing,” he said. “Our testing rate is much higher than other states. If you don’t test anybody, what is your rate? Zero.”
Guam tests an average of 500 to 1,000 a day. The positivity rate ranges from 5 to 10 percent.
“In many ways, our high numbers indicate positive things. If we have a high level of testing, that means we are touching a lot of people and we are able to isolate them,” Berg said.
But there is more than one explanation as to why Guam has a high rate of breakthrough cases, Berg said. A large number of people on Guam have comorbidities and that is a big factor, he added.
“Just because you are vaccinated doesn’t mean you can ignore all other health conditions that you may have,” Berg said. “Sometimes we have people come in and they do not even know they have diabetes or high blood pressure because they have not been seeing their health care providers.”
According to NPR’s Sept. 15 chart, Guam has 115 coronavirus infections per 100,000 people. Covid tests have yielded an average of 183 cases a day, with a 36 percent increase in two weeks. Guam leads the pack of Category Red states identified as highest-risk places that include Tennessee (with a population of 6.92 million), West Virginia (1.8 million) Wyoming (590,000) and South Carolina (5.2 million).
Among these red states, Guam has the largest number of breakthrough cases. Guam’s number began soaring shortly after the government lifted the restrictions on social gatherings on July 30.
Absent data analysis from the government, however, the high breakthrough rate on Guam has spawned all sorts of speculation and theories—sometimes bordering on absurdity— culled from social media.
There are hushed whispers about the vaccines that came to Guam. Did Guam receive a bad batch of vaccine doses? Was the vaccine supply improperly stored and mishandled?
Dr. Peter Lombard said there is no evidence to back these speculations. The irony of Guam’s high vaccination rate and large breakthrough cases, he said, can be explained by the vaccine’s own anomaly.
According to the CDC, the efficacy of Covid vaccines, particularly Pfizer’s, wanes six months after the second shot, specifically for people who are 65 or older or are at high risk of severe Covid-19.
The Moderna vaccine showed no comparable decrease in protection over the same time frame: It was 92 percent effective against hospitalizations four months after recipients’ vaccination, a level virtually identical to its 93 percent effectiveness before then.
“I think what you need to do is look at other places with good vaccination rates, particularly the ones that have high allocations early in the distribution process,” Lombard said. “Looking at the distribution of vaccines earlier, we had a higher number of vaccines given to Guam residents, and I remember saying how wonderful it was,” Lombard said. “I suspect that means we have more of our vaccinated population that waned sooner than that seen in other states.”
Given that it has been almost 10 months since Guam rolled out its vaccination program, Lombard said, the island is likely to see more breakthrough cases.
“The vaccination immunity starts to wane. We don’t know how much more the waning of vaccines is going to affect the rate of breakthrough cases,” Lombard said. “It would be no surprise if Guam is the harbinger of things to come in other states.”
The waning vaccine immunity theory, however, leaves some holes. A source said his family’s fully-vaccinated children contract Covid-19 recently. “Pfizer was just made available to children ages 12 to 18 last May, so our children and nieces in that age group ust got vaccinated. It makes me wonder why they tested positive,” the source said. “We had to get them tested because some of us tested positive.”
At any rate, Berg and Lombard said Guam’s seemingly alarming numbers are not necessarily something to be alarmed about.
“I firmly believe that the messaging should be ‘this is normal and expected,’” Lombard said.
The vaccine remains an effective tool, Berg said. “Our health care system is still manageable now. Without the vaccine, we would have been three times worse.”