In case the coronavirus might unknowingly be spreading in the islands, Hawaii hospitals are gathering backup emergency supplies, conducting drills and in some cases have already used isolation rooms for suspected COVID-19 cases that were quickly found to be the flu.

Hospitals have been operating somewhat in the dark because much is still unknown about the new coronavirus and diagnostic testing by the state laboratory was not possible until Friday, said Dr. Tarquin Collis, the chief of infectious diseases at Kaiser Permanente Hawaii.

“What’s unknown is how big a deal is this going to be,” he said.

Kaiser Permanente Hawaii held a drill with staff members this week to prepare for a potential coronavirus outbreak. Courtesy: Kaiser Permanente/2020

It could play out like a very bad flu season, where most people may recover at home. At worst, there could be a significant number of patients who need intensive care, which could stretch the state’s health system, he said.

“About 80% of people, judging by the Chinese experience, have mild infections and should not be coming to the hospital if we can avoid that,” Collis said.

Preparations hospitals made during the 2014 and 2015 Ebola scares bolstered their emergency protocols, doctors told Civil Beat. Now, it’s a matter of updating the action plan for COVID-19, which currently requires airborne disease precautions such as wearing N-95 masks and using rooms with negative air pressure.

On Thursday, Kaiser held a drill with nearly 100 staff, including nurses, doctors, transportation staff, check-in clerks and security personnel. A staff member arrived at the hospital’s Honolulu clinic and pretended to be a suspect case of the coronavirus.

“We’ve been doing this for years with Ebola,” he said. “It’s also to make sure our health care professionals are safe and to make sure they have their head in the game. This is what we signed up for, but it takes a bit of a leap and we want to give them confidence.”

Meanwhile, hospitals including The Queen’s Health Systems are reviewing their pandemic action plan with the state health department.

“Preparing for COVID-19 is a little bit more intense, in terms of the equipment and facilities,” said Dr. Julius Pham, Queen’s interim chief quality officer.

Getting Prepared

To date, there have been no cases of the new coronavirus, also known as COVID-19, confirmed in Hawaii. The Hawaii state laboratory verified its testing kits on Friday after a delay caused by one faulty ingredient that sabotaged earlier kits distributed by the U.S. Centers for Disease Control and Prevention.

Until Friday, no one in Hawaii had met the CDC’s criteria to be tested for the coronavirus. The first test Hawaii conducted Friday morning returned negative — a California health care worker who had tended to a patient later diagnosed with the coronavirus had the common cold, not COVID-19.

The new test kits enable Hawaii doctors to diagnose COVID-19 in 24 to 48 hours, according to DOH.

Hawaii receives federal funds from the Hospital Preparedness Program that funds supplies and extra emergency personnel, according to Hilton Raethel, president and CEO of the Healthcare Association of Hawaii.

Hilton Raethel, president and CEO of Healthcare Association of Hawaii, gave a tour of the organization’s emergency medical supply storage. Courtesy: Healthcare Association of Hawaii

His organization runs the Hawaii Healthcare Emergency Management coalition, a group of 160 health care organizations including hospitals, long-term care facilities, home health agencies and others. The state has extra masks, gowns, goggles, respirators and other personal protective equipment in the event that there’s an outbreak. Some of the state’s emergency supply of masks has already been tapped, though.

“There’s hyperawareness right now, but we are well prepared for different types of scenarios,” Raethel said.

He said a few organizations have seen a shortage of masks because supplies have been running low but backup supplies have filled the need.

Going forward, if someone in Hawaii is suspected by officials to have COVID-19 due to symptoms and travel history, they will be placed in precautionary isolation until a coronavirus diagnosis is confirmed or ruled out.

Ultimately the Hawaii Department of Health will need to determine which patients should be tested for the coronavirus.

The state has approximately 166 isolation rooms that could be used if necessary in the future, Lt. Gov. Josh Green said. Doors are sealed and air flow is controlled to prevent the spread of an infection.

“They receive their care in that room and individuals that go in and out would be provided with protective gear,” Green said.

Outbreak Protocol And Who Gets Tested

Testing criteria will evolve, but Hawaii and other states are following CDC standards that recommend testing patients who show suspect symptoms and recently traveled to high-risk areas or believe they have been exposed to someone infected.

Symptoms include fever, cough and shortness of breath.

On Thursday, the CDC updated the list of countries of concern for travel to include not only China but Iran, Italy, Japan, and South Korea.

Queens Hospital Mandatory temperature check area in lobby.
Because of a severe influenza season in Hawaii, hospitals like Queen’s Health Systems have mandatory temperature check procedures which help factor out potential coronavirus cases. Cory Lum/Civil Beat/2020

Pham said there have already been several patients who have gone to Queen’s concerned that they have the new coronavirus but many of them have instead tested positive for influenza.

The hospital is already caring for patients who potentially meet coronavirus infection criteria, he said.

“Folks are coming in on a pretty consistent basis,” Pham said. “We go through the process with them as if they were an exposed patient. We get the full history once we have them in isolation.”

Because this flu season in Hawaii is more severe than prior seasons and has surpassed national influenza rates, many hospitals including Kaiser and Queen’s are also conducting flu screenings among hospital visitors, which simultaneously weeds out potential coronavirus cases.

Travel Advisories And Self-Quarantine

As more travel advisories go into effect, the number of people in self-quarantine in the islands will fluctuate.

As of Thursday, there were 80 people who were instructed by public health officials to stay indoors for 14 days so they may monitor their health. Those people were instructed to self-quarantine because they had traveled to places that are dealing with coronavirus outbreaks.

Over the weekend, a Washington state man died from the virus and at least two new cases were confirmed in that area. Rhode Island also reported its first probable case.

On Friday, a second coronavirus case in California was confirmed in a person who had not traveled to places with ongoing outbreaks.

A map from the federal Centers for Disease Control and Prevention show the 56 countries where coronavirus cases have been confirmed since the outbreak began in December 2019. 

Those most vulnerable appear to be elderly patients. In China, fatality rates vary depending on the age group.

As of Friday, COVID-19 has been identified in 56 countries, infecting more than 83,000 people and taking the lives of more than 2,800.

Coronavirus ‘Inevitability’ In Hawaii

Federal health officials said it’s not a matter of if, but when the virus begins to affect communities throughout the U.S. and Collis echoed that sentiment.

“With Hawaii’s close ties to Japan and South Korea, to me it feels like an inevitability,” Collis said. “That’s just the nature of the current situation we are dealing with.”

The CDC has conducted fewer than 500 tests across the nation, 15 of which were confirmed. By comparison, South Korea, which is experiencing one of the most severe outbreaks outside of China, has conducted more than 30,000 tests, and the United Kingdom has tested close to 7,000 people.

Collis says testing in the U.S. has lagged slightly behind other countries because of quality control in addition to the delay caused by faulty testing kits.

“The reality is that there are regulations in our country that have to do with strict quality control of approved diagnostic tests for disease,” Collis said. “It’s awesome when we do get a test and we’re very confident in the specificity of the test, but it means it takes a long time to get on line.”

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