Update on Guam’s COVID-19 Cases and the Introduction of New Quarantine, Testing, and Monitoring Requirements for Travelers Entering Guam Press Briefing June 27, 2020 13:00 GOVERNOR & STATE SURGEON PHYSICIAN ADVISORY GROUP Prepared by: Felix T. Cabrera, MD, MT (ASCP) New Case Counts tell us the incidence of active cases. Test Positivity Rates tell us how wide of a net we are casting to identify active cases. GOAL =GOVERNOR Keep& STATE both as low as SURGEON possiblePHYSICIAN ADVISORY GROUP June 27, 2020 COVID-19 New Cases and Test Positivity Rates on Guam: For the Month of June to Present 10 6.0% New Case counts tell us the incidence of active cases, while Test Positivity Rate tells us how wide of a net we are casting to identify active cases. New Cases (7-Day Rolling Avg) 9 5.0% 8 New Cases 7 3.5% Threshold of Concern 5 2.0% 3 Jun 1 3.0% 2.5% 4 1 4.5% 4.0% 6 2 5.5% Test Positivity Rate New Cases 1.5% 1.0% Test Positivity Rate (7-Day Rolling Avg) Test Positivity Rate 0.5% GOVERNOR Jun 6 Jun & 11 STATE Jun SURGEON 16 Jun 21 PHYSICIAN ADVISORY GROUP Jun 26 June 27, 2020 DAILY NEW CASES 7-Day Rolling Average 7-Day Rolling Average As of June 25, 2020 9 300 DAILY NEW TESTS 8 270 7-Day Rolling Average 7 240 210 6 180 5 150 4 Tide Turn Warning DAILY NEW CASES 7-Day Rolling Average 120 3 90 2 60 1 and uptrend of Daily New Tests performed, visually intersects when test positivity rates start dropping below 3%. Countries that have considerably controlled their COVID-19 spread have test positivity rates <3%. *Staying in the green zone is one of the gated criteria in Guam’s reopening efforts. 26 Ju n 22 n Ju 16 n Ju 10 n Ju n Ju 29 M ay 23 M ay 17 M ay 11 M ay 5 M ay 29 ril Ap 23 ril Ap 17 ril Ap 11 ril Ap 5 ril Ap 30 M ar ch 24 M ar ch 18 M ar ch 12 GOVERNOR & STATE SURGEON PHYSICIAN ADVISORY GROUP Turning of Tide— By using this scale design, the downtrend of Daily New Cases 4 30 M ar ch Note the 2 different Y-axes. Daily New Cases and Daily New Tests have been scaled so that they are comparable. For example, 300 new tests corresponds to 9 new cases, which is 3% of 300. DAILY NEW TESTS COVID-19 Cases & Tests on Guam: Visualization of Testing Capacity Adequacy Source: Governor and State Surgeon’s Physician Advisory Group, prepared by Felix Cabrera. Visualization adopted from Tomas Pueyo’s methods in Coronavirus: Learning How to Dance, Part 3: How to Do Testing and Contact Tracing, published April 28, 2020 on medium.com June 27, 2020 Guam’s Mobility in Relationship with COVID-19 New Cases and Hospitalized 250% As of June 25, 2020 225% 20 18 200% 175% 14 Guam COVID+ Hospitalized (7-Day Avg) 150% 12 Guam New COVID+ (7-Day Avg) 10 125% Guam Mobility 8 100% COVID-19 Cases 16 6 75% 4 50% This anonymized mobility data is made available via Apple’s Mobility Trends Reports, which was created to provide insights into response to policies aimed at combating COVID-19. Google has a similar program for Android users called Community Mobility Reports. Guam is not included in their current data report. Data is based on a random sample of iOS devices (see privacy statement). This only serves as a sample representation of the public’s overall mobility. Data last accessed on June 9, 2020 at https://www.apple.com/covid19/mobility. Thr, Jun 25 Tue, Jun 23 Sun, Jun 21 Fri, Jun 19 Wed, Jun 17 Mon, Jun 15 Sat, Jun 13 Thr, Jun 11 Tue, Jun 9 Sun, Jun 7 Fri, Jun 5 Wed, Jun 3 Mon, Jun 1 Sat, May 30 Thr, May 28 Tue, May 26 Sun, May 24 Fri, May 22 Wed, May 20 Mon, May 18 Sat, May 16 Thr, May 14 Tue, May 12 Sun, May 10 Fri, May 8, 2020 Wed, May 6, 2020 Mon, May 4, 2020 Sat, May 2, 2020 Thu, Apr 30, 2020 Tue, Apr 28, 2020 Sun, Apr 26, 2020 Fri, Apr 24, 2020 Wed, Apr 22, 2020 Mon, Apr 20, 2020 Sat, Apr 18, 2020 Thu, Apr 16, 2020 Tue, Apr 14, 2020 Sun, Apr 12, 2020 Fri, Apr 10, 2020 Wed, Apr 8, 2020 Mon, Apr 6, 2020 Sat, Apr 4, 2020 Thu, Apr 2, 2020 Tue, Mar 31, 2020 Sun, Mar 29, 2020 Fri, Mar 27, 2020 Wed, Mar 25, 2020 Mon, Mar 23, 2020 Sat, Mar 21, 2020 Thu, Mar 19, 2020 Tue, Mar 17, 2020 25% 2 Sun, Mar 15, 2020 Relative Mobility of iOS Devices 22 0 PCOR1 PCOR2 GOVERNOR & STATE SURGEON PHYSICIAN ADVISORY GROUP Apple’s statement regarding user privacy, “This data is generated by counting the number of requests made to Apple Maps for directions in select countries/regions, subregions, and cities. Data that is sent from users’ devices to the Maps service is associated with random, rotating identifiers so Apple doesn’t have a profile of your movements and searches. The availability of data in a particular country/region, sub-region, or city is based on a number of factors, including minimum thresholds for direction requests per day.” June 27, 2020 Guam’s Mobility in Relationship with COVID-19 New Cases and Hospitalized 150% 10 Per Data Available as of June 27, 2020 140% 9 8 Guam COVID+ Hospitalized Guam New COVID+ (7-Day Avg) Guam Mobility Guam Mobility (14-Day Avg) 110% 100% Baseline 7 6 5 This anonymized mobility data is made available via Apple’s Mobility Trends Reports, which was created to provide insights into response to policies aimed at combating COVID-19. Google has a similar program for Android users called Community Mobility Reports. Guam is not included in their current data report. Data is based on a random sample of iOS devices (see privacy statement). This only serves as a sample representation of the public’s overall mobility. Data last accessed on June 9, 2020 at https:// www.apple.com/covid19/mobility. Sat, Jun 27 GG Pay Fri, Jun 26 Thr, Jun 25 Wed, Jun 24 Tue, Jun 23 Mon, Jun 22 Sun, Jun 21 Sat, Jun 20 Fri, Jun 19 Thr, Jun 18 Wed, Jun 17 Tue, Jun 16 Mon, Jun 15 Sun, Jun 14 Sat, Jun 13 GG Pay Fri, Jun 12 Thr, Jun 11 Wed, Jun 10 Tue, Jun 9 Mon, Jun 8 Sun, Jun 7 Sat, Jun 6 Fri, Jun 5 Thr, Jun 4 Wed, Jun 3 Tue, Jun 2 Mon, Jun 1 Sun, May 31 Sat, May 30 Thr, May 28 Wed, May 27 GG Pay Fri, May 29 Memorial Day Weekend Tue, May 26 Mon, May 25 Sun, May 24 Sat, May 23 0 Fri, May 22 50% Thr, May 21 1 Wed, May 20 60% Tue, May 19 2 Mon, May 18 70% Sun, May 17 3 Sat, May 16 80% GG Pay Fri, May 15 4 Thr, May 14 90% COVID-19 Cases 120% Wed, May 13 Relative Mobility of iOS Devices 130% June 8 Changes to Quarantine and Testing Requirements GOVERNOR & STATE SURGEON PHYSICIAN ADVISORY GROUP Apple’s statement regarding user privacy, “This data is generated by counting the number of requests made to Apple Maps for directions in select countries/regions, subregions, and cities. Data that is sent from users’ devices to the Maps service is associated with random, rotating identifiers so Apple doesn’t have a profile of your movements and searches. The availability of data in a particular country/region, sub-region, or city is based on a number of factors, including minimum thresholds for direction requests per day.” June 27, 2020 New Quarantine, Testing, and Monitoring Requirements for Travelers Entering Guam GOVERNOR & STATE SURGEON PHYSICIAN ADVISORY GROUP June 27, 2020 Testing is NOT required to board flight Residents S S Domestic & International Non-Hot Spot Arrivals International Hot Spot Arrivals FLIGHT Non-Residents ALL persons having originated from or traveled through international locations deemed to be “hot spots” shall be subject to 14-day quarantine at a GovGuam approved quarantine facility. R R U C P T RESIDENCY N E QUARANTINE E C O R (14-Day Mandatory for All) Testing is NOT required to board flight Residents Non-Residents 14-day quarantine at home residence allowed. No test required. 14-day quarantine at personal residence or rental lodging with negative PCR test within 1 week of arrival. Otherwise, will complete in GovGuam approved quarantine facility. GOVERNOR & STATE SURGEON A “Hot Spot” is defined as a country/location with COVID-19 case doubling rate less than every 30 days. A “Non-Hot Spot” location has a COVID-19 case doubling rate greater than or equal to every 30 days. Countries/locations hot spot status will PHYSICIAN ADVISORY ultimately be determined and updated by the Department of Public Health andGROUP Social Services in consultation with the Governor and State Surgeon’s Physician Advisory Group. Reference data sources from Johns Hopkins University, World Health Organization and other local government reports as compiled and regularly updated via The New York Times’ Coronavirus Map: Tracking the Global Outbreak at https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html June 27, 2020 New Policy for Travelers Entering Guam Due to the recent increase in COVID-19 cases on Guam and around the world, the following changes will be made to Quarantine, Testing, and Monitoring requirements for all travelers entering Guam, effective after midnight on Wednesday, July 1, 2020. 1. Hotspot locations will be renamed as “High Risk Areas” 2. For the US, risk status will be determined on a state-by-state level, to include territories. 3. The default level of quarantine required upon arrival on Guam is based on whether or not a traveler is coming from a High Risk Area. 4. A Pre-Arrival Negative PCR Test, in particular those traveling from a High Risk Area, is necessary to determine the location of quarantine required and eligibility to qualify for an abbreviated quarantine length. 5. Residency status will NOT determine the level of quarantine or testing required. Considerations for alternate quarantine locations will still be made in certain limited circumstances. GOVERNOR & STATE SURGEON 6. High Risk locations will be determined by a calculated COVID-19 PHYSICIAN ADVISORY GROUP Area Risk (CAR) score, which primarily assesses an area’s recently calculated Case Doubling Time and Test Positivity Rate. June 27, 2020 Originating From a COVID-19 High Risk Area? No Yes Negative PCR Test <72 hours prior to arrival on Guam? Yes Home/Self Quarantine No Government Facility Quarantine Those with Negative PCR Test within 72 hours prior to arrival on Guam may opt to repeat PCR test on Day 7 of Quarantine. Everyone else may opt to test on Day 10 (subject to testing availability). No Post-Arrival PCR Test Complete Full 14-Day Quarantine Negative Post-Arrival PCR Test Early Quarantine Release GOVERNOR & STATE SURGEON Must Fully Comply with 14 Days of PHYSICIAN ADVISORYSymptom GROUP Monitoring and Tracking June 27, 2020 High Risk States High Risk Asian/Pacific Countries Other High Risk Continents/Areas Alabama Nevada Bangladesh Africa Arizona North Carolina India Central America Arkansas Oklahoma Indonesia Middle East California Oregon Nepal South America Florida South Carolina Philippines Georgia Tennessee Idaho Texas GOVERNOR & STATE SURGEON UtahPHYSICIAN ADVISORY GROUP Mississippi June 27, 2020 End