A factor in Guam's high number of COVID-19 cases is the overall health of the community.
National reports ranking COVID-19 cases among states and territories, ranked Guam high both in vaccinations and in COVID-19 cases per capita. When asked about this during a Thursday press briefing with the Department of Public Health and Social Services, Dr. Ann Pobutsky and Dr. Annette David noted the rate of diabetes and other comorbidities in Guam.
"It could be because of the high rates of chronic diseases. We have high rates of diabetes and obesity, and it could be that people are more susceptible," said Pobutsky, territorial epidemiologist.
"The island isn't very conducive to walking or exercising, except of course the beaches – everybody drives. That's the one thing I noticed about coming back here and being in Hawaii where I biked and walked almost everywhere. I mean, these are things we need to think about because our obesity and diabetes rates are higher than the U.S. mainland."
Pobutsky added: "It's not just Guam; it's the entire Pacific that has an epidemic of diabetes and obesity."
Data shared by the Department of Public Health and Social Services shows that as of Oct. 14, during 2021 there were 13 COVID-19 related fatalities who were fully vaccinated, which is about 14.6% of the total COVID-19-related deaths, but all 13 "had multiple comorbidities."
According to the Centers for Disease and Control and Prevention, diabetes, being overweight or obese, having an unhealthy diet, physical inactivity and excessive alcohol use are among the medical conditions and lifestyle choices that put people at risk.
DPHSS data shows that COVID-19 was the third leading cause of death in Guam in 2020, and according to Pobutsky, it is again tracking to come in third for 2021.
Aggressive variant and increased vulnerability
David said Guam also still has close to 50,000 people who haven't been vaccinated, either because they're too young or their medical conditions don't allow for it.
She said one thing they look at, in terms of tracking diseases, is the epidemiological triad: the agent of the disease; the host; and the environment.
"In terms of the agent, the change really happened with the delta variant becoming very prominent, because the delta variant is much more aggressive, it's more transmissible and it tends to cause more severe disease. In addition, the waning of immunity from vaccination seems to be faster with the delta variant.
She reiterated Pobutsky's comments about overall health of the host – in this case, the people living in Guam.
"We just looked at these indicators for the community health assessment and the rates of diabetes, obesity, of cardiovascular and pulmonary disease are higher here in Guam. As a whole, our people are probably not as immunocompetent as the populations you would compare with in the U.S.," David said.
With respect to the environment, she noted that Guam is also testing more than other jurisdictions.
"At one point we were doing about 1,500 tests a day; that's about 1% of our population. ... I don't think you will find that in many places in the world. So when you test more, you will find more, including the asymptomatic cases," she said.
"And also in terms of the home environment, our transmission patterns here in Guam, they seem to indicate transmission happening in families, in the homes. ... If you look at the data in terms of the density of people living inside homes, there are more people per house, here in Guam, as compared to the U.S. (mainland).
"And so you put all these things together, and it's not surprising that we are still seeing this relatively high rate of new cases, despite the fact that we are doing OK for vaccinations," David concluded.
Both doctors reiterated that the key to slowing the spread of COVID-19 is to vaccinate those who are eligible.