GOVERNOR Ralph DLG Torres on Monday assured community members that contact tracing personnel are doing their best so “please don’t panic.”
“I am relying on [a report] from the Covid task force, as well as contact tracing,” he added. “They will make the proper decision after that. Again, it’s important that our community understands [that they should] not…panic. We have good people, hardworking folks [doing] the contact tracing. They are doing what they are supposed to do. We don’t have to create a new protocol until they finalize their reporting. I cannot emphasize enough to all of our government employees, our private citizens, our business partners, that until you get a call from the contact tracing, you need to continue to [go] to work and live your life and continue with the 3 W’s [Wear a mask, Wash your hands, Watch your distance]. That is the critical part,” he said.
“I know that there are so many questions, concerns, uncertainties, but one thing that is important to know is that the contact tracing…employees [are] doing their best,” the governor reiterated.
New cases
Also on Monday, the Commonwealth Healthcare Corp. reported that six additional individuals had been confirmed positive for Covid-19. This brings the CNMI total to 318 cases since March 28, 2020.
“The individuals were identified and confirmed through surveillance testing Oct. 30, 31, and Nov. 1, 2021. The individuals have been isolated and are actively monitored,” CHCC said.
“Since Oct. 28, 2021, there have been 27 new cases, of which 19 were identified via contact tracing, 7 were identified via community testing, and 1 was identified via travel testing. Of the newly identified cases, 24/27 (89%) reported experiencing symptoms. A total of 2,505 Covid-19 tests have been conducted, which comprises travel testing and surveillance testing,” CHCC added.
Drastic change
Joining the governor in an online media conference on Monday were hhis chief of staff William “Wil” M. Castro, CNMI Covid-19 Task Force Chairman Warren Villagomez, CHCC Chief Executive Officer Esther L. Muna, CHCC public information officer Guillermo C. Lifoifoi, Pacific Island Health Officers’ Association regional clinical epidemiologist to the CNMI Stephanie Kern-Allely and community disease investigation inspector III Dwayne Davis.
Governor Torres said unless there is a drastic change reported by the contact tracing team, CHCC, and the CNMI Covid-19 Task Force, he does not anticipate shutting down the government or changing the Covid-19 protocols.
“The task force and the contact tracers doing their job in making sure that those that have been contacted and are positive [for Covid-19] are being brought in as [persons under investigation, or PUIs] and that they have been isolated. Again, we’re not going to go out there and say, ‘Continue to celebrate.’ What we’re saying is… continue [practicing] the 3 W’s. The [coronavirus is] not going to go anywhere, not any time soon, so we continue to vaccinate, we continue to practice our 3 W’s, [and] listen to the right information through the right media outlets,” the governor said.
“I know there are many [advisories] coming out left to right telling you to do this, do that, don’t do this, don’t do that. Again, we’ve been through this since day one. We have the right folks, the right professionals that truly care about the community. So, before making any drastic changes, we listen to the information [from the experts], and then we sit down like we’re doing today and plan… the best course of action,” the governor said.
Index case
CHCC reported that the index case, or the source of the recent community cases, has yet to be identified.
However, the contact tracing team continues to conduct an investigation into every lead identified in the contact tracing process.
“We’re currently underway in… trying to identify that source case. The farther we go back, the more that we are limited by the memories of our cases. If someone asked you what you were eating for dinner yesterday, that’s already hard. Now imagine being asked who saw on a Friday a month and a half ago. So, we’re getting a little limited by that,” epidemiologist Kern-Allely said.
“We have traced all the way back to the beginning of October…our current cluster. We’re continuing to move further and further back to try and identify as far back as we possibly can, knowing that infection resolves at some point…. We have to do our best with the information we’re getting out. That’s why we’re expanding our net slowly and surely to make sure that we’re identifying…many high-risk contacts…and identifying that index case as best we can. But so far, we’ve really pulled up the root. We’re really seeing the cluster from our index case identified mainly through school-based testing, so that’s really been successful.
“We see a gradual increase in cases over time. We are detecting them now on the 28th, 29th, 30th, and 31st. These are all mainly found through contact tracing, which really highlights the great work that our team has been doing, the importance of…back-tracking, and understanding that the cases are going to pop up a couple of weeks later…. We’re seeing really excellent contact tracing work, heavy lifting from our team here that have identified a majority of our cases and been able to link all of these cases together,” Kern-Allely added.
She said the evidence of transmission so far does not indicate an acceleration of transmission.
“Our curve does not indicate that currently. I think, very obviously, we have seen a lot of testing in the last couple of days. We have not been seeing our cases skyrocket. In fact, we’re seeing fewer cases identified each day. A bulk of our cases were identified on the 28th and 29th…. But there is no evidence so far of acceleration of transmission, likely tied to the high vaccination rate with a large number of immunized people in the community. [We] are able to get close to that herd immunity, which can help break the chain of transmission.”
As of Monday, there were 28 active cases with no links to Rota and Tinian: 27 of which were new cases identified on or after Thursday, Oct. 28.
24 of 27, or 89% of the new cases, were symptomatic, with the individuals reporting mild symptoms.
The mild symptoms of Covid-19 are fever, chills, shortness of breath, nausea, headache, vomiting, and loss of taste or smell.
Of the 27 new cases, 14 are males and 13 are females, with a majority from the 20 to 49-year-old age group.
Four males and four females are under 20 years of age, of whom six are ineligible to receive the Covid-19 vaccine.
Two of the new cases are eligible for vaccination but are unvaccinated.
“We’re getting a better picture of our cases,” CHCC CEO Muna said. “We’re trying to see how it all links together. Maybe it has no link at all. We want to be able to complete our testing and our studies…. This may not be the first or the last time that we’re going to have this, so we just want to make sure that we have a system in place,” she added.
School based screening
On Thursday, Oct. 28, the first case in the cluster was identified through routine school-based screening: a student at a middle school.
Contact tracing led to the identification of multiple instances of household transmission to family members and close acquaintances in multiple households.
The earliest onset of these cases linked to this cluster was Thursday, Oct. 7. To date, there are a total of 12 cases for this cluster, all of whom are household contacts to another case in the cluster and are now in isolation at Kanoa Resort.
Close contacts were identified at the school, workplaces, households, and they, along with their guardians, are in quarantine at Kanoa Resort.
The first day of the five-day test-out for this first cluster is today, Tuesday, November 2.
A second cluster was identified on Thursday, Oct. 28, and the first case in that cluster was identified through routine school-based screening as well: a staff member at a middle school.
Contact tracing led to the identification of household transmission to family members in two different households and workplace transmission.
The earliest onset of these cases linked to this cluster was Wednesday, Oct. 20.
To date, there are a total of 9 cases from this cluster, all of whom are household contacts to another case in the cluster and they are in isolation at Kanoa Resort.
Two of these cases were workplace contacts to each other.
Close contacts were also identified at the school, workplaces, and households, and they, and their guardians are in quarantine at Kanoa Resort.
The first day of five-day test-out for this second cluster is also today, Tuesday, November 2.
There are a total of five unlinked community cases that were unlinked to the two clusters, but are subject to change depending on the course of the investigation.
Two of these five cases are household contacts to each other, with the first case identified on Friday, October 29 and the other on Sunday, October 31.
Another two are household contacts to each other, with the first case identified on Monday, November 1.
There are two active border cases currently in quarantine, one of which was identified on Saturday, October 23 and the other on Friday, October 29.
Prayers
“To the families that have contracted [Covid-19], we are praying for you,” the governor said. Those that are [persons under investigation], please continue to practice the three W’s. I know that some of them are in quarantine. But to the family members and to the community, continue to practice the three W’s and follow…the right [messaging] and the right media. We have the right media partners. They disseminate the appropriate information. Let’s believe in those messages and information,” the governor added.
“The team is working really hard in tracing the contacts. If you are called in, please share all the information that you can. Hiding information will not help anyone. It’s actually going to worsen the process and the people that you’re trying to save — you’re not actually helping at all.”
Governor Torres thanked CEO Muna and the contact tracing team for working day in and day out to find the index case of the recent community cases.
CHCC PIO Lifoifoi said the media and the community will be informed once the contact tracing investigation is completed.
“Contact tracing will continue until all leads are investigated,” he said, noting that persons will only be called by the contact tracing team if deemed a person of interest in the investigation.
Testing
CHCC reported that as of Monday, there had been a total of 2,505 total tests since Thursday, October 28.
“We are still at a low transmission,” CHCC CEO Muna said. “What we have done and what we continue to do since the beginning is that we do have testing for close contacts, which is basically [what] the contact tracers [are] doing now. They’ve been identifying those cases.”
She added, “We are also looking at…community-based testing. We have all these testing strategies that are in place, beyond even the fact whether it’s a low transmission. We don’t want to get to moderate or substantial transmission within this community…. We are grateful for what we’re seeing so far.”
The U.S. Centers for Disease Control and Prevention recommends that a low transmission test only symptomatic individuals, she added.
Epidemiologist Kern-Allely, for her part, said, “We have a couple of different data sources that are useful for us to look at in order to monitor the ‘heartbeat’ of this infection in the community. One of those is testing. We want to make sure that we are testing enough people and that we are testing a wide variety of people, as well as being able to target our testing to our highest-risk group. We don’t want to be testing ‘willy nilly’ all the time. One of the things that is very critical is making sure that we have targeted testing and testing availability for our community to access should they need it.”
“We also have syndromic surveillance in place here in the CNMI to monitor how often we see people showing up in the ER or clinics with Covid-like illness…. If we do see a spike in that, we can get that underlying ‘heartbeat’ on what’s going on in the community that might be going undetected. As we all know, Covid-19 can be frequently asymptomatic, and so even though folks are not showing symptoms, they may have a family member who does and we can find those cases that way, through making sure that people are able to access those,” she added.
“I think that the key test that kicked it all off was school-based testing, which has shown to be a pretty big success, I think, in being able to help us identify quickly and help our teams quickly reach cases… So far, we’re seeing a pretty low positivity rate by day, currently. We’re having a really high turnout. Our community is very engaged in getting tested. We’re seeing lots of tests and not a lot of cases, which is an excellent sign for us, but we’re not testing everyone every single day, so we’re still trying to reach as many people as we can.”
Testing is available at Kanoa Resort as well as at CHCC clinics.
Those who feel Covid-like symptoms are encouraged to see their health providers and to monitor their symptoms.
Vaccination
CHCC CEO Muna said the CNMI saw an increase in vaccinations on Friday and Saturday.
“We’ve never seen that number before in a very long time, so it’s good to see everyone out there getting booster shots and getting their first shot…. If you haven’t been vaccinated, do vaccinate. Get the vaccine. Get your booster shot if you’re due for one,” she said.
Booster shots are available six months after a Pfizer/BioNTech or Moderna dosage and two months after a Johnson & Johnson/Janssen dosage.
“Multiple studies have shown that antibody levels are associated with protection in the community and individual antibody levels vary, so this why it is important [to get vaccinated]… That is key… Having a community level of vaccination is important… Getting vaccinated, again, fulfills our public health goal of reducing the risk of infection, severe illness and death,” Muna said.
“Your best defense is vaccination and masking up… You can enjoy getting together with others. That’s fine, but again, vaccination [is important]. That’s one of the reasons why we’re rolling it out and we’re looking forward to getting the decision from the CDC about vaccination for 5 to 11-year-olds…. We’ve talked to [the Public School System] and we’re going to work with them to roll it out with them as smoothly and as quickly as possible.”
Governor Torres, for his part, said, “I know that we all want to get tested, but more importantly, at this point, [get] vaccinated. I can’t emphasize that [enough]. Get vaccinated…. Those that have not been vaccinated, again, we encourage you and your family and your loved ones to go and get vaccinated because that will help the community.”
“With the system that we have, in the future, we may not shut down the whole school,” he added. “We may just bring in the individual in the classroom, maybe just the classroom, shut down just the classroom. Again, it’s important to understand how much effort we’re putting into having our students, our kids get vaccinated. It’s not just protecting the community but individually. Hopefully by the next week, we will have an opportunity to vaccinate even [kids of] younger age.”
CNMI Covid-19 task Force Chairman Villagomez said, “Let’s make it a holistic community effort. Make it a win-win. Let’s ask ourselves, ask our loved ones [if] they’re vaccinated. If not, please convince them to get vaccinated.”
CEO Muna said quarantine protocols will be assessed upon the conclusion of the contract tracing investigation into the recent community cases.
Ralph DLG Torres
