A high-profile legislative committee of business and political leaders is calling for more oversight of the state’s coronavirus response effort and more detailed data to help guide the response.
The committee’s recommendations come as Gov. David Ige on Monday promised new “targeted restrictions” of activity on Oahu to stem the spread of COVID-19 on the state’s most populous island.
Ige’s announcement followed a meeting of the Hawaii House Select Committee on COVID-19 Economic and Financial Preparedness, where members warned that Hawaii’s hospitals will run out of available beds for the sickest patients by the end of the month if the government doesn’t take steps to stem the spread of COVID-19.
The committee, which includes chief executives of two of Hawaii’s largest medical institutions, called for a comprehensive plan to address the widening crisis.
The briefing included pointed recommendations from a body that has acted as a sort of shadow administration carefully watching the Ige’s administration’s response.
Two of the committee’s ideas were closely related: better oversight of the administration and Hawaii Department of Health and more complete data to provide accountability and transparency.
Its third recommendation calls for a communications strategy to better reach the public and prompt behavioral changes needed to stem the spread of the virus.
House Speaker Scott Saiki, who co-chairs the committee, said it could provide oversight, especially by gathering and interpreting the data.
The committee stopped short of calling for a shut down of economic activity to contain the virus. Instead, members focused on root issues, such as what they say is a lack of available data to guide a targeted response that could allow certain activities to continue while stopping others.
“We really do need data if you want to do a selective approach,” said Dr. Mark Mugiishi, chief executive of HMSA, Hawaii’s largest health insurance company.
For instance, Mugiishi said, if the public knew how many new cases on a given day came from spread at, say, house parties versus bars it would give people better information on what to avoid and officials a better idea of what to shut down if they chose.
“None of that is available now,” Mugiishi said.
Ray Vara, president and chief executive of Hawaii Pacific Health, said it is important not only to have data, but to communicate it so that the public responds.
“Half of the population is scared because they don’t know what’s going on, and half of the population is not scared enough because they don’t know what’s going on,” Vara said.
Meanwhile, with Hawaii recording 226 new cases a day on average for the past week, the state soon will run out of intensive care unit beds for everyone who needs one, said Vara, who oversees four major hospitals, including Kapiolani Medical Center for Women and Children, Pali Momi Medical Center and Straub Medical Center on Oahu, and Wilcox Medical Center on Kauai.
The House COVID-19 committee’s push for better data and communication comes as Hawaii experiences a spike in cases that appears increasingly out of control on Oahu. Continuing a trend, the state’s most populous island on Monday tallied 163 of the 174 new cases reported.
All of this follows a period in May when stay-at-home orders and public compliance appeared to have all but eliminated the virus in Hawaii. The seven-day average for much of May was fewer than a few new cases per day, and on many days there were no new cases.
The state’s plan, announced at the time, was to use extensive contact tracing, testing and isolation of infected persons to contain the virus in clusters as the economy reopened — first to residents and then to tourists. But last week, it became apparent that the Department of Health did not have adequate contract tracing capacity to deal with the expected surge in new cases, which began swelling in July. Hawaii has recorded more cases so far in August than all prior months combined.
Department of Health officials have announced moves to enhance the agency’s contact tracing capacity and have restructured the department, including leadership changes to deal with the challenge. But it is not clear whether enhanced contact tracing will do much good with the virus now spreading out of control.
Mugiishi said Monday that contact tracing is effective when there are relatively few cases, which can be contained, like small, smoldering fires – as there were months ago. The situation now, he said is like a wildfire out of control.
Mugiishi and Vara both pointed to a color-coded matrix adopted by the state to help guide a reopening of the economy, based on reaching certain public health milestones, including prevalence of the disease, hospital resources and contact tracing capacity.
The state is officially at a stage marked by yellow, known as “Act With Care.”
But, Mugiishi and Vara said, the current public health metrics appear to call for Hawaii to be in more restrictive phases: either an orange “Safer At Home” or red “Stay At Home” levels, which require stricter measures limiting activity. Mugiishi shared a graphic showing that three of the metrics place Hawaii in the orange level and two in red.
“It’s kind of hard to imagine we can stay yellow when none of our metrics are there,” Mugiishi said.
On Monday, Ige’s office issued a short statement, suggesting the governor and Honolulu Mayor Kirk Caldwell agreed.
“Governor David Ige and Honolulu Mayor Kirk Caldwell met at length today and agreed that additional targeted restrictions will be needed to prevent the spread of COVID-19 on O‘ahu,” the statement said. “We anticipate an announcement, with details, this week.”
So far Oahu’s targeted response has been limited primarily to closing beaches, parks, hiking trails and bars, but leaving open places like gyms.
Carl Bonham, executive director of the University of Hawaii Economic Research Organization and a member of the House COVID-19 committee, said more data from the health department could help inform a public skeptical that four people exercising together in a park is more dangerous than people exercising in a crowded gym, where cases have been reported.
“These just don’t make any sense, and the public knows that,” Bonham said of the current rules.
Caldwell’s spokesman, Alex Zannes, has said the move was based on state health department guidance advising restrictions on gatherings. Asked about the restrictions, DOH spokeswoman Janice Okubo referred questions to Caldwell’s office.
Even if Ige and Caldwell do craft additional, data-driven restrictions, there’s an additional question: Is there any point in stricter measures to get the virus under control given that the health department failed to implement its plan to conduct extensive tracing and testing after the first shut down, when there were almost no new cases each day?
Bonham said one way to reassure the public is for the Department of Health to provide more data on things like testing and contact tracing capability, including things like how many contact tracers are working, their case load and how long it takes to track down close contacts of an infected person.
Bonham expressed frustration with the health department’s response to information requests.
“We’ve been asking for more data for three or four months now,” he said.
Okubo said the department provides information including case numbers, deaths and the circumstances of each death; a map with the general locations of all cases on each island by district; and case numbers broken down by date and the risk factors of travel, travel-associated contact, and community spread.
She also said the department’s surveys show people know what they need to do to stem the spread of the virus.
“Our survey work has found Hawaii adults have a good understanding of the recommendations to keep themselves safe,” she said.
Meanwhile, the Department of Health on Monday responded to a request for more information made on Aug. 6 by Saiki to Bruce Anderson, the director of the department.
“I share your concerns and want to assure you that the Department of Health is actively making changes to enhance our capacity and improve our performance and transparency in these areas,” Danette Wong Tomiyasu, deputy director for health resources, wrote.
She said the department is creating a new data dashboard with metrics about disease prevention, detection, containment, and health care capacity and figuring out how to publicly provide additional details about transmission events without violating privacy or health information protections
“Your suggestions are part of this process,” she wrote.
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