Chronic Care Key for COVID Mitigation4
HSVG misson P.O. Box 206, Hagatna, GU 96932, USA
(01/17/2022)Did G20 learn lessons from the Delta? When the world welcomed 2022, many people were actually calling the new year “pandemic year 3.” If we have had it enough and do not want “pandemic year 4,” year 5 or year 6, let’s encourage Indonesian government step forward with its Group of 20 (G20) presidency to call for an international campaign helping people around the globe fearlessly live with the coronavirus and adopt the new normal as soon as possible. Quite a number of public health experts had advised before COVID vaccines became available that the human society was inevitably going to live with the coronavirus for a while and only sustainable measures would help everybody get through the pandemic. Unfortunately, most governments , with certain high-profile scientists and celebrities, put so much faith in lockdowns and looked forward to seeing COVID vaccines would work perfectly like a silver bullet even though, at that time, almost every vaccine developer was apparently targeting at lowering the numbers of severe patients and death victims instead of guaranteeing no infections after getting vaccinated. The Delta variant’s attack last summer was a wake-up call. Many countries, after enjoying reopening and sort of returning to normal brought by successful vaccine rollouts, experienced the Delta variant of the coronavirus caused a new wave of case surge, made hospitals overwhelmed again, and, sadly, took many people’s lives. It was the time that people started being familiar with a term called “breakthrough infections.” For example, Singapore surprisingly reported 28,901 new infections and 40 deaths in September 2021 after the vaccination rate was beyond 80%. Their COVID death number was zero in September 2020 when there was no CIVID vaccine at all. The epidemiological investigation and laboratory results concluded the changed situation was mainly caused by the Delta variant. Singapore was not the only place having a bad September last year. As of 31 August 2021, 80.43% of the residents 12 years and older were fully vaccinated, but Guam, an US island territory in the Pacific reported 47 COVID-related fatalities in September 2021. The figure was higher than the death number of 39 reported in September 2020 when no vaccine was available at that time. With almost the same land size, Guam is home of less than 200 thousand residents and Singapore has a population of 5.7 million. It means the highly-contagious Delta variant was influencing everywhere, no matter a busy and crowded city or a relaxed and rural place. In addition, obviously, vaccines alone are not suppressing the coronavirus. Europe’s experience reminded that nobody should drop his/her guard even thought the population reached a high vaccination rate. European Union has been leading its member states to keep precautions and try reopening in a gradual way. The continent has maintained a basically downward curve of infections as well as hospitalizations and deaths since its successful vaccine rollouts in association with well-managed medical capacity, even though the Delta variant did make a noticeable, but not really harmful, spike. However, it seemed that most parts of the world did not learn lessons from the Delta and implement proper measures when the Omicron came. The World Health Organization did not wait for sufficient morbidity and fatality data to be collected. Its warning message on the Omicron variant released late November last year triggered many countries’ panicked decisions of tightening COVID restrictions. It’s sad that South Africa’s variant identification efforts, which should have been appreciated, made its people punished by the almost worldwide travel ban. The wait wasn’t even long. Before last Christmas, at least three scientific researches caught the media’s attention and proved the Omicron variant may be much more contagious but it’s mostly causing mild cases. However, the chaos has hurt people. For example, Guam, which finally saw a little bit tourism recovery last November, immediately suffered from more than 5000 travel booking cancellations right after the Omicron panic widely spread. More variants will definitely come and we definitely do not want more chaos. While the Omicron has shown the new variants in the future are very likely to be less lethal and the COVID vaccines are actually promisingly reducing severe cases, plus the antiviral medicines are available, the whole world really needs a leadership that urges every jurisdiction to guide people fearlessly living with the virus by using more appropriate strategies to respond to every emerging variant. Let’s try to recall whether the system was encouraging people to get tested during the flu season to try to contain flu viruses. Were we worried so much when we experienced flu-like symptoms or got diagnosed as having flu? Wasn’t the goal of flu control to avoid severe complications and save people’s lives? The best tools helping us achieve the goal are always personal hygiene and flu vaccines although so-called “breakthrough infections” did happen to flu vaccines as well. COVID is not flu, but flu control experience could apply to COVID response, especially to the current situation of “pandemic year 3,” a year that G20 presidency returns to Asia, where people totally have no issue with wearing a mask and helped prove this measure could effectively prevent COVID spread. Indonesian government needs to work with its G20 partners and make history.(Published in The Jakarta Post on January 11, 2022) http://www.hsvg.org/hot_414422.html Did G20 learn lessons from Delta variant? 2022-01-17 2023-01-17
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(October 7, 2021)

Chronic Care Key for COVID Mitigation

If the most important goal of COVID response is to save lives, it seems the key for COVID mitigation should be extra care for people with underlying medical conditions in addition to vaccine rollouts.


Many people in our island community have noticed the surge of COVID infections since August. It is actually much more important to look into the COVID death number in September. While vaccines have been rolled out and, as of August 31, 80.43% of Guam residents 12 years and older is fully vaccinated, our island reported a total of 47 COVID deaths in September this year, which was surprisingly higher than the number of 39 reported last September when no vaccine was available at all at that time.


COVID deaths, Sep. 2020 vs Sep. 2021

Sep. 2020



Sep. 2021

39 deaths

47 deaths

32 Unvaccinated


9 vaccinated


6 Unknown


No Vaccine


Vaccines available and

as of Aug. 31, 80.43% of the eligible (12 & over) is fully vaccinated.


Not only the case-control clinical trials but also the piling data and experience from the real world have proven the COVID vaccines are promisingly effective in reducing the risk for severe illness and, most importantly, deaths once people get infected. After Guam’s vaccination rate was over 80%, it is reasonable to expect that, at least, we should have seen less fatal tragedies. Many people may wonder if it was the Delta variant of the coronavirus causing the worse situation this September than last September. However, most of scientific evidence show that the Delta variant is definitely more contagious but not more deadly than the original strain, which was dominant last year.


In fact, Guam’s September scenario this year provides a preliminary evidence rejecting the so-called “herd immunity” hypothesis, which many experts have been emphasizing after the vaccines became available, suggesting a high, 70 to 80 percent, vaccine coverage would protect the whole population including unvaccinated people. There were as many as 32 unvaccinated individuals died from COVID in September after Guam’s vaccine coverage was beyond 80%. The number told us the COVID vaccine may be not like the one against smallpox, with which the importance of herd immunity was first recognized. It seems more like a flu shot, which is functioning as an individual protection instead of being designed to pursue herd immunity. The unvaccinated people, therefore, are not going to be protected even after more than 80% of the eligible in the community was vaccinated.


Given the COVID vaccine seems more like a protection shot for every individual only, getting vaccinated or not could be a matter of personal choice. However, before deciding to stick with your “no COVID vaccine” decision, it is worth to notice that Guam’s 192nd COVID-related fatality was only 53 years old and he did not have any other medical conditions. He was not vaccinated and pronounced dead on arrival at the hospital on September 26.


The 185th fatality was pronounced dead on arrival at the hospital too. He wasn’t vaccinated either. He was only 56 years old and also did not have underlying medical concerns.


As for 9 vaccinated COVID deaths in September, it is sad that they still lost their lives in spite of all efforts they made. It is very important to learn lessons from these cases to find solutions to avoid this kind of sadness.


Excluding one case with unknown records of comorbidity, the remaining eight vaccinated COVID-related fatalities were distributed to different age groups, meaning not only the seniors have the risk. But, all of them had underlying medical conditions. So, in addition to offering vaccines, it is very likely that an extra amount of time and effort to take good care of chronic disease patients is necessary.

Vaccinated COVID deaths in Sep. 2021



Under 40















Over 70


Almost everybody in Guam is no stranger to chronic diseases. Many of our friends and family members are suffering from diabetes and kidney disease. Stroke and heart attack took the lives of our loved ones very often. Most of chronic patients regularly visit their physicians. If clinics could have designated personnel contact their regular chronic patients and remind them the risk for COVID complications, it could be very helpful.


While the high prevalence of diabetes, heart disease and other chronic illness could be the main factors affecting Guam’s COVID mitigation, perhaps it is time that we should have an islandwide health campaign to not only minimize COVID impact but also solve the island’s long-time health issue. For example, a raffle offering people who lost weight, improved blood sugar, or lowered blood pressure a chance to win a car or cash would be nice. A healthier island could be the most precious treasure that Guam eventually gets from the painful pandemic.