Half a year into the coronavirus pandemic in Hawaii, the state faces a grim reality: COVID-19 isn’t going away any time soon. And, although public officials continue to use stay-at-home orders when needed to stop surging contagion, a motto has emerged: we need to learn to live with the virus.
This means adopting as a habit the cardinal safety rules: wear a mask, wash hands, stay 6 feet apart from other people and avoid social gatherings.
The question is whether people can keep doing this long enough to keep the disease in check — and how to communicate the importance of these practices to a weary public that’s starting to tune out.
Dr. Mark Mugiishi, chief executive of the state’s largest medical insurance company says people first need to know exactly what to do and what not to do, understand why the behavior is important and care enough to take action.
“When you talk about piercing all four layers,” he said recently during a briefing by the House Select Committee on COVID-19 Economic and Financial Preparedness, “it’s not easy.”
That Hawaii officials now say the public must adopt such measures as a lifestyle shows just how much things have changed since the early days of the pandemic. At a time when all incoming airline passengers are still subject to a two-week quarantine, it’s easy to forget how cavalier the public once was about the threat posed by COVID-19.
And it wasn’t just non-medical types. As recently as late January, the then-state epidemiologist, Dr. Sarah Park, told a doctor concerned about an alarming report from China on an emerging virus threat that the state had no plans to screen passengers, much less quarantine them.
This is the last in a series of articles that analyzes 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.
“Nope. No plans to screen,” Park told the doctor in a Jan. 21 email. “We have no direct flights from China. Working on a medical advisory to help clarify things for our clinicians.”
Needless to say, Hawaii had no screening in place when the coronavirus first landed in the islands. The first case, reported March 6, was an Oahu man who had traveled on Princess Cruises’ Grand Princess cruise ship from San Francisco to Mexico before flying back from Mexico to Honolulu.
“We know the person did not have any contact with anyone once he got home so that’s good news for us,” Dr. Sarah Kemble, the deputy state epidemiologist, said at the time.
Just weeks after that first case, Hawaii Gov. David Ige imposed the 14-day quarantine for people arriving into the state.
Over the six months since, the public’s optimism about the situation has ebbed sharply, according to survey data from the research firm SMS Hawaii.
Back in May, 49% of residents thought the situation was getting better, and only 7% thought it was getting worse. By mid-June, 39% thought the COVID-19 situation was getting better, and 31% thought it was getting worse. And by late July and early August, as cases in Hawaii were surging, 81% thought the situation was getting worse. Only 8% thought it was getting better.
Faith Rex, president of SMS Consulting, said that the sentiment generally tracks the virus’ surge and suggests people are starting to feel tired and scared.
“I think people are getting worn out and a little more fearful,” she said. “Early on, they were much more positive.”
Against this backdrop, Hawaii soon will modify the quarantine order and allow people who test negative for COVID-19 to sidestep the quarantine. The big question is whether the public will step up and take the basic necessary steps needed to keep the virus under control.
Alex Zannes, a spokesman for Honolulu Mayor Kirk Caldwell, said the city is working to create clear information so people can understand what’s allowed and what’s not. But, he said, the public needs to help spread the word.
“It’s not just the government that’s going to get all the messages out,” he said. “There also has to be buy-in from the community.”
In a place where family is vital to social life and friends are often considered family, perhaps one of the biggest challenges is to tamp down family gatherings that officials say are among the events that most commonly allow the virus to spread.
To that end, Caldwell’s current order limits social gatherings to five people. And it defines “social gathering” as any event or gathering that brings together people from multiple households at the same time in the same place.
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While it might seem innocent enough to have a family barbecue with the kids and grandkids or a movie night with all the cousins, such gatherings aren’t allowed if they bring together more than five people from different residences. Zannes acknowledged it can be hard to get people to understand.
“That’s absolutely a challenge,” he said. “The last thing we want to tell people is you can’t see your family or it’s not safe to see your family.”
At the same time, Zannes said, the virus spreads between family members the same it does between strangers.
The best advice: “Assume everybody has it, or assume you do,” Zannes said.
Chris Daggett is a behavioral scientist and former Presidential Innovation Fellow for the Obama White House. To Daggett, a major problem with Hawaii’s communications response is that, at this point, it focuses too much on public awareness.
“There’s no gap of information or awareness here,” Daggett said in an email. “When I see commercials that are simply reiterating the same talking points but in different languages or elected officials saying the same things over and over again in a perfunctory manner, it demonstrates a misdiagnosis of the communications challenges at hand.”
Instead, he said, at this point, officials should be conducting surveys to find out why people aren’t complying with laws and rules.
“If I know x% of residents are not complying because they’ve lost confidence in my leadership, then my objective should be to address that — with communications or otherwise,” he said. “Similarly, if I know x% of residents are not complying because they’re simply exhausted with the situation, then I also need to find a way to address that which may involve a broader initiative beyond just communications.”
One thing that might be going on is that people are exhausted from isolating themselves during a time when most are facing economic uncertainty, increased child care needs, food insecurity or other uncertainties. In such situations, he said, people come to need a break, like a professional athlete or actor having a cheat meal.
“If the Rock can’t eat grilled, flavorless chicken and broccoli for more than five days in a row, what makes us think anybody can comply with shutdowns for weeks at a time?” Daggett said. “In the best of circumstances that’s a ridiculous ask of any human.”
One idea, Daggett said, is to identify some of the main super-spreader events in Hawaii, namely funerals and family gatherings, and show people ways to attend these safely. Larger family gatherings might be rendered safer if all family members maintained strict social bubbles, for instance. Likewise there could be models for funerals that are culturally appropriate and safe.
“We need to go beyond merely mandating face masks and social distancing at funerals, and actually examine and process map the situations to provide guidance that is specific to those situations,” he said. “We owe that to our residents; we should be finding ways to enable their humanity, safely.”
Department of Health officials agree that people aren’t responding to being told what to do the way they once were. That trend seems to have been going on for a while.
What is Fault Lines?“Fault Lines” is a special project that explores disruption and 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.
Data collected over the summer, in late May and early June, for instance, showed that people weren’t engaging in social distancing the way they had been in April. That included a 19% decline among those who said they were staying away from friends and family members who weren’t part of the household, from 72% in April to 53% in early June, and a 14% decline among those who said they were avoiding large groups and gatherings, from 85% to 71%.
In response, the department has produced public service announcements meant to connect with people better, like a series of survivor stories to run as public service announcements, along with longer YouTube videos, Janice Okubo, a department spokeswoman, said in an email.
“The latest data shows that, while people continue to experience high message recall on our public health messages, our residents are experiencing message fatigue when it comes to ads telling them to follow the guidelines,” Okubo said.
The department also is working on videos showing people how to do things like hold gatherings safely.
“The reality is that we will be in this pandemic for a while longer, even with the development of a vaccine, so providing people with more tools on how to do so is a priority for the Department of Health,” Okubo said.
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