Two more test positive for COVID-19

Two more people tested positive for the virus that causes COVID-19 out of the 90 that were tested on Wednesday.

Among those tested were the elderly living at Guma Trankilidat, as well as those living at government quarantine facilities, hospitals and clinics.

That brings Guam’s total COVID-19 cases since testing started in mid-March to 151. There have been 123 people who have recovered and five who’ve died.

The leaves the community with 23 people who currently have the virus.

Some cases that were previously released from isolation have returned to active isolation status after re-testing positive for COVID-19 through follow-up testing. To date, no additional cases have been linked to people released from isolation.

DPHSS Q&A about those Released from Isolation

Question: Why are individuals who were cleared of COVID-19 testing positive? What happened?

Answer: Some patients who were previously cleared based on CDC’s non-test based criteria chose to be retested to confirm they were negative for the virus.

Some of these patients were found to be positive by the Polymerase Chain

Reaction (PCR) SARS-CoV-2 test. A positive PCR test that follows an acute infection may not indicate “active infection” as the PCR test also detects dead virus particles which may linger after the acute illness resolves. Studies are ongoing to determine these characteristics of the SARS-CoV-2 virus.

Q: Why did this happen?

A: This is not unique to Guam. Globally, there are reports of patients who are initially cleared but then test positive via PCR, some many weeks after their infection started.

As mentioned above, the PCR test used in Guam identifies the presence of viral particles. It cannot determine if those particles came from a live virus or a dead virus. For many viral diseases, it is well documented that inactivated viral particles can be detected long after the disappearance of the infectious virus (note: 2 particles from the measles virus can still be detected 6-8 weeks after the clearance of the infectious virus).

In early April, South Korea had similar findings in 263 patients, and their experts opined that "dead virus fragments" were lingering in patients’ bodies after they recovered and that the virus did not appear to be active in the patients, nor did they feel that the patients were infectious.

The immune system can neutralize viruses by destroying their outer envelope or aggregating the viral particles (these stop infectivity, but do not eliminate the nucleic acids detected by PCR testing).

Q: Were these cases released too early and could they put Guam at risk?

A: Guam DPHSS followed the CDC guidance for releasing these patients. CDC

based the criteria on the best available studies at the time. As with any new virus, research is ongoing and evolving, which requires continual updates in Guam’s strategies used for diagnosing and treating COVID-19. On May 3, 2020: CDC updated its non-test based guidance for discontinuing isolation and extended the minimum period from 7 days post onset to 10 days to further reduce the risk of spread of COVID-19. At the same time, the ‘non-test based guidance’ was renamed ‘symptom-based strategy.’

More importantly, Guam DPHSS has released over 100 people based on CDC’s non-test based guidance, and has not detected any new infections linked to these released individuals.

Q: Why didn’t Guam DPHSS use CDC test-based guidance?

A: Throughout the world, and on Guam, only very few test kits were available. Like

the rest of the United States, Guam had many active cases in isolation and didn’t have enough tests to perform the CDC test-based criteria for all patients. Therefore, Guam DPHSS used the non-test based criteria for a proportion of our cases.

Q: How is Guam DPHSS addressing this issue moving forward?

A: Recently, Guam’s testing capacity has increased, and the number of active cases have decreased.

Moving forward, Guam DPHSS will be using CDC’s test-based criteria for releasing patients from isolation. This requires COVID-19 patients to have​ two consecutive negative tests at least 24 hours apart before being released from isolation.

Q: Why change the criteria?

A: Guam DPHSS is always trying to refine its response to best protect the local

community.

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