Joint Information Center - JIC Release No. 78
April 17, 2020, 5:10 p.m. (ChST)

Profiles of Earlier Confirmed Cases; Analysis by Territorial Epidemiologist

The Department of Public Health and Social Services (DPHSS) tested 11 individuals for COVID-19 on Thursday, April 16, 2020 with conclusive results. Zero tested positive through DPHSS and 11 tested negative for SARS-CoV-2.

Preliminary Profiles of Confirmed Cases

Profiles of the 135 COVID-19 cases include three probable cases (formerly called clinically diagnosed cases), reports of 11 confirmed positive cases received from the U.S. Naval Hospital that were tested by the Naval Health Research Center (NHRC) in San Diego, and five
confirmed positive cases through Diagnostic Laboratory Services (DLS).

To date, there are 135 confirmed cases of COVID-19, with 5 deaths and 97 recoveries. As this is an evolving situation, information is subject to change with little to no notice. For updated information on COVID-19 cases on Guam, to include residential villages of confirmed cases, visit http://dphss.guam.gov/covid-19/.

MEDICAL STATUS	GENDER	RESIDENTIAL LOCATION	TRAVEL HISTORY*	AGE GROUP
Stable: 27 Hospitalized: 6 Recovered: 97 Deaths: 5	Female: 72 Male: 63	North: 69 Central: 43 South: 21 Homeless: 2	Dubai: 2 Japan: 1 Philippines: 11 Singapore: 1 U.S.: 5   *Some cases traveled to more than one country	90+: 1 80-89: 4 70-79: 11 60-69: 34 50-59: 25 40-49: 24 30-39: 14 20-29: 14 10-19: 7 0-9: 1

Risks Among Guam COVID-19 Cases

Preliminary U.S. data show that people with underlying health conditions (diabetes, chronic lung disease and cardiovascular disease) tend to be at higher risk for severe COVID-19
associated disease.¹

Testing at the Guam Public Health Laboratory (GPHL) is limited to priority groups: hospitalized and emergency room patients with symptoms; people with chronic conditions; older people with symptoms; health care workers/first responders with symptoms; and household/community contacts of known positive cases. Commercial testing is available through DLS for patients who do not meet this criteria.

1 Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 — United States, February 12–March 28, 2020. MMWR Weekly / April 3, 2020 / 69(13);382–386. Available at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm

Underlying Conditions
Among the 135 positive cases as of April 15, 2020, a majority had at least one underlying condition (83.9%). The most common chronic conditions overall include diabetes (30.8%),
chronic lung disease (COPD or asthma) (30.9%), and cardiovascular diseases (22.6%). Current smoking (14.6%) and former smoking (14.5%) were also risk factors.

Underlying conditions and risk factors among confirmed COVID-19 cases
	0-49	50-64	≥65	Overall	Hospitalization
Any underlying condition	22.8%	100%	100%	83.9%	90%
Diabetes	8.6%	45.5%	42.3%	30.8%	30%
Renal disease	2.9%	12.1%	8%	7.2%	6.1%
Asthma or COPD	8.6%	45.5%	42.3%	30.9%	14.6%
Cardiovascular disease	0%	24.3%	37.1%	22.6%	20.4%
Immunocompromised	2.9%	6.3%	8.3%	5.6%	6.1%
Neurological disease	0%	0%	8%	2.2%	4.1%
Current smoker	18.1%	18.1%	0%	14.6%	14%
Former smoker	14.3%	16.6%	11.1%	14.5%	17.1%

These chronic conditions were more common among older populations. For those cases aged 50-64 years, 45.5% had diabetes, 45.5% had chronic lung disease, and 24.3% had
cardiovascular disease. Among those aged over 65 years, 42.3% had diabetes, 42.3% had chronic lung diseases, and 37.1% had cardiovascular disease (not including hypertension). Current or former smoking was a risk factor at all ages.

Hospitalizations
Among those with underlying chronic conditions, 90% were initially hospitalized. Those most at risk for hospitalization due to COVID-19 included 30% of confirmed cases with diabetes, 20.4% of those with cardiovascular disease (not including hypertension), and 14.6% with
chronic lung disease. Both former smokers (17.1%) and current smokers (14%) were also at risk for hospitalization.

Deaths
Among the five COVID-19 related deaths on Guam, all five were above the age of 65, three had
cardiovascular disease, two had diabetes, one had chronic lung disease, one had a neurological disease, one had cancer, and one was a former smoker.

Recent Data on Guam Risk Factors for Chronic Diseases
Based on the 2018 Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (CDC-BRFSS)2, the following are estimates of Guam’s chronic diseases prevalence:

• Guam’s rate of diabetes is 13.7%, compared to 10.9% in the U.S.
• 20% of those with diabetes are between the ages of 55 and 64 and 22% are over the age of 65
• Diabetes prevalence is higher among those with lower socioeconomic status.
• Coronary heart disease rates for Guam and the U.S. are similar at 4.3%.
• Obesity rates are similar with 29.8% on Guam and 30.9% in the U.S.
• Current smoking rates are higher on Guam at 21.9% compared to 16.1% in the U.S.
• Chronic Obstructive Pulmonary Disease (COPD) rates are lower on Guam (3.9%) than in the U.S. (6.6%).

Since Guam has a high prevalence of diabetes, obesity, and smoking, it is important that people take steps to minimize their risks for infectious diseases such as COVID-19.

If you have a chronic condition, practice good self-management, quit smoking (call
1-800-QUITNOW or 1-800-(671) 784-8669 for additional help), eat a healthy diet, and engage in regular physical activity.

CDC recommends that if you are at higher risk of severe illness from COVID-19, you can protect yourself by:

• Staying home if possible
• Washing your hands
• Avoiding close contact (6 feet, or two arm’s length) with people who are sick
• Cleaning and disinfecting frequently touched surfaces
• Avoiding all cruise travel and non-essential travel

More information can be found on the CDC website:
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html

For more information, contact Ann Pobutsky, PhD, Territorial Epidemiologist at:
Ann.Pobutsky@dphss.guam.gov

For inquiries on COVID-19, contact 311 through a local number, or call the Joint Information Center at (671) 478-0208/09/10.

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