Palau had no reported evidence of COVID-19 community spread until January 2022. We chart reviewed hospitalized patients who had a positive SARS-CoV-2 test result during early community transmission. Booster vaccinations and early outpatient treatment decreased hospitalizations. Inadequate hospital infection control practices contributed to iatrogenic COVID-19 and preventable deaths.
Keywords: COVID-19; Pacific islands; Palau; SARS-CoV-2; communicable diseases; early transmission; global health; hospitalized patients; patient characteristics; respiratory infections; zoonoses.