As Hawaii’s public health officials announced a record 355 new COVID-19 cases amid mounting criticism for their failure to execute the stated plan for controlling the virus, a new face emerged to assure a concerned public that the department was making changes to address a virus that appears to be spiraling out of control.
Instead of Bruce Anderson, who has been the most visible as the director of the Hawaii Department of Health, the public heard from Danette Wong Tomiyasu, a deputy director who will help oversee investigations. Also absent was Dr. Sarah Park, the state epidemiologist, who has become a focal point for criticism.
Gov. David Ige said Tomiyasu and a recently hired investigations branch chief, Emily Roberson, now will be in charge of leading the inquiries, including contact tracing, meant to identify and contain the virus.
“I have directed them to accelerate the increase in contact tracing so that we can meet the demand of those additional cases that we’re seeing,” Ige said.
In early May, Hawaii’s stay-at-home orders and extensive cooperation of the public had all but eliminated the virus. And with the restrictions poised to lift, contact tracing was identified as a key part of the state’s plan to deal with an expected rise in new cases. The only question seemed to be how to hire and train the contact tracers.
State and local officials like Lt. Gov. Josh Green, who is a medical doctor, and Honolulu Mayor Kirk Caldwell were calling for an army of contact tracers to be hired to quickly make calls, identify potentially infected people and help contain the cases contained in clusters.
And large numbers of contact tracers was considered so critical that Dr. Mark Mugiishi, the chief executive of HMSA, brokered a deal with the University of Hawaii nursing school to provide students to be trained as contact tracers. At one point a frustrated Gen. Ken Hara, the head of the Hawaii National Guard, said he was going to ask Ige to order Anderson to accept help from National Guard members who were willing to help as contact tracers.
For his part, Anderson assured the concerned officials that the department would be able to use workers from within the agency and not have to rely on outside help.
But that didn’t happen.
Over the last week, as cases surged consistently into the triple digits, it became increasingly clear that Hawaii doesn’t have enough contact tracers to deal with a virus that’s spinning out of control. Last week Park made such a bad impression on the Senate Special Committee on COVID-19 that members of the committee showed up unannounced at health department headquarters the next day to see what was really going on with the contact tracers. And the union that represents the contact tracers has filed a grievance on behalf of the overworked investigators, saying there are far fewer tracers actually on the job than Park and Anderson had led them to believe.
On Thursday, health officials announced 355 new cases. The seven-day average of new cases per day was just under 200 – up from fewer than two in early May – and the department said it was bringing on the outside help Park and Anderson had previously refused to accept, including National Guard personnel Hara had offered months before.
Ige said Park would remain in her position as epidemiologist, but he said investigations, including contact tracing, would be overseen by Roberson, a recently hired chief of the disease investigations branch who will report directly to Tomiyasu.
“We’ve tasked her with making significant upgrades to the contact tracing program within two weeks,” Tomiyasu said of Roberson. Park had previously been leading the contract tracing program.
Tomiyasu added: “As you can imagine, we are all stretched. Dr. Park is still a part of DOH and will focus on other aspects of the pandemic. There is more than enough to do.”
As part of the effort Tomiyasu said the department is standing up a call center with support from outside agencies to help with case management, and building in real-time monitoring and rapid-cycle evaluation of procedures and messaging.
The department now has 76 people working on contact tracing and investigations, she said, and nine additional staff providing supervision and other support.
This week, she said, the department brought on 15 additional contact tracers and case investigation staff, 21 additional personnel from the National Guard and 20 new contact tracers from the UH training program, with another 20 to begin coming aboard next week.
One question is whether building up the contact tracers while cases are soaring will do much good. Ige said he was optimistic.
“I don’t believe it’s too little too late,” he said.
There’s also a question of how much influence Anderson and Park will continue to exert.
Dr. Scott Miscovich, one of the leading critics of Anderson and Park, said Thursday they should be held accountable for failing to execute what Anderson called a “surge from within“ strategy to stand up enough contact tracers.
“The only effective change would be to start at the top,” he said.
“How can we stand by as the public and tolerate this when we have repeatedly been lied to for two to three months?” he added, referring to Anderson’s assurances that the department had enough contact tracers.
Public Behavior Is Key
Ige reiterated the message that it was up to the public to quell the spread of the virus. So far, in response to the mounting cases, Ige has restored a restriction on interisland travel. Honolulu Mayor Kirk Caldwell, for his part, has closed beaches, hiking trails and bars. Whether that strategy will produce results remains to be seen.
Ige said some recent cases have been attributed to seemingly harmless activities, like co-workers chatting at the water cooler or having lunch in an office break room. He stressed it was important to wash hands, wear face masks, limit social activities and stay 6 feet apart from others.
For now, Ige said, Hawaii still plans to open up for tourists who are willing to be tested for COVID-19 before they land here. Those who test negative can skip a 14-day quarantine. But Ige said the growing cases on Oahu could lead officials to change that. He said they need another few days of seeing how the trend in positive cases goes before making a decision to roll back the Sept. 1 test-before-you-travel plan.
“We hope that these measures will help control the virus,” he said. “But if things do not get better, we will have no choice but to look at more restrictions. This could include going back to the stay-at-home orders.”
“I know that going backwards will cause further harm to our economy, but we may have no choice,” he said. “Before we can fix our economy, we need to fix our health.”
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