EDITORIAL: An exit strategy needs to be communicated and implemented



If Guam's mission is to one day allow the free movement of people and the conduct of commerce, then there are two distinct (COVID-19) exit strategies that can be implemented; but only one can be chosen.


Strategy option 1: Either get rid of the virus...

The first strategy assumes that what we value is for no one to get sick. It means we wouldn't need to increase medical resources to respond to spikes in Coronavirus infections. Our goals under this strategy would include ridding the island of the virus. To achieve that goal, we'd likely have to remain in this shut down for many more days while the virus makes its way out of our systems. We'd have to sanitize, well, everything. We'd have to wait a certain number of days or weeks following the last confirmed positive case until it's safe to open everything back up knowing that the virus is gone. And then we would have to prevent any one from entering the island until the rest of the world does the exact same thing we would do.


The problem with this strategy is that it won't work. Guam can't control the arrival and departure of federal law enforcement.


Strategy option 2: Or live with it...

The second strategy assumes that what we value is adequate medical care to treat those who do become sick.


Under this strategy, our goals would include the timely identification of the sick and the exposed (contact tracing), and the adequate provision of medical care for those who do become sick. To meet those goals, we'd need contact tracers and a whole new way of looking at contact tracing protocols. Look at the seaport authority as an example of this. It is the only GovGuam agency outside of Public Health to deploy a contact tracing system, and it has led to early detection and proactive measures.


We'd also need adequate medical services at Guam Memorial Hospital. According to Dr. Vince Akimoto, the problem isn't necessarily space and money, but the lack of specialized nurses and respiratory therapists to attend to the sick.


There's also the need to shore up GMH's resource issues, which led to the closure of the Skilled Nursing Facility due to an aircon issue. The shutdown of this auxiliary center of care for the public health emergency has crippled capacity for effective response to spikes.


If we had the medical wherewithal to properly treat spikes of sick people needing intensive care, then we'd have at least the assurance of a lifeline, when we get sick from Coronavirus infection, if we get that sick.


We don't have that now, and that's what's led Gov. Lou Leon Guerrero to shut us down. The infection rate over the past three weeks has been crazy, and the GMH ICU and COVID-19 response resources are stretching dangerously thin. That lifeline may not be available to all who get dangerously sick if the infection rate continues at this pace.


The logic is, that if we had the means to keep people alive, then we could responsibly go about our business and even let tourists back in.


Why don't we already have these medical supplies and medical workers? Because if not COVID-19, what would we have done otherwise with a severe case of the common flu, or a Dengue outbreak, or something else that requires better capacity at our public hospital?


The bottom line is that Guam isn't open for anything because this government (and actually, the Leon Guerrero administration can't bear the blame for this because it's only two years old) has failed to prepare our only public hospital for its part in an islandwide strategy to adequately respond to a public health emergency. GovGuam has been aware since 2003 that a global pandemic can bring our medical infrastructure to its knees. We've had 17 years to prepare for 2020.


During that time, doctors like Akimoto, Mike Cruz, Tom Shieh, Hoa Nguyen, Larry Lizama, and Kozue Shimabokuro have implored the Legislature and governors to shore up GMH. The nurses have complained - all the time - about the nursing shortage. Well before COVID-19, GMH has been telling senators and governors about medical capacity being limited by an inadequate number of nurses, specialized nurses, critical care nurses, and respiratory therapists.


The reason a strategy to reopen Guam can't be initiated right now is because one of its main goals - the provision of adequate medical care to treat the sick - has not the political will to be attained.


If the governor wants to implement such a strategy, then she and our senators ought to commit to funding GMH, reprioritize funding within GMH, and doing a better job managing existing resources and channeling those to GMH.


And she probably should call up Pika Fejeran and apologize to her, then ask her to come back and work for her administration. Ms. Fejeran is one of Guam's only urban planners, and could very likely lead the governor's strategy on this.


And finally, the governor would need to do what all strategies need in order to succeed in public policy - communicate it effectively.


Guam needs an exit strategy from these stay-at-home orders and this lockdown. But until a strategy is employed, where the goals supporting that strategy are being met, then in the words of Samuel L. Jackson, "Stay the **** home." Because, in the words of our governor, "This virus is a bitch."

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