JIC RELEASE NO. 112 - End of Day Results: Two Test Positive for COVID-19 by DPHSS;DPHSS Information about those Released from Isolation

Breaking News Found at Governor Leon Guerrero’s Facebook Page:

https://www.facebook.com/govlouguam/

COVID-19 test results are reported from multiple labs at varying times of the day. The cumulative total from all labs will be reported on a nightly basis, unless unavailable. The following breakdown provides cumulative COVID-19 test results for Wednesday, May 6, 2020:

 

¹Beginning March 26, 2020

²Beginning March 31, 2020

³Beginning April 15, 2020

⁴Beginning April 23, 2020

⁵Beginning April 30, 2020

The Department of Public Health and Social Services (DPHSS) tested 90 individuals for COVID-19 on Wednesday, May 6, 2020 with conclusive results. Two tested positive through DPHSS and 88 tested negative for SARS-CoV-2. The results include samples from clinics, the Guam Memorial Hospital Authority, a quarantine facility, and an expanded testing site. DPHSS has targeted areas where infection may occur due to lack of access to health care, in densely populated apartment complexes, and senior housing.

Everyone who has been swabbed for the COVID-19 test can expect to be notified of test results from either their provider if samples were taken in a clinic or hospital or by DPHSS health care staff if samples were taken during the DPHSS community expanded testing. 

The DPHSS overall count also includes probable cases of COVID-19 and confirmed positive cases tested by the Naval Health Research Center (NHRC) in San Diego, the U.S. Naval Hospital (USNH) Guam, the Guam Memorial Hospital Authority (GMHA), Guam Regional Medical City (GRMC), the Guam National Guard (GUNG), and Diagnostic Laboratory Services (DLS).

To date, there have been 151 cases confirmed through COVID-19 testing provided with 5 deaths and 123 released from isolation. When a patient is released from isolation, he or she is no longer considered infectious. According to the U.S. Centers for Disease Control and Prevention (CDC) research and published guidelines, a patient is released from isolation after at least 72 hours have passed without a fever or additional respiratory issues and at least seven days have passed since symptoms first appeared. All remaining cases are in isolation. 

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. As this is an evolving situation, information is subject to change with little to no notice. 

DPHSS Q&A about those Released from Isolation 

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

  • 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.

• Why did this happen?

  • 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: 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).

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

  • 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.

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

  • 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. 

• How is Guam DPHSS addressing this issue moving forward?

  • 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.

• Why change the criteria?

  • Guam DPHSS is always trying to refine its response to best protect the local community.

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