Outside Guam Memorial hospital, blue medical tents have sprung up to accomodate an overflow of Covid patients.
The sight is bewildering for Guam residents. The island ran an incredibly successful vaccination campaign, with almost 90% of eligible people having received two doses, and even began offering jabs to tourists in an “Air VnV” – vacation and vaccination – scheme.
But the tents have been installed to accommodate an overflow of Covid patients at the hospital as the territory grapples with a third wave of the virus, with daily deaths reaching the highest rates since March 2020.
“We just have no space – we have Covid patients waiting outside,” Pauline Perez, a nurse at the hospital, said in a government-released video that appeals to the remaining vaccine stragglers to get their shots.
“We use the blue med tents for Covid-19 patients who are stable. They need to be checked up by doctors but they don’t need treatment.”
Even before the onset of the pandemic, Guam’s healthcare system was fragile, but the surge in Covid cases triggered by the Delta variant has pushed it to the verge of collapsing.
Last week, the government hospital paused its services for all elective surgeries in order to realign its limited resources.
“Staffing is the issue, which is why we suspended elective surgeries to free up more staff to support more patients,” said Mai Habib, a spokesperson for the hospital.
The Guam Regional Medical City, a private hospital, is in the same predicament.
“We are in a crisis. I will not sugarcoat that at all,” Dr Alexander Wielaard, its medical director, said. “We have been seeing an abnormal number of patients.”
‘I cried after I heard the news’
Guam has been seeing close to 300 cases some days in the last few weeks, reversing months of steady decline. It has recorded 14,705 cases – nine percent of Guam’s population of 160,000 – and 195 deaths.
Covid test results in the past two months have shown an alarming rate of breakthrough cases of people who had been vaccinated, including 554 of the 1,765 positive cases in August. Overall, breakthrough cases represent 31% of infections – the highest rate in the US, where most states have less than 1%. Breakthrough patients in Guam account for about 40% of hospital admissions.
The Covid surge is perplexing for a territory with a vaccination rate close to 90%, ranking sixth in the US. To date, a total of 118,756 people – or 87.13% – of Guam’s eligible population (residents 12 years and older) are fully vaccinated. That includes 10,318 residents aged 12 to 17.
The high rate of breakthrough cases has led to fear in the community.
“One of my officemates received her results of swab test and she turned out positive,” said Dori Leomo, a resident of Tamuning. “I cried after I heard the news. It’s my first time to feel anxiety. The following day, all of us at work went to get our swab tests. Thank God I tested negative.”
‘The numbers should not be taken out of context’
While there has been some vaccine hesitancy, experts caution that the vaccines are working to protect citizens, and estimate that case numbers would be three times higher than they are had the vaccination rate not been so high and that when vaccinated people are hospitalised, their stays are much shorter and illnesses much less severe.
“It is clear that most people who stay longer in the hospital are unvaccinated. The length of stay for people who are vaccinated average around two days. They are minor admissions and use less amount of resources at the hospital than those who are unvaccinated,” said Dr Nathan Berg, who heads the governor’s physician advisory group.
As for the reasons why there has been such a big third wave on the island, experts point to a number of factors.
“Best guess on our higher rate may be related to close family culture and our high co-morbidities, which might lower the immune system,” said Dr Hoa Nguyen, the former chair of the governor’s physicians advisory group.
He attributes the surge to the lifting of restrictions on social gatherings such as weddings and funerals, and believes Guam may have prematurely returned to normal as the Delta variant reached the island.
“You have to look at the number of tests we are doing,” says Berg, who pointed to the fact Guam’s testing rate was higher than any other US state. “That is a good thing, and those numbers should not be taken out of context.”
He added that the people who died despite being fully vaccinated all had multiple co-morbidities.
Dr Peter Lombard, a member of the advisory group, attributed the high rate of breakthrough cases to waning efficacy of the vaccine six months after being administered.
“I trust that the data is real. Now is it a cause for alarm? That is the question,” he said. “One thing you need to do is look at other places that have good vaccination rates and high allocation of vaccines early on.
“Looking at distribution of vaccines and the high volume of vaccines given to Guam, I suspect that is since we have a larger vaccinated population early on and the vaccines’ efficacy waned sooner than we see in other states.”
Lombard also said a premature lifting of restrictions was partially responsible for the Covid surge.
Lombard and Berg agreed that Guam had benefitted from its high vaccination rate, with Lombard saying Guam’s case numbers would have been three times worse if not for the vaccination campaign.
Berg said that despite the recent Covid surge, “if you look at the population’s fatality rate, we are still doing well – that is an accomplishment in itself”.