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  • Peter Lombard MD

Guam COVID update for April 8th, evening edition.

The charts and data from 4/7 was updated after the information provided at the press conference. 2 Navy cases and 1 from DLS testing. So there were 11 new positives 4/7, as opposed to 8. This didn’t have a huge impact on our 7 day rolling growth rate but now shows us how increased testing is going to make our previous data less useful moving forward. We have expected to see more positive cases with increased testing. If increased testing happens slowly I don’t predict it will affect our growth rate number dramatically.

Testing reported 4/8 includes just 1 new case of 34 tests. This may be adjusted tomorrow again if necessary with any new information at the press conference. Our 15 bed ICU break point is holding steady, about 9 days in the future, if you assume we will have steady 10% growth rate, and 5% of all our positive cases are in the ICU.


Only 1 positive out of 34 today is very good news. This brought down our 7 day rolling average of daily cases below 7. I had been a little bit worried that this metric was rising a little since the end of March. It bears watching closely. I’ve included this data in Figure 3.

7 day rolling growth rate is 1.07x. I'd love to see this go below 1.04 this time next week.


New Zealand is starving the virus: 2 weeks into total lockdown, declining number of new cases, more daily recoveries than new cases, only 12 patients in hospital in the entire country and only 1 death out of 1160 total cases. This is what’s possible at any given time, we can shut the virus down simply by starving it of new hosts. Can we aspire to have the same successes as our island neighbor? https://www.theguardian.com/world/2020/apr/08/ardern-optimistic-as-new-zealand-records-lowest-number-of-covid-19-cases-for-two-weeks


Disheartening news about antibody testing from China. Antibody levels may not be as useful as we had hoped, to determine if someone is immune. Antibody levels were even undetectable in some patients who had been positive cases. It’s theorized innate immune processes might have fought off the virus in these patients rather than the adaptive response, and/or the infection was confined to the upper respiratory tract. Let’s hope our rapid serum tests are more sensitive. https://www.scmp.com/news/china/science/article/3078840/coronavirus-low-antibody-levels-raise-questions-about


Furthermore, seroconversion (antibody development) does not necessarily mean a rapid decrease in viral load and may not indicate cases are no longer shedding virus. https://www.nature.com/articles/s41586-020-2196-x_reference.pdf


I think we need to consider waiting a lot longer than the current CDC recommendations to discontinue transmission precautions for recovered cases. The current CDC non-test-based strategy: 1) At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and, 2) At least 7 days have passed since symptoms first appeared. https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-hospitalized-patients.html


If I'm not mistaken the physician advisory group has a stricter recommendation in play for Guam already.


GovGuam will be providing rapid tests to local clinics hopefully within a week. Expect that most clinics will be able to offer this, including Lombard Health.


Stay the course this is World War C!


(charts accessible at https://docs.google.com/presentation/d/1YmBfAcbLcCk3TUdP4zV4oOTqipp_p32-Vfdh3IJ2XCE/edit?usp=sharing) #Masks4All #Covid19 #coronavirus #flattenthecurve


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