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Guam report: Household income a contributing factor to Covid deaths

DOAs account for 98% of deaths in 2021; Chuukese identified as a high-risk group

By Mar-Vic Cagurangan

Dead-on-arrival cases accounted for 98 percent of Guam's Covid-19 related deaths in 2021, the Department of Public Health and Social Services said, noting that a majority of the fatalities were from low-income households and had low educational achievement.

"The high proportion of DOAs observed in Guam in the summer and fall of 2021 is concerning and this analysis suggests that health and other disparities played a significant role," the department said in a report released today.

"The rise in at-home deaths and deaths occurring during emergency transport suggests that some patients are delaying, avoiding, or are unable to access healthcare services until it is too late for those services to provide life-saving benefit," stated the report prepared by Guam's epidemiologist Dr. Ann Pubutsky.

Guam had a total of 145 Covid-19 related deaths reported last year from Guam Memorial Hospital, Guam Regional Medical City and the U.S. Naval Hospital Guam.

During the delta-triggered summer surge from July 8 to Dec. 31, the report said, there were 127 Covid-19 related deaths of which 49 (38.6 percent) were DOAs, accounting for 98 percent of all DOAs in 2021 and causing public alarm, the report said.

A subsequent investigation conducted jointly by the DPHSS and the Centers for Disease Control and Prevention identified the Chuukese segment of the island's population as the most high-risk group.

"Throughout the pandemic on Guam, Chuukese and other Pacific islanders were disproportionately more likely to die due to Covid-19 compared to their proportions in the Guam population, for both DOA and non-DOA deaths. Chuukese are even more disproportionately represented in DOA cases," the report said.

Chamorros are less likely and Filipinos slightly more likely to be represented as DOA cases given their proportions in Guam’s population, stated the report co-authored by A. Scott Laney, Patrick Sotto, Vince Campo and Vince Aguon.

"Most DOA and non-DOA cases are from the northern part of the island, which is Guam’s most populated area. Interestingly there are more DOA cases from the south compared to non-DOA cases," the report said.

As reported consistently, a majority of Covid-19 related deaths had existing health conditions

"Among DOAs and non-DOAs the prevalence of comorbid conditions including diabetes, chronic renal disease and cardiovascular disease were elevated compared to the background population," the report said.


Covid report
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Public health officials stressed the importance of adequate management of chronic health conditions, especially during the pandemic.

However, the department's study found some patients procrastinated care for conditions such as diabetes and immune disorders either "out of fear of contracting SARS-coV-2 at a healthcare facility or limited access to routine appointments because of the strain of Covid-19 on the healthcare system."

While noting Guam's high vaccination rate at 93.5 percent, health authorities found that more than 80 percent of individuals who died of Covid-19 in 2021 were not fully vaccinated.

"This analysis confirms the importance of COVID-19 vaccination, particularly in the elderly and those with comorbid conditions in the prevention of severe clinical outcomes including death," the report said.

Other highlights of the report are as follows:

* The majority of Covid-19 deaths in 2021 were among males and the elderly and over one-quarter had an education level of less than grade 12."

* By education, a high proportion of DOA cases had a lower education (8th grade or less, or some high school), and are less likely to be high school graduates. * 67 percent of deaths were from households with a combined income of less than $35,000 a year with 22 percent reporting a household income of less than $10,000; 23.8 percent of DOAs did not have health insurance and only two individuals had private or employer-based insurance.

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