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The beginning of the end

Yo Amti By Vincent Akimoto

Last September, when the first terrible surge started, we mourned the 21 people who Covid-19 had killed since it landed on our island in March 2020. Then, the real terror began.

By New Year’s Eve, the virus had infected 7,317 Guamanians— roughly 4.4 percent of the island's population, including the governor and many island leaders and healthcare workers. Fortunately, most survived their illness, but 122 others did not.

Awash in uncontrolled diabetes, poorly treated heart disease, and an epidemic of renal failure, Guam has offered Covid too many vulnerable victims to kill.

While most other Pacific islands have been spared from the pandemic’s true fury, Guam’s fragile healthcare system has been laid to waste by an outbreak that almost everyone knew was coming. Despite sincere Public Health efforts, Covid has spread like a forest fire throughout the close-knit villages, shutting down churches, schools and businesses.

On an island too dependent on international sources for food and medicine, vital air travel came to a standstill. Prior to the pandemic, desperately ill cancer and cardiac patients would typically fly to California or the Philippines for tertiary medical specialty care.

With Covid locking down the island, these desperately ill patients were forced to fight for the few critical care hospital resources available locally. On an island of more than 154,000 people with a catchment area in Micronesia of another 200,000 islanders, Guam only has 33 staffed ICU beds and less than 400 total hospital beds.

When Guam received its first shipment of the Pfizer-BioNTech vaccine last December, villagers enthusiastically lined up for miles to get vaccinated. By Liberation Day in July, almost 80 percent of the island was vaccinated. Today, more than 90 percent of the population has been fully vaccinated and more than 18,000 people have been infected. As of this writing, 2,000 patients have active infections, 55 are hospitalized, and six are fighting for their lives on ventilators.

Meanwhile, island hospitals are full of non-Covid heart attacks and strokes and a worrisome rise in flu-related pneumonia.

As I write this missive, the virus has killed 235 people. An alarming number of patients are arriving to the Emergency Room so sick that they are unable to be helped in the end. On Oct. 28, a newly infected three-month-old baby boy was declared dead on arrival at the Guam Navy Hospital.

Last month, Guam’s Department of Public Health and Social Services reported that “dead on arrival” cases made up about two-thirds of recent Covid-19 deaths on island, which is only 30 miles long from tip to tip.

The U.S. Centers for Disease Control and Prevention has sent a team of medical investigators to determine why so many Covid-19 patients are arriving at this tiny island's hospitals already dead.

In recent weeks, Guam has been among the worst affected areas in America in terms of Covid-19 infections and deaths. While many places in the United States were decreasing in case numbers, Guam was one of the few to keep an upward trend.


The territorial epidemiologist has reported that about 45 percent of recent infections and 40 percent of hospitalizations have occurred in fully vaccinated persons. Meanwhile, stateside jurisdictions are reporting only 10 percent breakthrough infections and hospitalizations.

While we on Guam hear about hugely attended state fairs; witness fully packed National Football League stadiums; and watch the World Series on TV, we are experiencing more Covid deaths now than before the vaccines were first rolled out.

The Guam conundrum is what now to do to save our own lives from Covid if everyone has either been fully immunized or previously infected. Perpetuation of Guam’s social lockdown, while the rest of America are living a high life, seems untenable. Doubting the efficacy of vaccines that required ultra-cold storage in our hot tropical environment will give us little solace. Cursing the invasive species which brought us 1,000 infected sailors aboard the USS Teddy Roosevelt seems counterproductive.

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When abnormal becomes the new normal

Constructive criticism of our preventative health and wellness activities has resulted in more focus on cardiovascular risk reduction. People are now trying to be more careful with their diet. Many have enthusiastically returned to home gardening. People are swimming, biking, and hiking like never before. In this time of Covid, Guam has embraced the challenge to live healthier.

The enthusiastic acceptance of immunizations, pro-active diabetes management and a greater appreciation for the need for robust local healthcare resources has been witnessed in recent months. Over the past year, the Federal government has generously infused millions of dollars into indigent care and challenged the local government to bridge the gap between rich and poor.

The citizenry’s accountability should likewise be reflected in local Public Health services. During this pandemic, Guam reaped the bitter harvest of a neglected government service that too often served as a tool for political patronage.

We found a local Public Health woefully understaffed with healthcare professionals, burdened with disorganized leadership, and unable to work well with others. Even when less than 1,000 active cases existed on island, contact tracing was almost non-existent because poorly-trained field workers with antiquated information technology were being overwhelmed by the workload.


The virus was thus able to prey on the weak and disenfranchised as Public Health limited its efforts mainly to those who could drive or walk to air-conditioned shopping malls.

If a disjointed, out-of-touch Guam Public Health, as currently constructed, were a dinosaur, then Covid would be the meteor. We can only hope that the pandemic has been an extinction event for complacent governance and democracy-of-pain excuses. The new normal is government accountability even in the face of death.

Perhaps, in the end, what Covid will teach us is that kindness matters. Beyond politics, economics, and science lies the reality that the Covid pandemic required all of us to accept accountability for our own lives and the lives of those around us, even those with whom we had not always been kind.

Kindness may be hard to define, but Covid helped make clear who had it and who didn’t. As the wise man once said, people will care about what you know when they know that you care.

Dr. Vince Akimoto practices Family Medicine at the American Medical Clinic. Send feedback to

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