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  • Peter Lombard MD

Guam COVID update

Guam COVID update (charts accessible at https://docs.google.com/presentation/d/1YmBfAcbLcCk3TUdP4zV4oOTqipp_p32-Vfdh3IJ2XCE/edit?usp=sharing)


3/25 rate of daily increase since 3/15: 34%

Estimated ICU break point 4/2/2020


So much for providing good data… I noticed an error in *my* data and so the figures I gave yesterday for rate of increase and break point were inaccurate. Mea culpa! I think I’ve got it squared away now. I don’t have much time to work on this so some errors are inevitable, but no excuses… this was a pretty big mistake I should have noticed, my numbers were quite off and painted a better picture than reality. I hear all my prior teachers in my head, “Check your work!”


Despite 5 new cases announced today, our rate of daily increase actually went down from 36% to 34%, not enough of a change to push our break point out much past April 2nd, right about where it was a couple days ago. 5 cases seems like a lot (and it is) but our rate was high enough previously that 5 in a day brought the average down a little. Not enough flattening is occurring fast enough to change the course right now. A week from now we'll have over 60 positive cases on island. This is serious stuff and we have to continue to be vigilant and prepare our hospitals!


The last JIC report showed 10 inpatients and from the press conference, 1 was reported in the ICU. I think 10 inpatients is worse than yesterday, and much higher than 20% predicted of total cases. But admission to GMH doesn’t necessarily mean they are sicker, it might just be a better place for them than home isolation or the skilled nursing facility. Speaking of home isolation, this still makes many people wary. There is not much public confidence that this is being done correctly with appropriate oversight or control measures. If there have been any incidents of viral spread due to poor home isolation, I don’t think they would tell us. Which is a shame.


The new graphs don’t include the 4 cases now at NH Guam from the USS Theodore Roosevelt. Until better information comes out I won’t have much to say about these, but it will be interesting to see where the Navy says these cases came from, and whether or not they decide to add these to Guam’s numbers. I can imagine they’re doing surveillance on every single sailor on that aircraft carrier, and having all hands scrub the decks like an operating room.


A friend (Anne Rutter) alerted me to a new tacking site I hadn’t seen yet which is fantastic, http://www.91-divoc.com/pages/covid-visualization/. You can compare Guam’s per capita (per million) positive cases with the other US states, and also to other countries. We’re not actually on the country list so I ballparked where we would fall for day 10. In both cases we’re high and left on the chart, indicating high infection density for our population. I don’t think this necessarily means anything worse for us as a prognostic indicator though. It is more likely due to a delay in getting our testing started, and as mentioned previously, a good job by DPHSS to test those with greatest risk first. Our rate of increase is what matters more, if we can get that going horizontal then down then we’ll be able to say our social distancing efforts are working.


Yesterday I totally neglected to mention 76/Circle K provided yet ANOTHER donation of masks to GMH, including 500 N95s and even more surgical masks. This will definitely help until the supply chain fixes itself and/or we get PPE from an emergency container from Homeland Security. I’ve been told this will happen “soon” (no units).


It is still frustrating to have little data on the new cases… I’ll repeat my data wishlist again, with a new one:

- New positive case connections/associations with previously reported cases:

- Age cohort/comorbidities/general location for each new positive case

- How many are in the ICU? ICU current load/capacity?

- How many are on ventilators? Total ventilator load/capacity?

- Current test capability per day, and anticipated days until this will improve?


I’ve started to post these updates in a blog format at https://www.lhguam.com/blog in case you wanted to share with anyone that is not on FB. Keep doing your part Guam. We’re in for tough days ahead, and we will persevere.





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