Guam is likely to move to PCOR 3 sooner than expected, according to the governor’s medical advisor, who noted the zero positive result that came out of 300 tests over the weekend.
“We are on track,” Dr. Felix Cabrera said. “Even though we’ve been having cases here and there, it’s definitely below the threshold of concern for us. That I think is going to be confident in.”
PCOR3 means minimum restrictions. Guam currently has 179 positive cases.
While making adjustments to Covid-19 quarantine rules, the government’s main priority is to allow the return of traveling Guam residents and visitors in a way that will contain the spread coronavirus, Cabrera said.
“This isn’t about tourism travel,” Cabrera said. “Technically, you could come to Guam for tourist purposes if you’re willing to go through the 14-day quarantine but we don’t think there’s going to be a market for that.”
During his slideshow presentation on Monday, Cabrera defined what is considered a hotspot. “When you think about that, you think about how the virus is spreading overall in that country,” he said. “We’re not designating cities within a country because that gets different. The only sure, fair thing we can do is look at the country as a whole. It’s a proxy of telling how much active disease is there in that area and thus your risk of bringing it to Guam.”
Dr. Felix Cabrera
One issue discussed was why travelers cannot get tested before boarding a plane to Guam. "The reality that when it comes to testing, it's just too dynamic and there just too many variables,” said Cabrera. “If somebody tests too early, they may actually have coronavirus but it won't show on the test but they could still potentially bring it to Guam. Making people go through that but the cost versus benefit of that was not something that made sense at least for now.”
Another issue was that travelers are more likely to catch Covid-19 during boarding the airplane instead of during travel. “There’s actually a study about to be published in the Lancet that actually looked at 130,000 possible travelers and they sampled over 4,000 of those travelers and tested them. Out of that 4,000 of them, 160 turned out positive. Out of the 160, they did a lot of contact tracing and finding out the vast majority caught Covid prior to boarding through that contact tracing. Only two were determined to caught Covid on the flight.”
Cabrera also talked about whether or not there would be Covid-19 testing at the airport. “You have to remember that when you take a test, it’s a snapshot, it’s a snapshot in time of that person’s status of whether or not their having not just the virus, but are they having enough of the virus that we can pick it up at the test?” he said.
“If we just do it when they arrive at the airport, you’re going to miss a significant amount of those who may be actually bringing it on the island. The time is critical of doing this. There are different suggestions and proposals. In CNMI, it’s a mandatory at least five days and you’re tested at the five-day mark. There’s a reason why the five-day mark is chosen in that situation.”
The doctor mentioned that it is still debated on Guam what is the appropriate amount of days in quarantine to start testing. “For us here in Guam, that amount of tests that will have to be done and to be done that fast will be difficult and right now it’s unclear if the benefit outweighs the risk in doing so,” Cabrera said.
Cabrera also mentioned being able to test those in government quarantine if they are interested in getting tested.
Right now, DPHSS is only testing based on symptom development. “With that, we’ll actually be able to study and see if the requirements we’re actually putting in place right now actually make sense,” he said. “The only thing that is assure and proven to work is quarantine itself. In this situation, there is no option to test out of quarantine completely. That's different from our previous policies in the past. We made the concession. We needed to rely on more on quarantines overall.”
Cabrera said once individuals complete the 14-day quarantine, they don’t need to test out of it. “The assumption is that if you had coronavirus and you didn’t develop symptoms during that 14-day time period then there really is no reason to test at that point, because there’s a very low chance you have it,” he said.
The doctor believes that quarantining in a government facility is safer than home quarantine. “We all can relate to the facts of human nature,” Cabrera said. “When you’re home, the likelihood of compliance to the 14-day quarantine will likely decrease compared to being quarantined in a controlled facility, [where] you have staff in the area to monitor your comings and goings and other people’s interactions with you.”
When a person is in home quarantine, the government has little control over visitations. “Even though part of the quarantine requirements if you minimize that to your household contacts,” Cabrera said. “There’s a different level of risk that’s taken when we’re allow somebody to quarantine to at home. In the end this is a all a matter of balancing risk versus benefit and cost versus benefit.”
Despite his preference for GovGuam quarantining, the government will still have to pay for residents’ stays. Those quarantining at home will be checked up on by DPHSS. “The monitoring of those in quarantine is a spinoff of contact tracing,” said Cabrera. “They use similar resources to do that. The process is there are minimum expectation of when you’ll be checked up on. The main part of this that is frequent. It is randomized by the means that the check-in will occur, whether by phone or surprise visit to the household. They are doing that.”
Returning residents who are supposed to home quarantine may be subject to penalty if they leave their home. “It’s a $1,000 fine,” Cabrera said. “In Hawaii they enforce that fine. it’s all case by case. We reserve that right to impose that fine.”
The conference also addressed non-residents coming into Guam. “These are persons who may be here for a variety of reasons,” said Cabrera. “They may be here for work or they may be here for a hardship or emergency. All these things are taken into consideration.”
Essential workers who may work while being quarantined are not allowed to go shopping or dining in restaurants.
“If they’re quarantined at a hotel, but they will be allowed to go their place of business they need to their essential work and then return back,” said the doctor. “They will be required to strictly perform their duties and return to their quarantine area. There’s a system for that also. They have to report the times when they’ve left and when they’ve returned.”
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