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Dr. Sarah Park is Hawaii’s disease detective in chief, a job that has her directing Hawaii’s public health response to the new coronavirus.
As the state epidemiologist, Park is responsible for investigating the cause of COVID-19 infections in the islands, mapping how the disease spreads, promoting prevention methods and making decisions about who gets tested. She is the top health advisor to Hawaii’s governor and county mayors.
In the race to track the virus, Park relies on a combination of cutting edge data analytics and old-fashioned shoe-leather reporting. She’s well-versed in the techniques, particularly from her own experience working on the front lines of global outbreaks when she was on the world’s leading team of disease sleuths.
A self-described germaphobe, Park has probed everything from outbreaks of measles and mumps to cases of rat lungworm disease and leptospirosis. She even spent a month in Taiwan scrutinizing the 2003 outbreak of SARS, a relative of the current coronavirus.
But she never met a disease that made her worry — not until the new coronavirus invaded Hawaii.
“Unfortunately I think we’re looking at COVID-19 being a part of our lives for probably the next few years at the very least,” Park said. “I keep hearing people saying, ‘OK, we just have to make it to April 30.’ Well, I look well beyond April 30 and to me, it’s not a normal world. It’s going to be a new normal — that’s what I’m advising.”
As she choreographs Hawaii’s top team of disease busters, Park has become the center of controversy. Critics say she has led us down the wrong path in a number of ways — testing, accessibility to data, even her personality gets in the way.
Supporters say she is just the right person for the job and has the credentials to prove it. But she is being undermined in many ways, they say.
For this story, Civil Beat interviewed 15 people and researched Park’s record over the 15 years she’s been in Hawaii. Some people would only speak to us if we didn’t identify them because they feared losing their jobs and because they didn’t want to be seen as divisive at a time they feel it’s necessary to be unified in the response effort.
Park is a pediatric infectious disease specialist and practicing physician who formerly served as an officer for the Epidemic Intelligence Service, an arm of the federal Centers for Disease Control and Prevention. The EIS is an elite team of detectives that probe medical mysteries and public health emergencies around the world. Doctors in the EIS are responsible for discovering the deadly Ebola virus, linking tampon use to toxic shock syndrome and eradicating smallpox in Africa.
Park was an EIS officer assigned to the respiratory diseases branch in the CDC’s National Center for Infectious Diseases in 2002 when the West Nile virus was sweeping the nation for the first time. She also traveled to Taiwan for a month-long investigation of the 2003 SARS outbreak that led the country to screen incoming travelers, lock down medical facilities and mandate that people wear face masks in public buildings.
A graduate of Massachusetts Institute of Technology and Boston University School of Medicine, Park arrived in Hawaii in August 2004 when her predecessor, Dr. Paul Effler, recruited her for the state’s deputy epidemiologist job. Four years later, Park took over as Hawaii’s top epidemiologist in time to lead the state’s public health response to the deadly H1N1 pandemic that killed 13 and sickened more than 2,200 people in 2009.
In her dozen years as Hawaii’s top epidemiologist, Park has investigated the first case of brain damage linked to the Zika virus in the U.S., cracked the case of the fatal fat-burning supplement that sent 29 people into liver failure and choreographed a response to the Hepatitis A outbreak caused by tainted scallops served at Genki Sushi restaurants.
“I feel honestly quite heartened that she’s at the helm because I’ve seen her at work and she’s very steady.” — Dr. Alan Katz, University of Hawaii
Now as she addresses the coronavirus, Park’s strong CDC training shapes her thinking including her decision to test only people with symptoms, a CDC recommendation but one that has created much debate among medical professionals. She also relies on the real-time advice of CDC experts and the experiences of other state epidemiologists whom she conferences with on daily phone calls.
The network of public health experts with whom she confers is bolstered by her connection to the Council of State and Territorial Epidemiologists. The CSTE promotes the use of data to guide public health policy and advises federal public health agencies including the CDC.
Park is the organizations’s vice president and former president.
“I feel honestly quite heartened that she’s at the helm because I’ve seen her at work and she’s very steady,” said Dr. Alan Katz, an epidemiology professor at the University of Hawaii. “She knows what she needs to do, she’s assertive and she pushes through. She’s tireless. And she’s incredibly dedicated.”
But not everyone who has witnessed Park’s management or worked closely with her agrees.
In 2017, a state audit found that the Hawaii Health Department’s Disease Outbreak Control Division, under Park’s leadership, did not have a formal communications plan to share news and guidance on disease outbreaks with the public. It also uncovered poor information-sharing practices between the division and other arms of the health department, as well as outside agency officials.
The result, according to the audit, was confusion, discord and delayed or duplicated efforts in the division’s work to halt the spread of disease in the islands.
Criticisms of Park and her coronavirus response echo the audit’s findings. Several people interviewed by Civil Beat said Park is whip-smart, unflappable and devoted to her work, but also insular in her decision-making, dismissive of differing opinions and, at times, condescending.
“I think somewhat there’s an attitude of ‘You’re all amateurs,’” said Dr. David Derauf, a physician and executive director of Kokua Kalihi Valley Comprehensive Family Services. “I think that, you know, she’s the professional here. This is her kuleana. This is her program. And she’s a highly intelligent person. But it’s bigger than one person right now. No one person can do this.”
Park’s conservative approach to testing has come under fire, although it is based on CDC guidance to not test people who are asymptomatic or have only mild symptoms and can recover at home in isolation. This policy aims to preserve test kits and personal protective equipment that might be needed should the outbreak worsen, she has said.
Many Hawaii doctors say she’s wrong.
“I think it’s fair to say that (Park) probably might be the only individual in the state that has that view,” said Dr. Scott Miscovich, who has conducted dozens of drive-thru testing operations with volunteer medical workers across the state. “It’s so opposed to what the world experts are saying that I would classify it as medieval.”
Doctors like Miscovich who want more screening say it’s hard to measure the scope of infection in Hawaii under such narrow testing criteria when the most current research shows that most people infected with COVID-19 have mild symptoms or no symptoms at all.
U.S. Rep. Tulsi Gabbard went so far as to call on Park and her boss, Health Department Director Bruce Anderson, to resign for putting Hawaii residents in “grave danger” over their “refusal to carry out” an effective policy on testing and for poorly managing residents under home isolation.
Park, who in an interview with Civil Beat declined to address criticism of her directly, said she would like to be in a position to widen testing guidelines — if the state had a ready supply of test kits and PPE and if the legal limitations on testing weren’t so stringent.
The federal Food and Drug Administration authorizes clinicians to test people for the coronavirus only if they have symptoms. That, Park said, is a legal requirement she cannot break.
In any case, Park said more testing won’t necessarily make Hawaii a safer place.
“No amount of testing is going to stop the infection but social distancing will stop the infection, and so that’s what I advise,” Park said.
The guidance Park gives is not always heeded.
On Kauai — where people are prohibited from leaving their homes for eight hours each night and highway checkpoints operated by the National Guard and police aim to discourage nonessential road travel during the day — Mayor Derek Kawakami said his own district health officer has more influence on his decisions although she is in communication with Park.
Kawakami wants access to more public health data from Park. He’s frustrated by federal patient privacy laws that state health department officials say prevent them from sharing the names and locations of the people who test positive on Kauai.
“I feel that I have a better connection with people that may be affected, that I could get on the phone and talk to them,” he said.
But Kawakami commended Park for her steady, consistent guidance in the throes of a crisis full of unknowns.
“I’ve watched all the criticism that she’s been taking and I just don’t know everything that she’s dealing with but her ability to not waver, that’s something that’s admirable,” Kawakami said. “Not once have I ever heard her complain about how she’s being treated.”
Big Island Mayor Harry Kim said he was sharp with Park during a meeting in Honolulu on Jan. 30. He wanted to discuss what he could do as mayor to prepare for a disease outbreak that seemed all but inevitable. He said he felt like he hadn’t been properly counseled on where to start.
“Here is this local yokel mayor from the Big Island coming over to Honolulu almost literally lecturing, pleading, that we’ve got to do certain things to stay on top of this,” Kim said. “There are a lot of people you talk to like that, especially someone in her position, where the relationship doesn’t begin good and it ends worse.”
But Park, he said, did not get defensive. And she has since held steady in her guidance on what Kim can do to join the coronavirus fight.
Hawaii County was reluctant to shut down businesses including restaurants and was the last to impose stay-at-home, work-from-home orders, drawing widespread criticism from residents.
“With all the emotion that’s going on, fear and politics, I credit her for staying strong in what she believes,” Kim said.
His biggest concern is that Park’s team has sometimes been too slow to respond to him and his staff when they seek advice.
Park concedes that sometimes things get chaotic in her office. Chronic understaffing has been a problem. The Disease Outbreak Control Division has 64 positions, of which there are 16 vacancies including the senior-level job of investigation branch chief and several administrative positions.
A rotating roster of about 35 unpaid volunteers are helping to fill in the gaps in manpower.
“It’s a lot of different pieces and it looks a bit like Frankenstein,” Park said.
During the early weeks of the coronavirus outbreak in Hawaii, Park was frequently a central player at press conferences, on television news specials and in appearances before legislative committees. But more recently she’s been out of sight. Anderson, the DOH director, and Lt. Gov. Josh Green, a doctor who has been openly critical of the DOH testing effort in particular, have fielded most of the questions about the virus response.
“She’s being ignored and sidelined,” according to one person who is directly involved in Hawaii’s COVID-19 response. “In many cases she’s not even being invited to take part in policy discussions.”
On April 2, seated at Gov. David Ige’s side, Park went on Facebook Live for an interactive discussion about the state’s public health response to COVID-19. One viewer asked whether she would advise ordering residents to wear face masks in public.
Park said she wouldn’t, mainly because there’s no data to show that mask-wearing by people who are not health care workers provides any protection from coronavirus.
But three hours later, Honolulu Mayor Kirk Caldwell used a press conference to make a “very, very strong recommendation” that everyone on Oahu should wear a mask outdoors. He has since made it mandatory to wear a mask when entering pharmacies, grocery stores and other essential businesses and has suggested he may keep that policy in place for a long time.
Caldwell’s policy undermined Park’s stance on masks and is one of several examples in which political leaders seem to be making important public health policy decisions without following Park’s guidance.
Park told Civil Beat she is not always consulted on big policy decisions. It’s her job to provide Hawaii’s political leadership with public health guidance, but how they shape it into policy is up to them, she said.
“What I have been repeatedly saying is, ‘Social distancing is the key to stopping the spread,’” Park said, adding that it will also be key to preventing positive COVID-19 cases from spiking to unmanageable levels when the disease is inevitably reintroduced to the islands in future waves.
“But it’s up to the leadership to decide how they are going to implement social distancing. Some of the measures that were put in place were better than others.”
Park said she did not recommend that county mayors attempt to fight the virus with nightly curfews or driving bans, as Caldwell and Maui Mayor Michael Victorino imposed. And when pressed by a reporter, Park couldn’t cite a single public health justification for Honolulu’s Easter weekend ban on driving between the hours of 11 p.m. and 5 a.m. or Kauai’s 9 p.m. curfew, which has been in effect since March 20.
“Things like curfews, those measures are being put in place because our leaders are perceiving that there needs to be more done in terms of encouraging social distancing,” Park said. “That’s how I interpret it.”
Park’s guidance, including dismissing the use of face coverings, is based on her own experience and the experiences of other state epidemiologists, as well as CDC experts, whom she confers with weekly if not daily. Her recommendations also fit inside the CDC guidelines, which, in some cases, have changed.
“She’s toeing the line for the CDC,” said Dr. DeWolfe Miller, an infectious disease epidemiologist and former University of Hawaii professor. “Things that people may be grumbling about are a lot of things that she may not have any control about.”
So far, Hawaii seems to be keeping its coronavirus infection rate under control, and Park’s supporters say it shows that she has been handling the crisis correctly from the beginning.
In talks with Hawaii’s political leaders, Park has been beating the drum on the importance of social distancing since January. And there’s evidence that it’s working.
There are still new COVID-19 cases popping up and 12 people have died. But the new cases are fewer in number and elected officials are starting to focus on what needs to be done to get people back to work and the economy bustling again.
“We’ll get out of this first wave, but I think everyone needs to understand there will be other waves,” Park said. “The work that we do now as a community will determine how we are able to manage those subsequent waves and whether those subsequent waves will be very big.”
Going forward, Park said many features of public life in Hawaii will need to shift.
Reopening schools will be tricky, she said, because not enough is known about the role of children in spreading COVID-19. New controls will need to be introduced to slow down the spread of disease if it’s introduced into a classroom environment.
Employers need to think about how they can encourage people to work from home, where possible. They’ll need to improve sick leave policies and consider new provisions to allow employees to work virtually when they are sick but wish to work and feel well enough to be productive.
Some social distancing measures will be part of the new normal, Park said. So will frequent hand washing and sanitizing surfaces.
If you’re sick, it will be imperative that you stay home and keep your germs to yourself. Even as the state wrestles with a pandemic there are some people who are not doing this, Park said.
Even if we do all this, Park said we may face new crises caused not by the coronavirus, but by our response to it.
“The great tragedy would be that if we survive the pandemic but do not have good enough plans to get us out of this pandemic,” Park said, “and if, on the other side of it, we’re OK in regards to cases related to the pandemic — but we come out with a chronic disease crisis and economic collapse.”
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