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FEMA predicted over 3,000 cases by May 9 — how the NMI is avoiding disaster

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THE Commonwealth was projected to reach 3,676 cases of Covid-19 by last Saturday, May 9 according a model distributed by the Federal Emergency Management Agency in early April.

Around 150 of those cases would require hospitalization, severely overwhelming Commonwealth Healthcare Corp.’s 75-bed facility and even surpassing the Department of Defense’s 50-bed pop-up hospital. The CNMI’s peak was pegged for Wednesday after next. On May 20, the number of sick would reach 6.500, with 470 cases serious enough to require hospitalization. At the time of the model’s distribution, there were only 50 open hospital beds in the CNMI.

Using Covid-19’s mortality rate in the continental United States — 5.8% — the Commonwealth would be expected to suffer about 377 casualties if the model held true. Before the crisis, CHCC’s morgue capacity was limited to 40 deceased. With the help of the Governor’s Covid-19 Task Force, CHCC has since raised morgue capacity to 238 which, despite being an impressive 600% increase, would still leave 139 bodies unplaced.

“We would have to use the refrigerated truck,” said Dr. John Doyle of Marianas Medical Center. “It would be horrendous.”

And there’s reason to believe the death rate would potentially be higher in the Northern Marianas; the CNMI’s healthcare system has to work harder to access emergency equipment and supplies due to its remote location. The local community also suffers disproportionally from pre-existing diseases.

CHCC CEO Ester Muna said the CNMI population exhibits a “high incidence” of diabetes and hypertension.

“For an island of our size, we have a huge population on dialysis,” she added.

Dr. Doyle said that individuals with pre-existing illnesses “tend to be more severely ill and in much, much greater danger when they come in, just for the very fact that they've got so many concomitant [diseases].”

“So to the extent that Covid-19 does manage to penetrate the CNMI, our exposure will most likely end in worse results than it does in other places,” he concluded.

Yet as of May 14, the CNMI had confirmed only 19 cases of Covid-19. How did the Commonwealth manage to avoid the doomsday scenario that FEMA’s model predicted?

According to several healthcare professionals, the model was created under the assumption that the CNMI’s Covid-19 mitigation efforts began on April 6 when the Commonwealth government arranged for the suspension of flights between Guam and Saipan. However, true mitigation efforts began much earlier. In fact, the CNMI was one of the fastest responders in the world.

“I would say we were less exposed because of that early response,” said Dr. Shafransky, safety officer of CHCC’s Infection Control Committee “It really is the only thing that seems to prevent the spread of the disease.”

In fact, Dr. Doyle said mitigation effort started so early on Saipan that the CNMI constitutes “a statistical anomaly,” confounding any data-driven prediction of the islands’ future.

According to Press Secretary Kevin Bautista, the CNMI’s protective efforts began in January. Government officials had already established surveillance and health screening procedures at the Francisco C. Ada/Saipan International Airport in response to a measles outbreak in Samoa and other Pacific islands. As news of the “new coronavirus” began to stream in, those surveillance procedures were redirected toward travelers arriving from affected areas of China.

Bautista said coronavirus screening officially started on Jan. 20, making the CNMI “the first U.S. state or territory to take local preventative action” against the disease.

CEO Muna said at that time, she and other CHCC staffers had made a habit of waking up at 3 a.m. to discuss proper mitigation procedures with continental U.S.-based officials at the Center for Disease Control and Prevention.

“We knew we were at risk,” she told Variety. “It’s easier for anyone from China to travel to the Commonwealth…there’s less restriction because of the visa.”

CHCC sent a sample taken from a patient under investigation or PUI to a laboratory in Georgia in late January. The sample, which came back negative, was the first incidence of coronavirus testing in the U.S.-affiliated Pacific Islands.

On Jan. 29, Gov. Ralph DLG Torres took measures a step further by signing an executive order requesting that the Commonwealth Ports Authority collaborate with the U.S. Department of Transportation, U.S. Federal Aviation Administration, U.S. Department of Homeland Security, and international airlines to “suspend travelers from mainland China arriving directly and indirectly into the CNMI.”

“Public health is our priority, and safety and security of our people will take precedence over anything else,” Governor Torres said at the time. This order, doomed to cripple the Commonwealth’s tourism-based economy, was signed 59 days before the CNMI would confirm its first case.

“He, with just the stroke of a pen, probably saved four to five hundred lives,” Dr. Doyle reflected. “And I say that conservatively.”

According to Bautista, the executive order also “sent shockwaves” through the federal agencies involved. The Commonwealth was the first of any U.S. state or territory to make a request of that nature, and Governor Torres immediately received a stream of phone calls from Washington, D.C.; federal officials were anxious to learn more about the CNMI’s emergency quarantine measures.

The next day, Jan. 30, the World Health Organization declared the Covid-19 outbreak a “Public Health Emergency of International Concern.”

And on Jan. 31, the Trump administration released its own proclamation, suspending entrance into the United States by non-U.S. citizens who recently traveled through China.

February was a blur of disease and prevention. In China, infection rates skyrocketed and thousands died. South Korea declared a red alert. Italy shut down schools. The Dow dropped 1,000 points.

On Saipan, the CNMI’s healthcare sector mobilized as its economy crumbled. CHCC obtained 23 additional ventilators (for a total of 41), sought alternative care sites, and arranged for the arrival of six additional critical care nurses and the DoD’s 50-bed healthcare facility.

Guam confirmed its first three cases of Covid-19 on March 15, shortly after initiating its own Covid-19 screenings at Antonio B. Won Pat International Airport. The next day, Dr. Doyle and a handful of medical professionals signed a letter warning Governor Torres of the dire threat facing the CNMI by providing some predictions of their own:

“If we were fortunate enough to limit our exposure to 10% of the population, that would be about 4,500 cases,” they wrote. “20% will have complications. That puts us at 900 cases that are potentially more serious…we do not have 900 ventilators, nor does anywhere else for that matter.”

The doctors requested that the CNMI shut down its schools indefinitely. Government offices had just been closed, but classes were only temporarily suspended pending a Board of Education meeting later in the week. The doctors also recommended curbing unnecessary travel, prohibiting large gatherings of people, and increasing testing.

“Components of the letter were absorbed into the governor’s overall action plan, which has driven the policies and decisions of the taskforce in coordination with CHCC,” Press Secretary Bautista said. “What was reassuring was that the advice that the doctors gave the Governor was in line with what was being said by CHCC.”

On March 17, Governor Torres declared a State of Public Health Emergency in the CNMI (Guam would follow suit five days later), suspending classes through April 1, shutting down all government offices and all non-essential government functions for two weeks (these actions have been consistently renewed), and prohibiting gatherings of over 50 people.

He and Dr. Doyle explained the threat of the pandemic and the importance of social distancing on KKMP radio the following day.

“The less we leave our houses, the better our chances that we’ll overcome this virus,” the governor said. “This is a community effort.”

“He listens to people,” Dr. Doyle said of the governor.

“I laughed with him at the time,” he added. “I said I wouldn’t trade places with you right now for one million dollars.”

During the third week of March, the CNMI set a 7 p.m. curfew for minors. Business hours were limited and all CNMI arrivals were required to quarantine at Kanoa Resort or the Pacific Islands Club for 14 days. Public parks were closed, and gatherings on the beach were prohibited.

By March 27, the U.S. had confirmed 100,000 cases of Covid-19. China’s numbers still hovered around 80,000. Korea had almost 10,000 cases, and Guam had 45, not including the three reported cases aboard the USS Theodore Roosevelt, which had just arrived that day (on May 1, the Navy offered a “final report” that 1,102 crew members tested positive). 

The CNMI discovered its first two cases on March 28; allegedly a couple of ministers were infected after traveling through the Philippines and Guam. They returned before the new social distancing orders, and had already held a religious gathering.

“When our first case started, it should have exploded,” said Dr. Doyle. “But it had no place to go because we were already shutting down.”

Governor Torres extended curfew hours to all adults on the 29th. The next day, the first CNMI resident succumbed to Covid-19, though it would take days for testing and contact tracing results to confirm that he had contracted the disease and been in contact with the first two cases.

On March 31, government officials announced that United Airlines flights into and out of the CNMI would be cancelled beginning April 6, the starting date used in FEMA’s original model.

FEMA released a new model on April 20 which attempted to adjust for the CNMI’s early start. The CNMI’s new peak is projected to occur in mid-June, with total cases adding up to 2,500, though FEMA clarified that even the new model lacks “predictive power greater than 2-4 weeks.” Using the same approximate hospitalization rate as in the first model, this would mean the CNMI will need around 180 beds, and 85 spaces in the morgue.

And yet the CNMI’s 19 confirmed cases of Covid-19 remains far below the projections of even this latest model, which predicts we’ll rack up about 250 infected individuals in the next few days. Only four new cases have been confirmed in the past two weeks, despite the several thousand people who signed up for community-based testing since it became available on April 28.

But Dr. Doyle warned that the threat of an outbreak is still present.

“With the contagiousness of this disease and the variance of this virus, all it takes is a few cases,” he said. “We have no right or reason to feel secure until this thing has been beaten down.”

“Our biggest threat is people becoming complacent because it’s working…. There’s a huge difference between ‘it’s working’ and ‘it worked.’”

 

November 2020 pssnewsletter

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