Hospital administrators and state officials are scrambling to hire more personnel from the mainland and are making preparations to enlist more help from the federal government as more people are hospitalized for COVID-19 on Oahu and medical staff are increasingly overwhelmed.

“We are tracking the census numbers and we are very concerned,” Healthcare Association of Hawaii President and CEO Hilton Raethel said. “What we said two weeks ago was if the same rate of increase continues, or we continue to have triple-digit infection rates every day for two weeks, that we would be reaching a limit of our hospital capacity around now, and we are very, very close to doing that.”

Gov. David Ige said Thursday that the National Guard has been activated and a team called Task Force Medical — national guardsmen and women with medical backgrounds — are working with all of the providers on the island.

Ige, county mayors and health officials are monitoring staffing shortages in hospitals across the state on a daily basis, he said.

Masked Governor David Ige during joint press conference with Mayors from maui and Kauai counties during COVID-19 pandemic. August 20, 2020
Gov. David Ige said Hawaii has begun to alert federal authorities about health care worker needs. Cory Lum/Civil Beat/2020

Hawaii has also alerted the United States Indo-Pacific Command that the state may need more medical personnel.

“The Department of Defense has a pretty significant cadre of doctors, nurses and health care professionals that are here in the islands,” Ige said. “We wanted them to begin the process of taking inventory, identifying those who may become available should there be a shortage on any of the islands for health care professionals.”

The state has also initiated a request to the Federal Emergency Management Agency to place them on alert that Hawaii is seeing surges, Ige said.

“There may be a need for medical resources at the national level should the surge continue,” Ige said. “We are prepared to support the counties should there be a specific shortage.”

Staffing Is The ‘Greatest Concern’

Not all coronavirus patients require a ventilator or intensive care, but they do require more people to care for them, along with various kinds of personal protective equipment.

As cases on Oahu continue to grow, staffing is the greatest concern among hospital administrators, Raethel said.

“Overall we are 100% capacity which means we have all staffed beds occupied, on average,” Raethel said, noting capacity varies by hospital and more patient transfers are occurring.

The health care system is already under pressure as some health care workers have contracted the virus or they are taken out of commission because of potential exposure to COVID-19.

“That’s happening on Maui, for example, and at a couple of other facilities,” Raethel said. “The number of nurses available has decreased because of labor issues and also because of the people under investigation, or testing positive or having symptoms.”

Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, said hospitals are tapping into mainland networks for staffing as Oahu’s outbreak worsens. Cory Lum/Civil Beat/2020

Lt. Gov. Josh Green said more than 200 people are currently hospitalized for COVID-19 across the state — double the hospitalization count two weeks ago.

Oahu has more than 2,000 licensed hospital beds, almost 250 intensive care unit beds and approximately 334 ventilators. About half the state’s ICU beds and 15% of its ventilators are in use.

The state has the ability to put up tents for beds and make space for non-critical COVID-19 patients if needed as an emergency, according to Raethel. But the increase in hospitalizations means ICU capacity is threatened. A lot of ICU beds are already taken by non-COVID patients.

Roughly 9.4% of the 2,512 COVID-19 test results received within the past 24 hours were positive, he said.

“This is why I’m pressing hard for a firm response because we still have a very high prevalence rate,” Green said, noting the state’s active cases could translate into 400 or more hospitalizations.

Typically, one-fifth of cases in a hospital will progress to need critical care, according to Green, who is also an emergency medicine physician.

“If we are unlucky and get a full 80 additional ICU cases over the next two weeks, that would be very significant and push right up against our capacity,” he said.

Hospitals such as Kaiser Permanente and Adventist Health Castle, which have hospital networks in other states, may be able to hire staff via their national network first, Raethel said.

There are also national health worker staffing agencies, but because the pandemic is impacting the entire country, it’s been increasingly hard to hire people. If local resources are depleted, that’s when federal resources are tapped.

“We’re exploring all options actively right now,” Raethel said. “You have to reach a critical threshold and exhaust other corporate resources.”

Lt. Gov. Josh Green said Hawaii has the ability to “staff up” if needed at hospitals. Cory Lum/Civil Beat/2020

Wahiawa General Hospital is currently caring for about six COVID-19 positive patients and is trying to hire more nursing staff to create a dedicated COVID-19 unit on its campus of up to 36 beds.

The hospital has already received transfers of non-critical COVID-19 patients from other hospitals on Oahu such as the Queen’s Health Systems.

“Certified nurse assistants are hard to come by right now … we’re in the same boat as everyone else,” said Brian Cunningham, CEO of Wahiawa General Hospital. “We’re like every other hospital having to contract staff from the mainland. The other challenge is not every nurse wants to work in a COVID unit.”

In addition, the hospital has five beds in its ICU and seven ventilators. The hospital is waiting for the delivery of three more ventilators.

“That’s really around our capacity to manage. We think with our respiratory therapists, physician and nursing staff we can safely manage them. Theoretically, we could buy 20 ventilators but we wouldn’t be able to manage that many patients.”

Neighbor Islands Are Fragile

Maui County Mayor Mike Victorino said the 14-day interisland quarantine for travelers has been valuable in preventing cases and keeping hospitals on Lanai, Molokai and Maui from being inundated.

Victorino said Maui has about 45 ventilators and has been able to deal with a new outbreak at Maui Memorial Medical Center that has affected at least 45 patients and staff at the hospital this week. Victorino said Thursday’s report of just one new additional COVID-19 case was a positive sign after 20 were documented on Wednesday on the island.

Oahu’s situation has gotten so bad that Maui doctors have received requests from Oahu hospitals for help as Oahu hospitals brush up close to capacity, he said.

“Right now we’ve got to take care of what we have here in Maui County,” Victorino said.  “I’m very concerned because Lanai and Molokai depend on help from Oahu more than Maui.”

Kauai has only nine ICU beds and 14 ventilators, Mayor Derek Kawakami said Thursday. “At any given time we’re half occupied just from our normal day-to-day patients that need that type of care and attention,” he said.

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