Editor’s note: This is the first in a series of articles that analyze Hawaii’s experience with the coronavirus over the past six months. We’re taking a collective deep breath and exploring what’s transpired in a number of different areas — including leadership, communications and data, schools, hospitals, business and the economy, tourism and even with people themselves — to better understand how we came to be in the situation we’re in now and how best to move forward. For this overview analysis, Deputy Editor Jessica Terrell revisits what’s happened since the virus emerged in March. She spoke with numerous public health, economic, government and social science experts who put Hawaii’s experience in perspective and provided some thoughts for the future.
It’s been six months since Hawaii’s first stay-at-home order went into effect, barring residents from most public spaces and shuttering thousands of businesses in an attempt to stop COVID-19 from spreading across the islands.
On Wednesday — 184 days later — residents on Oahu are waiting to emerge from a second stay-at-home order, with many wondering what there is to show for months of personal sacrifice.
More than 11,000 people in Hawaii have been diagnosed with the virus. Outbreaks at jails and nursing homes are challenging our ability to manage the disease in vulnerable settings. And the virus has established itself so firmly in the community that the federal government had to step in to help health officials get a grip on the exploding number of cases — this in a state that had only recently made plans to market itself as “the safest place in the world.”
“There’s no way to look back at what happened and come up with any conclusion other than we failed,” says Carl Bonham, executive director of the University of Hawaii Economic Research Organization.
Things are not all bad. Despite its summer surge, Hawaii still had the sixth-lowest per-capita rate of cases in the country as of Monday — though much of that may be due more to luck than effective governing.
Hawaii had major advantages aiding its pandemic response: An ocean to help seal its borders more tightly than any other state seeking to quarantine travelers. A population more likely to don masks than residents on the mainland unfamiliar with the custom or unwilling to give up personal comfort in the name of safety. The support of residents, a majority of whom said they were willing to bear extreme financial burdens in order to keep the state safe.
And we had time: Washington state saw its first fatality from COVID-19 on Feb. 29. Hawaii didn’t lose a resident to the disease until April 1.
Still, six months into the pandemic, the fight against the virus has battered Hawaii’s economy and taken a serious toll on the mental health of residents.
As beleaguered parents brace for the second month of virtual classes, businesses continue to lay off employees and federal benefits dry up, the state is facing perhaps its biggest challenge yet: restarting tourism safely when just relaxing restrictions for residents was enough to send cases skyrocketing and force the state back into lockdown.
“We sort of have a second chance now,” Bonham says, “and we have to get it right.”
A lack of clear leadership, failure to bolster contact tracing when cases were low, and poor public communication undercut the state’s virus response. To get it right moving forward, the state will need to get better at pivoting quickly as situations change and bring a more diverse group of experts to the table to help find solutions.
Hawaii moved quickly at first to contain the virus and prepare for economic fallout.
State and federal officials hammered out an agreement in early February for Pearl Harbor to serve as a quarantine site. Lawmakers approved $10.5 million in emergency funding to combat the virus. House Speaker Scott Saiki created a 26-member panel with some of the biggest names in Hawaii business to buttress the economy. Gov. David Ige appointed Lt. Gov. Josh Green, an emergency room physician, to work with health care providers as the state’s coronavirus health care liaison.
Within two weeks of Hawaii identifying its first coronavirus case on March 6, the government’s pandemic response was already being slowed by political infighting, poor communication and missed opportunities.
Part of the problem is that states are not equipped to handle major health crises like a pandemic, says Scott Greer, a political scientist and professor at the University of Michigan who has done research on past pandemic responses.
States simply don’t have the incentive or the cash to build the kind of response system needed, Greer said. There is no state that can fund an agency with the necessary firepower.
“The whole system depends on the federal government and the federal government depends on the White House,” Greer said. “So in the event that the White House just simply refuses to do its job, there’s literally nobody else capable effectively of picking up and replacing it, which gives us the situation we’re in now.”
In the absence of strong federal leadership, Hawaii faltered. Ige, well-known for his deliberative governing style, was slow to impose closures and so county mayors began acting on their own — despite little guidance on what power they had to make such decisions.
Honolulu Mayor Kirk Caldwell ordered bars and restaurants to close to in-person dining, and shut down all city parks, even though he said he was uncertain what state laws or county ordinances gave him the power to do so. Kauai Mayor Derek Kawakami ordered a nightly curfew, and Maui Mayor Mike Victorino put limits on public gatherings and restaurant service.
By March 19, Saiki sent a letter to Ige calling his pandemic response “utterly chaotic” and implored the governor to quarantine incoming travelers and impose a statewide lockdown on residents.
Still, Ige resisted ordering residents to stay home. So once again, county officials acted on their own. Caldwell issued a stay-at-home order for Oahu residents starting March 23. Victorino issued a similar order on Maui. Ige followed suit with a statewide stay-at-home order starting two days later, but only after intense lobbying from lawmakers.
By then Green — who had also been critical of the governor’s action, or lack thereof, had been sidelined from the pandemic response. Green and Ige publicly patched up their differences, but criticism of the government response kept rolling in.
A pandemic is as much a communications emergency as it is a medical crisis, points out Tetine Sentell, director of the Office of Public Health Studies at the University of Hawaii Manoa.
“Public health really depends on public trust,” Sentell said. “And if people feel they’re being misled or misinformed, they won’t be willing to make sacrifices.”
The failure of state and county leaders — in Hawaii and across the country — to clearly articulate why they were making decisions and what data they were basing those decisions on, is pointed to as a major failure by most experts Civil Beat interviewed for this story.
In April, the stay-at-home orders appeared to be working. Cases started to decline and by the end of the month, people who had recovered from the virus outnumbered people still sick with the disease. But Hawaii officials at every level of government were struggling to clearly communicate — with the public and with each other.
The failures were on clear display. On April 17, a Senate budget briefing descended into a shouting match between lawmakers and the governor’s chief of staff, who senators accused of withholding information critical to the state’s pandemic response.
The information-sharing challenge has never been fully resolved, despite months of pushing for data from the Department of Health about the source of infections, locations of case clusters and contact tracing capacity.
Month after month during the pandemic, as new emergency orders and restrictions were rolled out and then lifted, confusion abounded. County mayors called for new restrictions publicly before getting approval from the governor, and announced — and then retracted a day later — decisions that were not made on clear science.
This kind of instability and unpredictability has a trickle-down effect on the public.
“It creates a lot of tension and, you know, a sense of instability and unpredictability that also contributes to our mental health,” said Jane Chung-Do, an associate professor at the Office of Public Health Studies at UH Manoa.
At the start of the pandemic, officials worried that Honolulu airport was going to be the site of a superspreader event. It was not. Our spike came from within.
In June and July, as restrictions eased across the state, residents freed from the confines of overcrowded homes and set loose in a Hawaii devoid of tourists for the first time in generations, started gathering together again. Restaurants and bars reopened. People could suddenly shop and go to beauty parlors again.
Clusters began to pop up. At a Hawaiian Airlines training. Gyms. Bars. Honolulu Hale. The health department shared little information about where the cases were spreading from and how successfully they were able to trace those cases. Then the number of cases skyrocketed.
Every successful effort in the last century to halt a pandemic through public health measures has involved four essential tactics, Greer says: test, trace, isolate, protect.
The goal of a shutdown, then, is to reduce the number of cases to a level that testing and tracing can be effective — and to buy enough time to bolster the government’s ability to wield those four tools, Greer said.
This didn’t happen.
“We did make the right decisions on the quarantine,” Bonham said. “And then, you know, while we should have been doing the hard work to be prepared for opening, we dropped the ball.”
Even as cases dropped, concerns began to surface about the health department’s ability to contact people diagnosed with the virus and identify the source of new infections. Health officials, meanwhile, insisted for months the department had the staff it needed to handle its workload. By the time the department admitted it was overloaded, it was too late.
By now, the rest of the story should be familiar. Hawaii suddenly had one of the highest rates of infection in the country. Plans to restart tourism through a pre-travel testing program were pushed back again and again. That program is now supposed to go into effect on Oct. 15, but few details have been released on how it will work.
The state re-instituted an interisland travel quarantine. Oahu went back under a stay-at-home order that it will start to emerge from later this week. The U.S. surgeon general flew to Oahu to help launch a federally funded testing surge. When he got here, the surgeon general called out the racial disparities in Hawaii’s COVID-19 cases as “astounding.”
If Hawaii’s unique geography and culture helped stave off an initial wave of infections, its political culture presents its own set of challenges.
The state has new leadership at the Department of Health, but that may not be enough to change systemic challenges, Bonham says.
To make matters worse, Hawaii’s government is not very nimble — a quality that it desperately needs to survive this crisis, says Peter Adler, a professional mediator.
“We’ve gotten fat and lazy on a lot of stuff and just not very responsive,” Adler said. “We don’t have very good ways of engaging the public.”
The state doesn’t have enough community-level forums for problem-solving, Adler says. COVID-19 is a unique challenge, and recovering from this crisis will call for new approaches that bring together good thinkers, diverse people, not just the same old people.
Bringing more people to the table could play a critical role in moving forward, said Catherine Pirkle, an associate professor of Health Policy and Management at UH Manoa.
The people who are driving the response so far have not necessarily been experts in population health or behavioral health — two disciplines that can help us understand how people as societies behave and engage.
“We’re asking people to fundamentally change behaviors that are usually very healthy and that are very much at the essence of what it is to be a human being,” Pirkle said of efforts to limit socializing. “And so if we’re asking for such fundamental changes in behavior, then it’s really important to bring experts to the table who are experts in things like behavioral change.”
Working with people from hard-hit communities is also critical. Non-Hawaiian Pacific Islanders have the highest rate of COVID-19 cases of any ethnic group in Hawaii, but community leaders had to fight hard for resources, attention — and to be involved in the state’s response, points out Tetine Sentell, professor and director of the Office of Public Health Studies at UH Manoa,
One of the things that has happened is that fault lines or inequities in our society have become very clear, Sentell said. These inequities have exacerbated the pandemic, but it also gives Hawaii a chance to finally address them.
“We can also very clearly see how we’re all connected and we need to do well together as a collective for our shared health and economic growth,” Sentell said. “Our economy is shut down in part because we couldn’t figure out how to make sure everyone stayed safe, healthy, and informed.”
As Oahu gets ready to emerge from its second shutdown, the state has a chance to do things differently.
But the stakes are high, Bonham says. A third shutdown would be worse than another round of delays, he said.
Bonham is hopeful that changes in leadership — the state has a new health director and a new person in charge of contact tracing — will pay off. But lawmakers and business leaders will have to demand better data to show that it’s working.
“We can be cautiously hopeful or optimistic or whatever,” Bonham said. “Well, we have to verify, right? It’s like trust but verify. And the verifying part is really important.”
If states reopen without a solid plan to test, trace and isolate, Greer said, the results will be bad.
You get a little bit of tax revenue, he said, but you’ve also set a time bomb for an explosion of COVID-19 infections.
Greer says his No. 1 piece of advice for governments is to throw everything at strategies to “test, trace, isolate, protect” — even if it means leaving government services faltering.
Those four strategies will only work, points out Pirkle, with careful implementation. Which is why bringing together a diverse set of voices from multiple professional fields becomes essential.
Underpinning all Hawaii’s strategies should be a better communication strategy for keeping the public informed about the pandemic response.
“A lot of governments by now have comprehensively blown their credibility on this,” Greer said.
But there’s also an incredible appetite in the public for information, Greer said. So even governments that have destroyed public trust for information, still have a chance to get the benefit of the doubt by changing course.
The best strategy, Greer says, is to have a clear spokesperson — someone with credibility and good media presence — to voice health policies. When those policies change, explain exactly what changed and why.
“Give people the underlying logic so they don’t get caught up in making fun of your pettifogging rules,” Greer said. “Explain your reasoning.”
Government reform often comes about in times of crisis, said William Eggers, executive director of the Deloitte Center for Government Insights.
The key is that government agencies have to start thinking of themselves as “learning organizations” with a big sense of urgency to adapt to the challenges ahead. To get better at anticipating challenges and moving quickly to put new policies and programs into place.
If that can happen, there may be a real silver lining from all this upheaval: communities that are better equipped to tackle the next big challenge.
“I think it’s going to really dramatically accelerate that notion of what is a resilient city,” Eggers said.
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