For the first time since the onset of the pandemic, leaders helping to supervise the state’s COVID-19 response say there’s finally a consensus on how to move forward in fighting the virus while allowing the economy to rebound.

New leadership recently touted by Gov. David Ige includes some familiar key players, but they’ve been given new authority to act on their decisions in a way that’s giving some officials hope that things will be different as the state tries to balance goals to safeguard public health with those to stave off long-term economic ruin.

Changes in leadership include a new acting state epidemiologist who recognizes the importance of bending public health guidance in order to facilitate other priorities, such as the need to prevent mass closures of local businesses or to allow families from the same household to sit together at a park or the beach, Dr. Mark Mugiishi said.

Dr. Sarah Kemble, acting state epidemiologist, has a decidedly different philosophy on guiding the state’s public health response to COVID-19 than her embattled predecessor Dr. Sarah Park, who was forced to take a leave of absence earlier this month.

“It was a breath of fresh air,” said Mugiishi, the chief executive of HMSA and a member of the House Select Committee on COVID-19 Economic and Financial Preparedness, on a newfound willingness of leaders to find a path forward that protects people against the virus while allowing them to learn how to live alongside it.

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“Certain things are just important for people’s health and well-being, like allowing more people to wander around together when they exercise or go to a park,” Mugiishi said. “That’s just what we need as a society. So we also have to take those things into account.”

A New Approach

Six months into a pandemic that has sickened thousands of Hawaii residents and devastated the economy so deeply that experts predict recovery will take years, leadership shuffles among the state’s top COVID-19 responders signal a critical shift toward a more proactive and unified virus-fighting strategy. 

This past Wednesday, Gov. David Ige announced a four-person executive leadership team to direct the state’s virus response, which has been widely criticized as understaffed, reactionary and, in some instances, disingenuous with the public.

The team includes Gen. Kenneth Hara, the state’s incident commander; Dr. Libby Char, acting director of the Hawaii Department of Health; Lt. Gov. Josh Green, who serves as a bridge between Hara and Char with specific roles in coordinating the state’s pre-travel testing program set to launch Oct. 15 and a future vaccination program; and Dr. Virginia Pressler, who is a liaison to the private sector as the head of a new and still ambiguous commission called Laulima Alliance. 

The job titles of Hara and Green remain virtually unchanged, but their roles and duties now have greater definition. And they have more autonomy to devise solutions and put them into practice, according to Mugiishi and Green.

Overall, Green said the new power structure is stronger because it replaces key decision-makers who were rigid and insular in their thinking with those who are more flexible and willing to embrace different perspectives. 

Hawaii Lt. Govenor Dr. Josh Green gestures as he speaks at the Aloha Free Clinic in Honolulu, HI, on Thursday, July 2, 2020. (Ronen Zilberman photo Civil Beat)

Lt. Gov. Josh Green said he has been able to work more effectively with other members of the leadership team now that Anderson and Park are out of the picture.

Ronen Zilberman/Civil Beat

The shift in philosophy would not have been possible prior to the departures of Bruce Anderson, the former health director who retired last week, and Dr. Sarah Park, the embattled state epidemiologist who was forced to take a paid leave of absence after a whistleblower exposed that the department had grossly exaggerated its capacity to perform contact tracing, according to Green.

Both Anderson and Park made public claims that the DOH had contact tracers that did not exist while repeatedly refusing to accept help in the form of additional manpower from volunteers, University of Hawaii medical students and trained members of the National Guard.

Although he had previously defended Anderson and Park, Ige ultimately acknowledged that the DOH hadn’t hired enough disease investigators to contain the virus.

There was a lot of micromanagement from Park, Green said.

“Before we would make decisions in committee, they would go back to the Department of Health and Dr. Park, and decisions would then be turned upside down or stopped in their tracks and then we wouldn’t go forward,” he said.

Not only is there a marked shift in philosophy among officials guiding the state’s COVID-19 prevention strategies, but decisions about programs and policies to combat the virus are coming at a faster clip.

A week ago, members of the new executive committee determined over the course of a single meeting what kind of COVID-19 tests will qualify for Hawaii’s new pre-travel testing program. Later that day, the decision was incorporated into the governor’s emergency proclamation, Green said.

“Dr. Park and Dr. Anderson were not ideologically completely in sync with much of the rest of the team, though they were working very hard,” Green said. “And that meant that we did not adequately operationalize the contact tracing and testing programs. We can debate these things, but at the end of the day we have to take action. And now some of us are able to work together better and be more effective, so as a team we’re getting a lot of that action that was missing.”

What is Fault Lines?
“Fault Lines” is a special project that explores discord in Hawaii and what we as a community can do to bridge some of the social and political gaps that are developing. Read more here.
Green points to other markers of progress in the absence of Anderson and Park. He said the executive leadership team has developed and started implementing new plans to build an army of more than 400 contact tracers. It’s working to increase the state’s daily testing capacity from about 4,500 tests to more than 10,000 tests per day, which he said is essential to allowing people with a recent negative COVID-19 test result to travel into the state without having to quarantine.

 

The state’s hospital capacity has been augmented by hiring more than 200 traveling nurses who will work at 10 Hawaii hospitals over the next two months. And a new data dashboard unveiled by the DOH is providing the public with more detailed information about the status of the virus and the prevention methods.

“Many of these things have been lingering for a long time,” Green said. “And we needed to, I think, just be more proactive and have more direct decision-making authority. So it was good that the governor has empowered us to do that.”

Green is also laying the groundwork for a system to roll out a voluntary vaccination to residents who wish to receive one when it becomes available.

“I think that now everyone is more fully aligned,” he added. “There had been a significant tug of war between the previous health leadership and almost everybody else in the state about tracing and testing. That’s out the window. Now we’re moving forward as a unified team.” 

Boosting Accountability

Both Mugiishi and Green say DOH’s new acting director Dr. Libby Char offers a new approach to coordinating the state’s public health response — one that recognizes the need to rekindle the economy at the same time as it prioritizes its charge of managing the risk that the coronavirus poses to public health.

“This is less about epidemiological validity and dogma,” Mugiishi said. “That’s one input that comes in but the other input that comes in is how can we create a society as we recover that we can all live with?”

The new power structure also notably makes specific leaders responsible for the success of critical programs.

Gen. Kenneth Hara, the state’s COVID-19 incident commander, now has the autonomy to do his job more effectively, according to public officials familiar with the leadership shakeup.

Cory Lum/Civil Beat

“Before it was a huge committee with lots of people and it’s just hard to run an operation by committee,” Mugiishi said. 

For example, Hara is now in charge of the operational success of the pre-travel testing program, whereas before it was unclear who the accountable party was, according to Mugiishi.

House Speaker Scott Saiki said he’s already seeing early evidence of progress as the DOH builds its contact tracing capacity under Emily Roberson, who took the lead at the Disease Investigation Branch in mid-July. Since then, she has restructured the various roles staffers play to make contact tracing more efficient.

Administrative tasks were shifted away from senior investigators to other staff. New specialized investigation teams were created to work on tracking COVID-19 cases that occur among high-risk populations and settings. The branch is working now with the National Guard, graduates from the University of Hawaii’s contact tracing program and other volunteers — groups the department repeatedly refused to accept help from under Anderson and Park.

Nearly 260 people are now working on disease tracking, including 60 people dedicated to making those first contact calls and eight specialized teams of 10 to 15 people. The plan is to scale staffing up to 500 people.

When the pre-travel testing program launches, Roberson says the team will focus on collecting accurate contact information for everyone entering the state.

“Right now with case investigations, including the contact tracing, one of the biggest challenges that we have is not being able to actually reach the people. That’s not because we’re not trying,” she said.

Contact tracing won’t be a “panacea,” Roberson said. “It will just be one piece of the puzzle.”

More Need For Improvement

There’s still much progress to be made — and quickly — according to Saiki.

For example, few details have so far been made public about the Laulima Alliance headed by Pressler, who preceded Anderson as the state’s DOH director. The group was announced last week as a vehicle to provide the private sector with a voice in pandemic-related policy decisions and program creation.  

Pressler described the Laulima Alliance at a press conference this past week as “a safe place for leaders to gather and share their concerns and ideas so that we can continue to keep our efforts on track, and as we reboot the economy, to stay on track.”

Health Director Virginia Pressler listens during a legislative briefing in 2017. Her role in the pandemic response is unclear.

Nathan Eagle/Civil Beat

Mugiishi said he agreed to join the group when Ige called him over the weekend to ask for his participation. 

“I think this group is an attempt to find a balance between public health and the societal wellbeing of our whole community,” Mugiishi said. 

Saiki said he heard that there may be as many as three dozen people on the committee, but he said he hasn’t received any formal indication of how or when it will take shape. 

“Three dozen people sounds unwieldy but that’s why it’s important that whoever’s leading it have the authority to make decisions,” Saiki said.

The state also needs to vastly improve its public communication strategy if it expects people to comply with the changing rules about group gathering limits and social distancing, Saiki said.

“There’s public confusion on what the public health standards are and there’s frustration,” Saiki said. “And that’s not good because if people are frustrated, they may reach a point where they won’t comply with any rules. We have to prevent that from happening.”

Civil Beat reporter Eleni Avendaño contributed to this story.

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