Pago Pago, AMERICAN SAMOA — LBJ Medical Center has completed the Preliminary COVID-19 Mortality Analysis since the COVID surge began in American Samoa and among its finding, is that 75% of individuals who succumbed to COVID related deaths were in poor health prior to their COVID-19 infection.

LBJ’s acting chief of staff, Dr. Akapusi Ledua presented the analysis during Monday’s COVID-19 Task Force virtual news conference, and the analysis received support of federal partners including U.S Centers for Disease Control and Prevention (CDC). 

Dr. Ledua explained that the purpose of the evaluation is look at the characteristics of deceased and hospitalized patients with COVID-19 in American Samoa. Furthermore, determining  common characteristics of those who died of COVID-19 will enhance response activities and community messaging.

“It is also to guide efforts to improve inpatient management of those infected with COVID-19,” he said and summarized the method used in the review and analysis, which was done through reviews of those who died of COVID-19, reviewing their charts in the electronic health records, verification of their vaccination status taken from the data base and the analysis was done using Excel.

The analysis reviewed the first 27 COVID-related deaths, since the beginning of the COVID community surge and the median age for those who died was 73-years old and ranged from 29 to 93 years old. And 52% of the deaths were female and 48% were males.

Data presented by Dr. Ledua looks at the “contribution of the COVID-19 to the death”. And LBJ categorized the deaths according to:

 •          Primary — patient developed and died due to COVID-19 related respiratory failure and died mainly from COVID-19 pneumonia;

•           Contributory — patient died from other causes with COVID-19 as a secondary cause (e.g. hypercoagulability);

•           Minimal — Patient who died from other causes that likely was precipitated by COVID-19 infection; and

•           Possible — Patient died at home, with little or no history of illness but tested positive for COVID-19.

Based on the data presented, Dr. Ledua pointed out that “30% of the deaths” — or 8 deaths —  were related to COVID pneumonia and the other 70% were either contributory (with 37% or 10 deaths), minimal (with 15% or 4 deaths), or possible (19% or five deaths) contributed by COVID-19/

On the vaccination status, LBJ data shows that six had no vaccination; two incomplete vaccination - meaning only one dose; 15 had full vaccination but not boosted and 4 were fully vaccinated and boosted.

For the “Primary” COVID related deaths — patients who died from COVID pneumonia, Dr. Ledua points out that four of them were not vaccinated and 4 were fully vaccinated but not boosted.

LBJ data on COVID related deaths by age group and vaccination status, Dr. Ledua said that most of the deaths occurred in the age group 61 to 90 years old and most of the deaths were fully vaccinated with no booster, within that age group.

The morbidity analysis also reviewed “prior health status” of the those who died and the results were that 78% or 21 fatalities, had “poor health status” — e.g. bedridden, refusing dialysis, multiple poorly managed medical problems; 22% or six had “moderate health status” — referring to patients who had other pre-existing conditions (past heart attack, heart surgery, morbid obesity); and zero — Healthy: and none of the deceased had little to no past medical history, according to Dr. Ledua.

On “pre-existing conditions” that resulted in COVID deaths, LBJ data shows that 81% had heart disease; 44% were diabetics; 30% had chronic kidney diseases; 26% with pulmonary disease; 22% disability; 19% with end-stage renal diseases — dialysis; 7% with cancer; and 7% with liver disease.

LBJ also provided data on the locations of the deaths, with 10 of them dead on arrival (DOA) at the hospital — or patients who passed away at home and were brought to the hospital; one died in the emergency room; one passed away at the COVID tent; 4 at the COVID cohort ward; 9 at the COVID ward; and two at the non-COVID ward.

Dr. Ledua explained that the two who passed away at the non-COVID ward, are the patients who initially tested positive and then tested negative after a few days and were moved on to the non-COVID ward where they passed away, but their death is still regarded as a COVID related death.

FINDINGS

Dr. Ledua presented seven findings at the conclusion of the analysis. In the deaths that were primarily due to COVID, those who died of COVID-pneumonia, 50% of them had no vaccination and no COVID-pneumonia death occurred in a boosted individual. Other findings by LBJ analysis:

•           Unvaccinated people aged 5 years and older had a 32 times higher risk of dying compared to those who were boosted.

•           Most deaths occurred in older people with a median age of 73 years old.

•           In the deaths of people under the age of 50, most were morbidly obese with an average Body Mass Index of 50 for that age group;

•           75% of those who died were in poor health condition prior to their COVID-19 infection, with 88% having some form of heart disease;

•           40% of all deaths were dead on arrival, but this trend has seemed to slow over the past few weeks.

•           Only 26% of the deaths received early COVID-19 therapy and treatment.

Dr. Ledua noted that the other important thing that has come out of the analysis was the premorbid conditions — and this was the prior health status of those who died after being infected with COVID-19.

He said this is an issue and a problem that needs to be solved by primary and preventative healthcare, as well as assistance of every member of the community from individuals to healthcare facilities and healthcare personnel.