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  • By Dr. Vince Akimoto

The State of the Island from the Covid frontlines

In the year 2020, the Covid-19 pandemic crashed upon our shores like a murderous biologic tidal wave overwhelming our poorly prepared, fragile island healthcare system.

The Guam Memorial Hospital was falling apart and had lost national patient safety accreditation. The Department of Mental Health had been struggling to remain out of federal receivership due to longstanding human rights violations. Most famously, Public Health’s main clinic and laboratory had just been ruined by a catastrophic electrical fire due to foolishly deferred maintenance.

Covid-19 brought Guam to its knees, stranded one of America’s mightiest aircraft carriers in our waters, and forced churches across the planet to close their doors.

As I write this report, the virus has infected more than 123 million poor souls and killed more than 2.7 million people around the world.


Guam infamously became one of America’s top coronavirus hotspots with the most Covid-19 cases and deaths per capita right after the Centers for Disease Control declared our island unsafe for travel in August 2020.

Globally, lockdown measures like the quarantine of billions of human beings and the massive closure of international borders were implemented. While too much of the American nation had been slow to fear the virus, the people of Guam wisely figured out how to mitigate the spread of Covid-19 and flatten the curve.

One year later, the lockdown did what it needed to do: starve the virus and allow Guam’s medical community to strengthen itself in order to save lives.

As we work to regain accreditation at GMH and build a stronger public health system, we must also acknowledge the essential role TIER 2 clinics played in our fight against Covid-19.

The Centers for Disease Control warned that during widespread Covid-19 transmission, large numbers of very sick people will need medical care at the same time. Public health centers and hospitals may become overloaded with terrifying rates of critical illness and unnecessary deaths. Critical infrastructure, such as law enforcement, emergency medical services, and community transportation may be expected to be overwhelmed.


In March 2020, as already beleaguered island hospital resources were being inundated by the rising tide of acutely ill non-Covid patients, Guam’s governor declared, “We must do more… if we don’t cut our (Covid) spread rate in half to 16.5 percent, our health care system might be overwhelmed by next week.”

Gov. Lou Leon Guerrero thus issued an executive order to create the Covid-19 Unified Response Action Team. The C.U.R.E. team was empowered to make use of all medical facilities on the island to fight the spread of the coronavirus.

Tier 2 status designated FHP, the American Medical Center and the Seventh Day Adventist Clinic as Urgent Care centers for non-Covid-19 medical care and satellite emergency facilities for the Guam Memorial Hospital.

Without concern for their own comfort or safety, TIER2 clinics shared their staff resources and expertise to all who came seeking care. In the spirit of Inafamaolek, the men and women of the TIER 2 clinics enthusiastically accepted the responsibility of taking care of all of Guam’s people. Because of prolonged material delays in the government of Guam, Tier 2 clinics patriotically invested in enhanced protective technology to quickly expand Guam’s very limited testing and triage capacity.


“We prioritize if you have symptoms, all patients who are symptomatic we try to see them the same day at the Tier 2 clinics and those patients are seen at no-cost to them. They come in, they get screened for symptoms, get seen and they walk out. Whether they have insurance or no insurance…it’s at no cost to them,” said Hoa Van Nguyen, American Medical Center chief physician.

Dr. Nguyen warned that the limitation of the Tier2 clinics is the number of patients they can realistically see every day. Nguyen said the only way they’ll turn a patient away is if they’re absolutely maxed out for the day. “Typically, on an average day we’ll see 30-50 patients, sometimes much heavier, depending on how sick the population is,” Dr. Nguyen observed.

Tier 2 clinics kept their clinic staffing levels fully operational as they were swarmed with patients who were diverted from the hospital. In order to free up the hospitals, Tier 2 clinics had to shut down their usual business operations to all other types of patients.

Based on the governor’s orders, Tier 2 clinics stopped their routine clinic work with established patients and took in everyone who came for treatment regardless of their ability to pay. Immediately, Tier 2 clinics were overwhelmed with Guamanians who were coughing, short of breath, and febrile.

In addition, many patients with chronic medical problems were anxiously scrambling to see a Tier 2 doctor because many outpatient medical facilities including Public Health’s Southern Regional Community Health Center were closed due to fear of the Virus or deferred air conditioner maintenance.

The tragedy is that chronic conditions like hypertension, diabetes, kidney disease, emphysema, stroke, and obesity are treatable but will worsen when medical services are disrupted. As a result of Guam’s Covid-19 chaos, a surge in deaths from non-communicable diseases like heart attacks and kidney failure is possible. Recognizing this real threat to Guam’s health and despite the great cost, the Governor wisely forced the TIER2 clinics to provide necessary patient services in order to save lives thus likely saving the economy.

According to a World Health Organization report released last September 2020 when Guam’s worst Covid surge was occurring, the number of people dying prematurely due to poorly treated diabetes increased 5 percent world-wide during the Covid pandemic. Because of the Virus, more than half the countries around the world including some of the richest nations were reporting massive disruption of medical services to treat diabetes, hypertension, cardiovascular emergencies, and cancer.


On Guam, Tier2 clinics used an innovative mix of medical triage, telemedicine, and the sweat of their brows to help mitigate the impact of Covid-19 in our community. Locally grown healthcare workers quickly became expert at state-of-the-art Polymerase Chain Reaction Covid testing and epidemiologic contact tracing. High-resolution virtual conferencing activities became the clinical standard for timely scientific updates within a fast-changing, fluid Covid environment.

As many wise people have recently observed, Guam’s economy cannot thrive if its people and its private businesses are sick and dying.

In navigating this pandemic, the government of Guam must first prioritize the health of our community. Tier 2 clinics and many other private sector entities have sacrificed greatly and suffered much fiscal pain while the Government of Guam has refused to cut its own waste and internal corruption.

The state of Guam’s healthcare and the health of all its people will never collectively improve until the Government of Guam finally and sincerely puts service before self.

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

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