Public Health releases comprehensive COVID report; Chuukese have disproportionately high mortality rate

Department of Public Health and Social Services (PNC file photo)

The Department of Public Health and Social Services has released a highly anticipated report detailing the landscape of COVID-19 on Guam.

The report covers data from March 12 to December 4 and comprehensively lays out COVID-19’s medical toll on the island’s residents.

Guam’s data does confirm what the health community has been saying all along — older people are more likely to get hospitalized and/or die from the virus.

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As of Dec. 4, the island was at 6959 positive cases. Of those cases. a whopping majority were people under 59. But it’s those over that age that end up suffering most.

Dr. Ann Pobutsky, DPHSS Territorial Epidemiologist, said: “What we find is the majority of the cases are among people who are aged 20-59, so that’s 73%, almost 3/4 of the cases and maybe 16% under 20 and 11.3% over 60. But the problem is the people who are hospitalized are more likely to be elderly. So the young people may be more common for cases but they’re not the ones being hospitalized or dying.”

To back up that statement, Pobutsky says the data shows that two-thirds of people aged 80 and above needed hospitalization for COVID-complications and between 30-40% of anyone 60-70 needed hospital admittance also.

Only hospitalization data from GMH is reported since it’s the island’s designated COVID hospital and while GRMC had to death with some spillover in the thick of the second wave, for the most part, hospitalizations have been contained to GMH.

Interestingly, the rate of cases is higher among men at almost 60% but women tended to be hospitalized more at 11% versus nearly 9% for men.

Nonetheless, it appears both males and females passed away at the same rate, with Guam’s COVID case fatality ratio sitting at 1.6% for both sexes.

The graphs in the report show two major spikes in hospitalization during the resurgence of COVID-19. One peak was mid-August and a second in mid-October…that coincides with spikes in cases as well.

The report went into an in-depth analysis of 91 deaths up to November 10 because that’s how many they had complete data for, including death certificates.

A key risk factor for COVID mortality is older age, with elderly people over the age of 60 making up nearly 60% of all deaths. Compare that to only 7.7% death among people 39 and younger.

“Because as we get older, we tend to have more chronic conditions including things like heart disease,” Pobutsky said.

As known already, death data confirms that those with underlying health conditions like cancer, kidney disease, lung disease, obesity, diabetes or those who smoke are far more likely to develop severe COVID-19 conditions and/or die.

As for an ethnicity breakdown, Chamorros and Chuukese have the highest proportions of cases who were hospitalized, making up just over 30% of the total cases hospitalized combined.

And the Chuukese community had the highest fatalities overall in the ethnic groups, above the average case fatality ratio, at 2.6%.

Public Health says a risk marker for COVID mortality is ethnicity, with Chuukese comprising only 7.1% of Guam’s population, but accounting for 16% of total cases and 31% of COVID deaths.

Dr. Pobutsky says further analysis will be done to determine why.

“If you have a 5 or 6 bedroom house and you have 30 people living there it’s really hard to social distance. So, overcrowded housing is a big issue and especially for migrants who have lower socio-economic status. They might also be frontlines, they’re working in probably those professions, whether they work at stores or they work in food service, wherever, where they’re exposed a lot more…we just don’t know. They’re considered a vulnerable population,” Pobutsky said.

Filipinos make up around 26% of Guam’s population. They account for almost 30% of all the cases on island yet have the same death rate as the Chuuk community. They’re the 2 highest ethnicities with fatalities.

“It’s not an inherent genetic difference. It’s just culture, or behavior, or living conditions and so on,” Pobutsky said.

Also, a key risk factor for mortality on Guam is diabetes with around half of Guam’s deaths having diabetes as an underlying health condition.

“It just comes up repeatedly: diabetes, hypertension, diabetes, hypertension…those are key risk factors for death. We do have a higher prevalence of diabetes and it’s complications and if people have uncontrolled diabetes or uncontrolled hypertension then that’s a big issue – almost everyone with diabetes has cardiovascular problems…diabetes really messes with your circulation,” Pobutsky said.

She added: “They actually talk of diabetes and obesity as being twin epidemics in the United States including here on Guam…and out in the Pacific it’s a big problem.”

Pobutsky says Public Health is working on tackling the widespread diabetes issue on Guam.

One thing that did surprise Dr. Pobutsky is the low rate of lung disease being associated with deaths.

“In the mainland they’re seeing a lot more with lung diseases…we haven’t seen a lot of that. I don’t know if that’s because everyone quit smoking. We have seen some cases where people had chronic lung conditions but the main ones are complications due to diabetes or cardiovascular events,” Pobutsky said.

Here’s the full report:

GUAM COVID_Surveillance Summary Report (1)