In early January, the coronavirus pandemic emerged as an existential threat to humanity. Like a thunderous biologic tidal wave, COVID-19 overwhelmed an unprepared world. Now, this terrifying pandemic has infected more than 10 million people and killed more than 500,000 poor souls across the planet.
Globally, lockdown measures like the quarantine of billions of human beings and the massive closure of international borders have been implemented. On Guam, face masks and hand-washing and personal distancing and contact tracing have become the stuff of TikTok videos. Three months later, the lockdown did what it needed to do: starve the virus and allow Guam’s medical community to strengthen itself in order to save lives.
While too much of the American nation has been slow to fear the virus, the people of Guam wisely figured out how to mitigate the spread of COVID-19 and flatten the curve. At the same time, our island community helped the U.S. Navy deal with unprecedented challenges aboard the USS Theodore Roosevelt and has assisted the U.S. Air Force in its efforts to contend with 38 inappropriately adventurous airmen.
Guam’s COVID-19 success has been built on personal hygiene, social distancing, strategic surveillance and control, and the widespread use of face masks. These basic, essentially low-tech elements have imperfections but when applied together are foundational and they shut down the virus. Eliminate one element, and the treatment won’t work. Knock one latte stone pillar down and the whole house will crumble.
As island leaders push to reopen businesses and schools, they are just now beginning to talk openly about how to pay for these tools that have kept health care workers safe from infectious disease threats even before COVID-19.
Science and ongoing experience demonstrate that these tools have worked to stem the tide of COVID-19 deaths on Guam. Thus, the mind is boggled by the realization that Guam leaders have not yet invested enough local funds to make certain that these tools will be effectively maintained as our island hopes to open its doors to more than 1.3 million tourists.
Without the wise fiscal commitment of local government resources to ensure surgically precise, strategically efficient, and empirically effective COVID-19 control, mandatory quarantine will remain a medically effective method to protect Guam from disease and simultaneously kill the local business economy.
Biblically, quarantine would be a time of trial and testing in order to be purified, perfected, and made strong. In the time of Noah, it rained for 40 days and 40 nights before the dove flew over the rainbow. Mandatory quarantine is an effective way to control communicable disease outbreaks but has been accompanied in every age and under all political regimes by distrust, economic ruin, and riots.
Assuming that Guam’s political leaders sincerely want to cultivate local business and eradicate wasteful government corruption, they will work tirelessly during this time of public health emergency to lift Guam out of quarantine and safely reopen our economy.
Several basic parameters have emerged as essential to safely reopen Guam to tourism: rates of new COVID-19 cases should be low and falling for at least two weeks; island hospitals should have available nurses and beds to treat all sick coronavirus patients especially those who need mechanical ventilation; and there should be a capacity to test and control everyone with symptoms.
Contact tracing is an effective disease control strategy that involves investigating cases and their contacts and then interrupting disease transmission – typically by asking cases to isolate and contacts to quarantine at home voluntarily. Contact tracing is a key strategy to prevent the further spread of COVID-19.
Critical elements of the implementation of contact tracing are community engagement and public support; careful planning and consideration of local contexts, communities, and cultures; a robust workforce of trained contact tracers and supervisors; logistics support to contact tracing teams; and a system to collate, compile, and analyze data in real-time.
Thus far, no clear or coherent plan to sustain a competent contact tracing and control program to safely keep open Guam has been presented to the public. This is unacceptable.
A clear and coherent plan to maintain COVID-19 surge capacity at the Guam Memorial Hospital has likewise not been presented to the people of Guam. Instead, we have heard repeatedly that GMH is so hopelessly bad that it needs to be replaced.
Many Guamanians are anxious that GovGuam is recklessly opening the economy and exposing our people to danger. Thus far, Public Health has presented no formal plan for surveillance testing to look for early signs of failure. Many now feel that if we continue to head down this path, the virus will overwhelm our hospital intensive care facilities beyond capacity and we will soon be making tough decisions like who gets a mechanical ventilator and who doesn’t.
On a positive note, the presence of robust military medicine resources strengthens Guam’s total position vis-à-vis the reopening to tourism. Certainly, a mutually beneficial partnership with ready and competent military health care professionals whose boots are on Guam ground inspires confidence in this island doctor. The basic logic is: I protect you; you protect me.
Now, the Government of Guam needs to be purified, perfected and made strong. Forsaking payroll politics and gamesmanship, a disbelieving and unprepared GovGuam must finally and totally put service before self. All of GovGuam must hunker down and protect home, not just shelter at home and get paid to do nothing. All essential local government funds must be directed aggressively towards health care, education, and public safety. All nonessential GovGuam positions should seek federal funding or be transferred into the military buildup workforce. The time for excuses is over. The virus is here.
Dr. Vincent Taijeron Akimoto is a family physician.