Guam has entered its fourth COVID-19 "surge" of 400 to 500 new cases a day, which "probably" is driven now by the highly transmissible omicron variant of the coronavirus, Department of Public Health and Social Services officials said Friday.
Numbers of hospitalizations, intensive care unit admissions and deaths, however, are lower than in previous surges, which is a bit of good news, DPHSS officials said.
Dr. Robert Leon Guerrero, interim chief medical officer for DPHSS, said the lower hospitalization and death rates are a major reason why the department is not recommending new or additional restrictions despite spikes in the numbers of new daily cases after the New Year's Eve holiday.
Social gathering restrictions remain at 100 people outdoors, and 25 indoors, regardless of vaccination status.
"I think the initial uptick I thought was most likely due to delta, but, yes, we’re probably getting omicron, but we just don't have the proof that it’s omicron," Leon Guerrero said at the DPHSS weekly COVID-19 press briefing. "But I do believe that we’re starting to see omicron."
It could take about two more weeks to get the genome sequencing results on the latest specimens that DPHSS sent to the Hawaii State Laboratory to confirm omicron's presence on Guam, Public Health said.
While waiting for the arrival of the results and operation of the $25,000 genome sequencing machine that DPHSS bought, the department will continue to send samples off island for testing.
Military cases high
Leon Guerrero said the ongoing COVID-19 surge is partly a result of high positivity rates among those tested by the Department of Defense, including active service members, their dependents and DoD civilian employees.
Some days, Defense Department cases made up nearly half of the overall cases, though the military makes up only about 10% of Guam's population, DPHSS said.
Until last week, the military had lifted the mandate to wear masks at its facilities.
"Although the numbers are high, proportionally, if you look at the armed forces, their numbers are jumping up a lot higher because they're not doing the mask mandate (until recently) so that also kind of points to what we've been saying all along – wear your mask, get your shot," Leon Guerrero said.
The 18-to-39 age group continues to drive the spike, DPHSS said, in both military and civilian populations. On the civilian side, the surge also is driven by teens, followed by those in the 40-to-59 age bracket.
Use of CAR Score, alert app end
GovGuam has stopped using the COVID-19 Area Risk Score, or CAR Score, because it does not capture the true picture of the current situation on Guam, said DPHSS territorial epidemiologist Ann Pobutsky.
Based on the governor's Physicians Advisory Group discussions Thursday, the CAR Score is "not really a good indicator at this point in the pandemic," Pobutsky said.
The CAR Score takes into account only the test positivity rate and the retransmission value, among other things.
It does not consider the severity of the cases that can be gauged by the number of hospitalizations and ICU admissions or the use of ventilators to help patients breathe, Pobutsky and Leon Guerrero said.
Recent CAR Scores soared as high as 233, much higher than the 2.5 that GovGuam deemed to be safe.
That's a lot higher than when Guam was going through a delta surge, even though there were dozens of deaths, cases of patients pronounced dead on arrival, and hospitalizations at the time, compared to the current situation.
"We have seen an uptick in hospitalizations, but we’re really not seeing a huge bump in the ICU or in deaths, which is good," Pobutsky said.
GovGuam has also recently "turned off" the Guam COVID alert app, DPHSS spokesperson Janela Carrera said, because it "didn't work as much as" DPHSS wanted it to.
The goal was to have 60% of Guam's population using the tool, but only a fraction of that number downloaded it. Moreover, those who tested positive for COVID-19 were not entering the DPHSS-provided codes into the tool, so there was no exposure notification that was coming out of the app, Carrera said.
Omicron's telltale signs
At the press briefing, Leon Guerrero laid out the reasons why he believes the ongoing COVID-19 surge is now being driven by the omicron variant.
- The positivity rates are high, but the hospitalization, ICU admissions and death rates are not as high as during the prior surges. Studies have shown that omicron is milder than the delta variant, resulting in significantly less severe illness.
- There are now more COVID-19 patients who do not respond well to the monoclonal antibody treatment, although about 90% still get better after receiving it, Leon Guerrero said. Research has shown that the MAB is highly effective with the delta variant, but not with the omicron variant. DPHSS awaits the arrival of antiviral pills which work well with omicron cases.
- Guam has been seeing more patients with symptoms similar to the common cold or mild flu, with the sore throat, cough and congestion associated with omicron, whereas previous surge symptoms involved loss of taste and smell along with the common cold symptoms, Leon Guerrero said.
But while the omicron variant has been known to cause milder symptoms and fewer hospitalizations, DPHSS officials said residents should not let their guard down.
They continue to urge people to wear masks, watch their distance and wash their hands properly, as well as get fully vaccinated and boosted.
High demand for testing
Thousands of free tests are now conducted nearly every day on Guam, with DPHSS expanding the testing hours and days as well as increasing the number of locations in public schools.
But even with expanded testing, the wait times and lines for testing are long.
"There's high demand for testing right now. It's not only at Tiyan," Carrera said. Private clinics are also testing people for COVID-19.
So DPHSS transitioned from a first-come, first-served basis to an appointment-based system for testing, but the lines have remained long.
Beginning Jan. 17, priority will be given to those with symptoms among those with no appointment at the Tiyan testing site, Carrera said.
While DPHSS wants to test as many residents as possible, it can no longer further expand the current testing because of limited personnel, Carrera said.
Supreme Court on vaccine mandate
The U.S. Supreme Court on Thursday stopped the Biden administration’s vaccination-or-testing requirement for the nation’s largest employers.
Leon Guerrero said, however, that the Supreme Court upheld the vaccine mandate for hospitals and health clinics. The court allowed vaccination mandates for most health care workers at facilities that receive Medicaid and Medicare funds.
"The only good thing about that, though, is that I think people are realizing that if they want to go to work, they want their kids to go to school, they need to get vaccinated," Leon Guerrero said. "That's what's going to drive these COVID numbers down."