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  • Peter Lombard MD

Guam COVID update 3/28

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


Updated estimated ICU break point: 3/3 (unchanged)


3/28

Case fatality rate 2.0%. This has decreased from 3.7% since our first patient death 3/22. Nothing remarkable here, falls easily within expected rates for COVID-19.


Based on our number of cases, we’re tracking pretty well with the expected number of hospitalized and number in the ICU. New data published yesterday demonstrated 20-30% hospitalization rate and 5-10% ICU rate for COVID positive cases. For my charts, I am now using 25% for hospitalization rates and 5% for ICU rates. 15 bed ICU break point is unchanged from yesterday using these rates.


Despite 6 cases 3/27, our average daily increase in cases continues to trend down (Fig 1). In fact it has decreased below 30% for the first time. I’d still hesitate to say this is a trend. Now that we know the Naval Hospital is also testing Guam residents, we may see more positive test cases. And I have heard DLS lab is also close to being able to offer testing. More testing is what we need but expect our daily increase to rise.


Still no accessible data or graphs from DPHSS, unfortunately. We also now need at least some basic data about the cases that were tested at Naval Medical Center San Diego. I assume these are Guam residents which is why they included these in our positive case number. Are they on home isolation, admitted, and/or in the ICU?


I’ve had a number of people ask me how appropriate it is to compare Guam’s data with that of other countries. We know that with low power, there’s a lot more noise, so it’s really hard to know if a comparably low or high number really means anything. Maybe with enough data we’ll match the numbers seen elsewhere. If not then we should be looking for explanations for that difference. But even early on, I think it’s a useful exercise to start looking for patterns, signals, or trends.


Look at our gender predilection so far: females 29, males 18, many more females than males. This is in contrast to data from other countries suggesting a similar predilection for men and women. I would guess this disparity in Guam is simply due to low power. As numbers rise, this should equalize. But if not, you might conjecture at some point that there’s a reason why in Guam we have more cases of women than men. Perhaps there are local socialization patterns or habits that would put more women in Guam at risk as opposed to men. But until we have a lot more numbers, the difference is just noise. Incidentally, it’s also been reported everywhere that men are twice as likely (or more) to die of COVID-19 than females. So if we end up with a lot more women than men, our case fatality rate may end up lower than average.


Regarding Guam’s high per capita (per million) infection rate. I’ve tried to compare Guam’s early data to that of other countries with the highest per capita rates: Faroe Islands, Gibraltar, San Marino, Brunei, Iceland, Denmark, Slovenia, Liechtenstein, Qatar, and Seychelles. At a glance, there are not a whole lot of similarities between these countries that I could determine. I thought maybe population density, but that was all over the place. There aren’t any very populous countries in this list, which probably reflects the time it takes to ramp up screening. If anything, it seems more likely you’ll have a higher case density for a fairly small country by size, with total population also on the lower side (exceptions being Denmark, Slovenia, Qatar). Once testing starts, these countries are quickly able to identify and test patients with a high likelihood for disease. And possibly because of their smaller size, the virus was able to spread throughout more of their population. If it were possible to compare against cities, maybe the same effect would be noted.


In my data I’ve also now included age cohort data since it’s been about 5 days since they started providing this. Comparing one day to the next and we can figure out the age of the new cases each day. At a glance I don’t see anything that remarkable other than to say nearly 30% of our cases are under 50, and we have 3 cases in their 20s, diagnosed before 3/23 when they started providing age data.


I’d be remiss to not mention the Ysrael family and to thank them for their incredible $250,000 donation toward to help the “frontliner” medical staff in this war on the virus!


Stay safe, stay HOME Guam!


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