Guam governor: It's too soon to relax

April 15, 2020

 Recent test results have indicated that the Covid-19 transmission may have slowed down on Guam but Gov. Lou Leon Guerrero said it’s too soon for the government to lift the emergency restrictions and for the community to relax.

 

Guam has 135 Covid-19 cases, with the most recent tests showing between zero and two positives.

 

“While Singapore saw great success in the beginning stages of Covid-19 pandemic, it loosened its restrictions too early and as of 10 hours ago they reported 386 new cases in a single day. Despite having a much larger population than ours, this is what happens when we declare victory before we’ve actually won,” the governor said.

 

In North Carolina, Leon Guerrero noted, violators of an executive order would be a Class 2 misdemeanor.

 

“No such penalty or fine is in Guam law, even though it exists in nearly every jurisdiction throughout the country. So, I ask a simple question: if someone knowingly puts your family at risk of COVID 19 infection, could you live with the knowledge that what they did was not punishable by law,” said Leon Guerrero. “No new laws would be necessary if we simply took responsibility for ourselves. I’m sad to admit that my social media accounts have seen numerous examples of those who violated our social isolation directive this weekend—potentially placing themselves and those around them in danger.”

 

Leon Guerrero is aware that Guamanians may lie when telling law enforcement about their business on the road. “If you don’t say the information accurately or in truth, you’re hurting yourself and you’re hurting the community. That's the question you need to answer: do you want to be that responsible person that causes greater demise for our people here in Guam?” she asked.

 

Leon Guerrero hopes for the authority in order to enforce tighter restrictions. “I’ll put up more roadblocks if I have to,” she said. “Yes, I'll have all our police officers out there patrolling if I have to. Yes I will have them come out and break up social gatherings that aren’t supposed to be there.”

 

The governor added, “If they don’t pass the legislation, then I won’t have the teeth behind some of my executive orders. I'll continue with the measures we’re doing now. I'll continue to work within my legal authority to put in the measures and enforce the measures as best as I can within my legal authority.”

 

                                                                                 Gov. Lou Leon Guerrero

 

Leon Guerrero will be meeting with a new business panel on Thursday to start thinking of business recovery. “I am establishing a panel and in fact the business community is already organizing. I'd like the panel to be representative of experts that could come up with a plan,” she said. “The requirement of the plan is we do it slowly and at phases so we can monitor each of the actions we have taken to assure we are not re-infecting our community again. So, we are ahead of that. We're already discussing guidelines of what we’re going to be doing.”

 

Dr. Felix Cabrera, one of the governor’s medical advisors, said business recovery is not yet achievable until Guam can answer four major questions. “It's not necessarily when, but how will we know when,” he said. “Can we continue to take care of patients without compromising quality care? Can we continue without resorting to crisis standard of care? Number two, would be would we have enough tests to test everyone with symptoms? And number three is can we continue to do tracings without compromise and contact tracing of those that are known positive and do that in an effective way? And number four is being clear that cases are sustainably going down or absent for minimum 14 days?”

 

The timeline of the quarantine was also brought up during the conference. “I am concerned about extended timeline. I am concerned about us being able to recover and to be back in our normal lives,” said Leon Guerrero. “I am very concerned about that, but I am much more concerned that if we prematurely try to lift restrictions and prematurely get back to opening businesses and being as normal as we be, I don’t know if we can ever be normal again given this pandemic crisis; I would prefer to air on the more conservative side and to be rest assured through medical advice.”

 

Leon Guerrero talked about how preventative measures are vital in order to reopen businesses. “That's my challenge and that's something we have been discussing and I know some of the guidelines out there is that if you don’t have a case for 14 days that’s' a good mark. Also, if your hospital capacity is back to normal, you can be assured that quality of care is delivered in a capacity wise method—those are main indicators of when we can look at opening,” she said.

 

 “Also, Dr. Felix Cabrera has been very upfront about when you institute a measure it takes about 11-14 days to really see the outcome of that measure. That's what we’re seeing now. We started on March 14 and now we’re seeing measures along the way that was done and is proven to be positive—to be good outcomes. I want to make sure the measures we put is going to continue to be good outcomes. There's no one answer, there’s no one concrete guide. We have to take it as the circumstances arise and make the best judgement we can. I will say that if we are starting lifting restrictions, I'm going to lift them very slowly and I'm going to monitor them very, very closely. And once we start seeing any kind of re-infection, I'm going to go back again and put in the measures we have put.”

 

Cabrera revisited the projections presented on April 3 and what that means for Guam today. “In this model, the projected peak may not be until the first week of June. FEMA’s own independent modeling has a projected peak as early as mid-May. Therefore, any discussions on Guam already being past our peak, is not only extremely premature, but potentially dangerous,” Cabrera said.

 

“This is especially concerning, now that there’s a growing consensus among the country’s experts that Covid-19 has the potential to hit us in waves if we relax our preventatives measures too early or too rapidly. Multiple waves by definition have multiple peaks. It would be irresponsible of us to believe we are out of the woods or even close to it.”

 

Cabrera reminded the public that projections from epidemiological models are actually not meant to predict the future.

 

“Judging them as either right or wrong is a misuse of its purpose. Instead they are a planning tool that describes a range of possible outcomes that are highly sensitive to our actions as a community,” he clarified.

 

“We must understand that these actions have significant lag time in what ultimately gets reported as new cases, hospitalizations, or deaths. If we act only on the best or most hopeful projected scenarios, we are likely to end up with the worst-case scenarios. If we prepare for the plausible worst-case scenarios, and continue our resolve to strongly enact our early prevention efforts, we are much better likely to end up with a much better scenario.”

 

Cabrera added, “We're at the extremely early stages of even what our initial projections were showing. You have to understand that context. We're looking at a very zoomed in portion of that very big curve that was shown. Really understanding that, we may have breaks in the cloud so to speak, but we really have to understand what’s looming offshores.”

 

Cabrera explained the context of how these projections can change. “If one patient from every village on Guam were to present at GMH’s emergency department with COVID 19 and be admitted, you’re looking at tripling at consensus of Covid-19 cases on Guam and we’re right back to where we are in terms of even more heightened state,” he explained. “Even we’re seeing these cases decrease, it doesn’t give us any solace because we know it doesn’t necessarily represent the potential incidences in the community. That's why with more testing capability we’ll have a better idea of that.” 

 

Cabrera discussed the importance of being conservative in their projections. "In South Korea, these patients who've supposedly recovered from COVID 19 are being tested positive again, I just want to clarify we’re not sure of what we’re actually seeing in these cases. Are we dealing with reactivation or re-infection?” he said. “We have to be really conservative in terms of our efforts. Even though we’re reporting these recovery cases, in no way can we assume they are completely immune and not going to be at risk of having COVID 19 again. That is a scary thought overall, but it’s why we’re taking as much precaution as we can.”

 

Another topic of discussion was new medical tents set up on grounds Naval Hospital. “There is a contingency of medical units that is here and the tents they are constructing in the Naval Hospital area. They are increasing the hospital beds there and also their ICU,” said Leon Guerrero. “There is also another bigger tent that they’re going to be constructing at the south Finagayen. That one is going to be 120 bed capacity, plus another 20 ICU. The beauty about that is it comes with medical personnel.” Leon Guerrero said those medical tents would be available to the community once the request is made.

 

As for the CARES Act, the governor hopes the funds will be available by next week.

 

“We are in touch with the federal government. We have signed the necessary certification papers, that is required and we should be getting our share shortly. As far as unemployment, we are in track to get unemployment benefits,” said Leon Guerrero. “The other great news that I’ve mentioned of course is the pay protection loan which is related to unemployment because you are then allowed to write off that portion of the loan that pays for your payroll. However, you have to employ your employees. It affects the number of unemployed individuals.”

 

The governor mentioned that there is still more discussion to take place in order to get the most of the CARES Act. “The use of the monies—there are three criteria, three conditions and it is all related to Covid expenses. Prevention measures, measures done at a cost—which is an unbudgeted cost to your fiscal year budget and then any expenses that has to do with the Covidvirus,” she said. “The governors of the 50 states and governors of territories are lobbying strongly with the president and U.S. Treasury to allow the use of those monies to be put into lost revenues, because right now they were very clear we cannot use it for loss revenue. 

 

As the island waits for funding from the CARES Act, Leon Guerrero believes economic stimulus checks will come soon. “Director Dafne Shimizu from DRT and her team have been working hard all weekend to process it,” she stated. “She's looking at possibly distributing the checks by this week for sure. I know it’s already Tuesday but she’s working hard.”

 

Another concern was the Covid-19 exposure in healthcare clinics. “I do know that all private clinics are triaging and screening individuals. I don’t have information as to which clinic,” Leon Guerrero stated. “The key here is that the people who need to know, know it. They are the people who need to do the contact tracing. They are the people who need to do the surveillance. We're trying to keep as much privacy for patients or individuals that frequented those clinics.”

 

Public Health Director Linda Unpingco-DeNorcey said, “One is a private clinic, the other one is not. The first setting we had, we were assured the private clinic addressed that issue. Right now, your question of where exactly it is, we’re going to keep that confidential because the fact that we have done all our investigation already.”

 

A concern brought up during the conference was 11 DOC officers in close approximation with a recruit who tested positive for COVID 19. “We already had our team come in there,” DeNorcey stated. “We're going to test all of them. The deputy director and I made that decision to test all of them. We're going to test everyone of them once we get them all to agree.”

 

DeNorcey also discussed getting more testing supplies. “We just got two new machines—the Avid ID NOW. We're already launching that. That machine is a point of care machine. We've given one to GMH,” DeNorcey said. “With this Avid ID NOW, they can do one test and if it’s a positive test, it’d be red within five minutes. If it’s a negative result, it’d be ready within 13 to 15 minutes. Right now, we have about 176 cartridges. We were given a little more, but we used some of that to calibrate the machine.”

 

DeNorcey said that Guam Public Health will also look into getting rapid test kits from South Korea.

 

The director also mentioned that they will be receiving more tests from International Reagent Resources as well as Pacific Island Health Officers Associations. “Once we get these test kits, we can to mobilize all three machines simultaneously,” said DeNorcey. On top of that, with GMH already having their machine, this is going to expedite it. And remember we also have DLS and as I mentioned earlier 86 samples already went out.”

 

DeNorcey stated that the Covid-19 tests will soon be very accessible to the whole island. “In fact, all the tests that are Medicaid MIP, or uninsured they're all going to be covered,” she said. “MIP Medicaid is going to cover it. I’m giving the okay to have them all tested. Anything that we’re going to cover and if anything, private insurance should be able to cover it. And Public Health also has an account with DLS, as we have a contract with them. So, it is very accessible.”

 

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