To Guam & the world | Protect the vulnerable, develop testing and tracing, and don't put faith in lockdowns

 An opinion letter was published in Marianas Business Journal on September 7, 2020 (Guam time).

While most people around the world are still worried about the rising number of COVID-19 cases, the analysis based on statistics of EuroMOMO, The European Mortality Monitoring Activity, has actually shown that COVID-19 did not cause more deaths than the mortality rate projection for 2020, especially in countries that responded well.

EuroMOMO is the official body monitoring EU member states’ mortality data. Their analysis in the end of April, when the pandemic still looked bad in Europe, has already shown the deaths from COVID-19 did not make the total mortality be over the projected normal range in Germany, Austria, Greece, Norway, Finland and Denmark. Even in Sweden, with a controversial “no-lockdown” strategy, its death toll number was still under the extremely high excess mortality.

COVID-19 became a frightening killing bug of the new decade right after it was emerging in China mainly because the coronavirus is in the same family with SARS and MERS. However, the comparison of case fatality rate (CFR), which is the ratio of deaths from a certain disease to the total number of people diagnosed with this disease for a certain period of time, actually showed SARS had a CFR of around 10%, MERS killed 34%, and a collaboration of Hong Kong University and Harvard University in February estimated the CFR of COVID-19 would be around 1.4%. The latest data from Singapore, 27 deaths out of 55,938 cases found by its aggressive testing and contact tracing protocols, indicated a CFR of 0.48%, which is getting closer to a seasonal flu’s CFR 0.1%.

The key is absolutely to well respond to the pandemic with proper strategies. When Singapore government decided to reopen the country after a two-month lockdown on June 2, the city state, with 6 million residents, had reported over 35,000 COVID-19 cases and 24 deaths. As of August 14, its total confirmed cases were over 55,000, which means 20,000 increase after reopening, but Singaporeans have switched their focus to watching hospitalization rate, instead of paying too much attention to daily testing results, and the death toll therefore increased 3 only during the period.

On the same day, August 14, when Guam’s cumulative COVID-19 cases reached 500, there were 8 patients who were hospitalized. This number was actually four times higher than the hospitalization rate two weeks ago, which was 2 hospitalized patients only on July 31. It has even jumped to 45 on August 31. It's two times higher than the record-high hospitalization rate during Guam's first lockdown, which was 21 hospitalized COVID-19 patients on April 6 when the confirmed cases were just over 100.

The increase certainly needs to be taken seriously. However, do not forget the hospitalization number did go down to zero on July 23 after the island lifted the restrictions on Mother’s Day. There is no doubt that the majority of Guam residents have been doing their part to avoid infections and severe illness and Guam’s medical community has done a great job to treat patients and save lives in the past several months although many people have been thinking the medical capacity on Guam is relatively weak. Obviously, It is very important that we keep living the healthy new normal and our government keeps supporting our medical heroes to help our island get through it together.

The new normal is not a guess, or a theory only. A number of solid research findings have actually proved that there are effective protection measures helping people live with the coronavirus in the long run. For example, a research article published on June 11 in the Proceedings of the National Academy of Science analyzed data from three epicenters - Wuhan (China), Italy and New York City - and proved that mandated face covering “alone” significantly reduced the number of COVID -19 infections. The researchers concluded that this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic.

There are, of course, studies showing lockdowns help as well. However, the excess death analysis based on EuroMOMO’s data, mentioned earlier, proved that the strictness of a country’s lockdown measures had little associations with its fatality of COVID-19. These analysis concluded that it’s better to respond quickly, with proper testing and tracing protocols, rather than relying on strict lockdowns.

The biggest myth about lockdown is to believe it is the only solution when the epidemic gets worse. In fact, lockdown is a measure to lock the seriously-affected area in order to protect people in other areas. When SARS hit Taiwan 17 years ago, the health authority there locked a hospital where a serious nosocomial infection occurred to protect the community outsides. When Wuhan became a miserable epicenter of China in January, Chinese government issued a lockdown order in Wuhan to avoid the coronavirus’ further spreading to other cities and provinces. The price the whole world had paid for the chaotic restrictions was the collapse of supply-chains happening in the second quarter. It sadly led to many frontline medical personnel being forced to fight the coronavirus without personal protective equipment (PPE).

When new cases are emerging, it is time everybody should be told that there are not any “coronavirus free” places in the world and we are inevitably going to live with the coronavirus for a while. Only a sustainable strategy can help us carry on together.

The US CDC Morbidity & Mortality Weekly Report on July 24 emphasized, again, that older adults and those with chronic obstructive pulmonary disease, heart disease, diabetes, chronic kidney disease, or obesity are at higher risk for severe COVID-19-associated illness. An estimated prevalence of any of five underlying medical conditions, mentioned above, among US adults was 47.2%. The percentage could be higher in more rural areas like Guam, especially of diabetes and obesity.

The most relevant measure is therefore to protect the vulnerable, including the elderly and people with those underlying medical conditions, from the risk for severe illness, and watch those who ignore response advice and continue high-risk behaviors. Don’t forget the coronavirus has such a highly contagious nature and the aggressive testing and contact tracing policies will definitely dig more infections. Paying too much attention to daily testing results is just causing panic and very likely to result in a chaotic response.