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  • Peter Lombard MD

Guam COVID update for April 17th

As of today we had as many active cases as we did around March 25th. 0 positive and 11 negative tests reported yesterday. Hospital census is low, because we have had so few new cases in the past week, unless there are people trying to gut out their illness at home. Let's hope that's not the case.


Tempered optimism.


I had to check to be sure... but can you believe it, we have had only one positive test at the public health lab in the last 7 days! That's just 1 out of about 200 tests, half of 1 percent. Yes there were 3 DLS positives (delayed 3 to 4 days) and 1 clinical diagnosis in the past week… but if we're at even 1% positive out of all Public Health testing now, we just aren't going to see many positive cases even if we start testing more people for active disease.


More tempered optimism.


It's not a given that testing a lot of people right now with our current throat swab tests is going to be that helpful. Blasphemy! I’m not saying not to test at max capacity, but practically I just don’t think we’ll find many positive cases, and of those that are positive it’s probably not clinically significant, meaning it’s possible that some will have a positive throat swab but not be infective (inactive viral particles can cause false positives). We might pick up a few asymptomatic positive cases that may or not be actively infectious, and we will isolate those cases for sure but I would guess the prevalence of active cases is going to be very very low. I’ll say it again, until we have new cases/clusters, the serology tests will be more valuable to us.


But we still should be utilizing our current tests to their capacity, even if they are going to be low yield.


Not going down FDA/EUA rabbit hole today. I was there yesterday and it was dark and scary. But even with less than stellar accuracy, sensitivity and specificity, serology results would at least start to give us a hint of how far the virus penetrated into the community and how many of us are immune already.


Don't be disappointed if we eventually find out our immune population is only 15% or less of the total. Even on the TR it looks like 20 to 30% will be positive, and it's likely a chunk of their throat-swab negative tests would be serology-positive from exposure... but for Guam 15% immune is probably the best we could hope for right now. A far cry from the 70 to 80% needed for herd immunity.


The irony is that while nobody anywhere wants a devastating surge, once that surge is contained, we also secretly hope the virus spreads harmlessly into more of the population than we could have guessed, conferring more people immunity to future waves. The idea that California had earlier exposure to the virus, more people immune, and less of a surge than New York, has been fairly well debunked by Trevor Bedford. https://threadreaderapp.com/thread/1249414291297464321.html


The models were wrong. And that’s ok. They were still useful, and we need to learn from their limitations so better prepare for the future.


As Denmark’s prime minister Mette Frederiksen said, “We cannot open a textbook, neither on healthcare nor economy, and find the right answer…The strategy we follow is a political choice.”



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

#Masks4All #Covid19 #coronavirus #flattenthecurve

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