By Nancy I. Maanao
(Tumon, Guam) Dr. Thomas Shieh has pointed out a discrepancy in the governor's quarantine order that can have significant implications for the spread of the virus.
"The lockdown is four days too short," Dr. Shieh said. "The virus incubation is 14 days. The Gov called for only 10 days lockdown, we need to extend minimum of 14 days. But cannot lift it until we assess the infectious curve, we must learn from countries who have gone through this and still going through this. If there is someone that the governor will listen to please let her know."
Dr. Vince Akimoto, in an interview with Kandit News this morning, said that the current emergency response by the government of Guam is unsustainable and will lead to fatalities.
A huge gap in the Guam-only testing criteria for COVID-19 is that patients with symptoms who go to their doctors will be asked (according to public health's guidelines) if they've been in contact with confirmed COVID-19 patients. In order to get tested for COVID-19, they have to answer yes to this question and provide the name of the confirmed COVID-19 patient. If not, then the territorial epidemiologist, sociologist Ann Pobutsky, will make the determination for testing - not the doctors.
"It's a stupid question," Dr. Akimoto, telling the government to remove this criteria so that people who doctors determine should be tested are tested. He said this is a choke point in the process.
Both doctors have lamented from the start of the public health emergency that not enough information is being presented by the government for residents to be properly informed and cautious of their environment and potential exposure to the virus.
Dr. Peter Lombard agrees. In a lengthy letter to government officials, Dr. Lombard says there is far more information that can and should be provided to the public without violating the Health Insurance Portability and Accountability Act (HIPAA):
More detail pertaining to the positive cases (that protect patient privacy and the surveillance efforts), such as presenting symptoms, potential source of infection, relationships or connections with other known infections, local areas/villages/establishments involved, clinics involved, etc.
For positive tests from individuals on airline airline arrivals, include the flight #, date/time and # of pax
# of positive cases with presumed community transmission, and of these, which villages are involved
# of quarantined individuals at Government-assigned locations (# at hotels, # at hospital and SNF)
# of isolated individuals, at sites other than Government-assigned locations (homes?)
The updated medical status of known Covid-19 positive patients: stable, improving, worsening, deceased, etc.; and the approximate age and comorbid conditions for those in extremis
# of COVID-19 patients admitted to the GMH ICU and the total # in the GMH ICU
# of COVID-19 patients placed on ventilators in the past 24 hours, and total # on ventilators
"I don’t think it’s unreasonable to ask for this data and it would demonstrate transparency and a commitment to keeping us informed. Additionally, based on conversations I have had with other Guam doctors, there are multiple avenues being explored to dramatically increase our testing capabilities, which we hope will be available as soon as the end of next week, at best. This type of information is important to share with the people of Guam to show them the efforts of their leadership and to provide them with some positive news we can look forward to. Data from other countries has already shown us that identification and isolation of asymptomatic positive patients is critical to slow spread of disease." - Dr. Lombard
Sinajana Mayor Robert Hoffman said Guam's mayors and vice mayors all agree with Dr. Lombard. "We want these answers, too," Mr. Hoffman told Kandit.
"We saw his request and we told the administration it's within reason," Mr. Hoffman said. "If a doctor is telling us that this is what they need and it doesn't violate HIPAA, let's listen to the doctors. I don't want to listen to a lawyer," Mr. Hoffman said.
It is unclear whether the lawyer he was referring to is Ms. Leon Guerrero's legal counsel and son-in-law Haig Huynh, who continues to practice as the governor's top lawyer without a full license to practice law on Guam.
Information isn't the only thing doctors are lacking under Gov. Lou Leon Guerrero's emergency response. They aren't the ones making decisions about patient testing for patients under surveillance and they're not even provided data on the numbers of PUI and PUS there are. They're also not getting support for simple protective gear.
"I called Homeland Security yesterday [to] ask for [a] mask, and they said they don't have," Dr. Shieh commented on Facebook.
Dr. Akimoto has real-life logistical concerns for families and for the already-strained law enforcement system. He believes that while people are being told to self quarantine and tempers flare throughout households because of these unprecedented times that the responsible thing to do is to remove alcohol from store shelves to minimize the risk of family and neighborhood violence. Dr. Akimoto writes:
Island neighborhoods very tense tonight. Many assholes drinking cheap beer, already drunk.
Mangilao has many M+P stores making a killing on liquor.
This is going to be a bad night to be at Hemlani Apartments.
This is going to be a terrifying week for law enforcement.
Please ban alcohol sales for duration of Lockdown. We have women and children in close quarters with drunks and drug addicts.
We need to help GPD every way we can.
Please ban alcohol sales now"