Chronic Care Key for COVID Mitigation4
HSVG misson P.O. Box 206, Hagatna, GU 96932, USA
Vaccines alone won't suppress COVID surge  The recent wave of COVID infections since August is not the first frightening surge in Guam. The island community experienced something similar last August and September, and actually the situation was even getting worse in the fourth quarter.   While vaccines have been rolled out and, as of Aug. 31 this year, 80.43% of Guam residents 12 years and older were fully vaccinated, our island reported a total of 47 COVID-related fatalities in September, which was surprisingly higher than the death number of 39 reported last September, when no vaccine was available at that time.   Obviously, vaccines alone aren’t suppressing the surge.   Guam is not the only place having a bad September. Singapore reported 28,901 new infections and 40 deaths in the month after the vaccination rate was, exactly like Guam, beyond 80%. Their COVID death number was zero last September. The epidemiological investigation and laboratory results concluded the changed situation was mainly caused by the delta variant of the coronavirus.   So, Guam and Singapore have been using the same effective vaccines, have reached the same high vaccination coverage, and then encountered the same more contagious variant. However, Guam, with less than 200 thousand residents, relatively reported much more COVID deaths (47) than Singapore, with a population of 5.7 million, did (40) this September. It is very likely that, under the same conditions, Guam had more severe cases than other places. Perhaps that consequently resulted in more fatal tragedies.   Of the 60 COVID patients in the hospital on Oct. 7, five were children, ranging in ages of 1 day old to 8 years old. However, the worldwide data show that children usually do not develop serious illness once they are infected with the coronavirus. More information, therefore, is needed. For example, if these little patients have any underlying health conditions, to help Guam figure out the factors.   For adults, Guam also needs to investigate if the high prevalence of obesity, diabetes, renal issues and heart disease might be the reason why Guam is, relatively, having more severe COVID cases than other places. If it is the case, the system has to pay a bit more attention to the control and prevention of those chronic diseases and consider it an important part of the long-term strategy in the post-COVID era.   Singapore Prime Minister Lee Hsien-Loong emphasized in his Oct. 9 national address: “When the number of cases grows very large, even 2% of a very large number will translate to many patients needing hospital and ICU beds. Our healthcare system would rapidly be overwhelmed.”   Singapore therefore further expands health care capacity and strengthens case management so that they can “better identify COVID patients with mild symptoms to recover at home” and make sure the system can “properly care for those who fall seriously ill” as well as continue to attend to many non-COVID patients who also have urgent medical needs.   It seems Guam needs to do what Singapore is doing now. Guam also needs to learn from Palau’s effort to promote a healthy new normal after their vaccination coverage reached 80%. Thoroughly adjusting to the new normal might be the reason why Palau is still a paradise of extremely low COVID risk. Guam should take its inspiration from the neighboring island’s success.   http://www.hsvg.org/hot_405520.html Vaccines alone won't suppress COVID surge 2021-10-21 2022-10-21
HSVG misson P.O. Box 206, Hagatna, GU 96932, USA http://www.hsvg.org/hot_405520.html
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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.