By Jacob Nakamura
(Tumon, Guam) While the rest of the country is following broadened CDC guidelines to test and report patients with Coronavirus symptoms, new Guam testing guidelines issued Thursday night largely takes testing decisions out of the hands of doctors, makes up an entire tier of suspected cases, and skips the testing of tourists who go to a clinic with COVID19 symptoms.
While the U.S. Centers for Disease Control and Prevention has broadened the criteria for the testing of patients, and nearly all states and territories are following those exact guidelines, Guam is narrowing the guidelines for testing patients who exhibit Coronavirus symptoms. Anywhere else in the country, if you go to a clinic or hospital with Coronavirus symptoms and you've recently arrived from a Coronavirus hotspot (tourist or returning resident), you would be classified as a Person Under Investigation (PUI), tested, and reported to the CDC. The government of Guam has enacted other guidelines that will skip over tourists and travelers who have symptoms and are not hospitalized.
For example, in Hawaii, a PUI is a person who meets the following criteria: has fever and cough or shortness of breath, has traveled to a location that has been affected by the virus, and whose healthcare provider has consulted a disease investigator with the state’s Disease Outbreak Control Division.
On Guam, that same person would not be considered a PUI if they went to the clinic with the same symptoms. That person would have to be hospitalized which means more severe symptoms to then be considered a PUI and tested for Coronavirus.
What Guam has done is created an entirely new classification for people who have symptoms, have not been in contact with confirmed COVID19 patients (no one on Guam has been confirmed so far), and even if they have travelled recently, but are not hospitalized - as a Person Under Surveillance. This is not part of the CDC guidelines, and cuts out doctors in the determination of a PUI. This also means that patients who, in other states and territories, would be classified as a PUI and reported to the CDC, would not be reported by Guam officials.
And despite CDC-recognized increased risk to doctors, nurses, and clinical and hospital staff, the Guam guidelines do not even include those symptomatic health care providers as PUI. According to the CDC broadened guidelines:
"For healthcare personnel, testing may be considered if there has been exposure to a person with suspected COVID-19 without laboratory confirmation. Because of their often extensive and close contact with vulnerable patients in healthcare settings, even mild signs and symptoms (e.g., sore throat) of COVID-19 should be evaluated among potentially exposed healthcare personnel."
This is not included in the Guam guidelines.
As of March 4, 2020, the U.S. CDC recognized the need to test more Americans, and expanded its guidelines for testing. If Guam were to follow the CDC guidelines, then doctors would determine who should be tested, and symptomatic tourists (or residents who recently came from a trip to a Coronavirus hotspot) would be tested and classified as PUI. Those numbers would be reported to the CDC and made available to the public.
Guam and the Northern Mariana Islands are the closest American destination to the epicenter of the Coronavirus outbreak, which calls into question Guam's decision to disqualify a larger percentage of people who - in clinics throughout the rest of the country - would be tested.
Instead, and despite a Presidential directive narrowing travel from Coronavirus hotspots, airlines servicing Guam are offering $138 roundtrip plus taxes deals to Guam from Korea, and direct flights from Hong Kong restarted this year after being canceled just last year.
Every PUI identified by states and territories is required to report the suspected case immediately to the CDC. With Guam’s change in criteria there will now be less reporting to the CDC and not as many news releases and articles published regarding the confirmation of PUI cases. Those articles could clearly startle an already weakened travel industry on Guam which would further the drastic tourism declines seen in the market.
Guam also has one of the least transparent processes in place when compared to other states and territories. Many jurisdictions give daily updates on what is happening in their community and listing of all PUI and confirmed cases. There are no daily updates on Guam and the government is in a reactive mode with conflicting information coming from different agencies and officials. This lack of transparency and cohesive communications is what leads to community panic during uncertain times.
And while Guam has taken steps to narrow the testing guidelines, which would mean less tests for suspected cases on Guam, Hawaii has instituted proactive testing measures. Among them is a weekly random community sampling. According to the Hawaii Department of Health:
"Hawaii is shifting its COVID-19 response efforts into higher gear this week by launching a statewide surveillance testing program to identify cases of community spread of the coronavirus. This additional layer of testing helps detect COVID-19 cases earlier so that appropriate steps can be taken to contain the virus. About 200 COVID-19 tests will be conducted each week under the new program for people who are not designated as PUI. Samples collected for influenza testing from patients with respiratory symptoms will be randomly selected and also tested for COVID-19. These samples are collected by healthcare providers in doctor’s offices and other outpatient settings. The information will help responders understand the scope of such a spread when it occurs."
Hawaii is one of several jurisdictions throughout the country implementing such a program.