Last month, state Rep. John Mizuno visited the 92-bed Liliha Healthcare Center after receiving a tip from a nurse there about an uncontrolled COVID-19 outbreak.

The nursing home’s director of nursing told Mizuno she needed help — immediately.

So he contacted senior administrators at the Hawaii Department of Health, who in turn contacted the DOH’s new acting director Dr. Libby Char. Four hours later, Char and her colleagues had organized the relocation of 15 nursing home residents who tested positive for COVID-19 to Wahiawa General Hospital.

Removing those sick patients from the nursing home to help contain the virus required the DOH officials to problem-solve with the hospital, the nursing home and the Healthcare Association of Hawaii. 

That kind of swift, collaborative action was uncharacteristic of the DOH before Char became the department’s top decision-maker last month, according to Mizuno.

“There were no barriers, there were no hurdles,” said Mizuno, chairman of the Health and Human Services Committee. “The fact that (Char) was able to work with us so fluidly and easily and quickly to avert something that could have been catastrophic, it’s a great success story.”

Department of Health Director Dr. Elizabeth Libby Char.
Dr. Libby Char, an emergency medicine physician, is the new Hawaii Department of Health director. Her predecessor Bruce Anderson retired last month amid a torrent of criticism. Cory Lum/Civil Beat/2020

Char took over leadership of the Department of Health on Sept. 16, replacing Bruce Anderson who had increasingly come under fire — along with then-State Epidemiologist Sarah Park — for what many saw as a bungled state response to the spread of coronavirus in Hawaii.

Anderson had been blasted for grossly exaggerating the state’s capacity to conduct contact tracing while refusing to accept help in the form of additional manpower. He has also been rebuked for his failure to roll out widespread coronavirus testing or release comprehensive data about COVID-19 hotspots.

These mistakes, critics say, left the state ill-prepared for crisis when the virus exacted its largest toll this summer, sickening more people in August alone than during the five prior months combined. Honolulu Mayor Kirk Caldwell reacted to the surge in infections by sending Oahu into its second shutdown since the onset of the pandemic in March, serving another blow to restaurants, retail stores and many service sector businesses that were already barely staying afloat.

Char said she agreed to take the job because she believes she can guide the state’s pandemic response in a better direction.

Now, she runs an agency with a billion-dollar budget and 2,600 state employees who facilitate marriage licenses, food inspections, mental health services and water quality monitoring. But Char’s most urgent charge, no doubt, is working to beat back a new and menacing virus that has sickened nearly 13,000 residents and propelled state leaders to impose social and business restrictions that have devastated the local economy. At least 177 people have died from the virus.  

What Char says she’ll do differently is partner closely with other government agencies and business leaders to help translate pandemic-related medical guidance into effective policies and programs. She also pledged to be more transparent with these partners and with the public.

Governor David Ige walks toward podium as Dr Bruce Anderson heads back to sit down during press conference held during COVID-19 pandemic. June 15, 2020
Dr. Libby Char’s predecessor, former Hawaii Health Department Director Bruce Anderson, left, retired in September after critics faulted him for a lack of transparency and collaborative leadership. Cory Lum/Civil Beat/2020

The challenges Char faces as Hawaii’s top health official are immense. While her chief concern is staving off the virus, she must also consider that repeated economic shutdowns and strict social restrictions can breed public health problems of their own. Residents have lost their jobs and health benefits. The pandemic has also chipped away at many people’s mental health. At the same time, a community in which the virus runs unfettered would not be conducive to rekindling a thriving economy.

These dual pressures could soon come to a head when the state reopens to tourism later this month.

“We’re in a really tough place right now,” Char said. “I think we all need to step up and we all need to try to do our part. And that’s what I’m trying to do.”

An emergency medicine physician who previously served as director of some of the largest emergency medical services agencies in the state, Char has spent much of her first three weeks on the job meeting and talking with county officials, business leaders and community medical experts to strengthen their relationships with the DOH. To combat the virus, Char said it will require all of these groups to collaborate and cooperate effectively.

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.

She’s also committed to rebuilding public confidence in the DOH. Char said she wants to make more data about COVID-19 cluster outbreaks available to the public so people can have a sharper, real-time understanding of the scope of infection in the community.

“I think it’s really important that you come in and earn the trust of the community,” Char said. “I think one of the ways to do that is by being more transparent, sharing more information that will allow people to make good decisions.”

What’s plainly different about Char’s approach to the pandemic is her embrace of what she calls “the three pillars”: widely testing people for COVID-19 to reveal who has the virus, quick contact tracing to determine who else has been exposed to it and isolating people who are infected in state-sponsored beds if they do not have the ability to isolate themselves at home.

“It’s really those three things together that are going to help to keep us safe,” she said.

This puts Char’s approach to slowing down the spread of the virus in sync with most other state leaders and many community medical experts.

Lt. Gov. Josh Green said with Char in charge of the DOH he and other public officials are able to work much more effectively with health regulators. Decisions about programs and policies to combat the virus are coming at a faster clip now that the department is no longer in what he called a “tug of war” with other state leaders.

He commended Char for being flexible, communicative and willing to embrace different perspectives. 

“I think that it was just time to get some fresh legs on the field and get more energy,” Green said. “There was a lot of good work that was done by the previous health department leadership. But we needed kind of a reboot.”

‘A Straight Shooter’

A graduate of the University of Hawaii John A. Burns School of Medicine, Char practiced medicine at The Queen’s Medical Center before taking on a string of director roles at the Honolulu Emergency Services Department, Hawaii EMS Oahu district and American Medical Response.

She is a longtime assistant clinical professor in JABSOM’s surgery department and has provided medical direction for numerous EMS and fire agencies across the state.

Char formerly represented Honolulu on the Eagles, a prominent coalition of EMS medical directors from major U.S. municipalities and their global counterparts in Europe, Australia, New Zealand and the Pacific. The group gathers annually to exchange ideas and lessons learned when it comes to responding to emergencies and measuring outcomes.

House Committee on COVID19. Dr Mark Mugiishi, President and CEO of HMSA during House committee meeting on COVID-19. July 13, 2020
Dr. Mark Mugiishi, president and CEO of HMSA, said the Health Department must shift to implement measures that not only deal with the virus but also support economic recovery. Cory Lum/Civil Beat/2020

This year she won the organization’s Michael Keys Copass Award for her leadership in emergency medicine and for serving as a role model to EMS personnel and medical directors across the U.S.

JABSOM Dean Dr. Jerris Hedges describes Char as calm, tireless and devoted to her work. He said she’s well versed in the art of toggling her focus between the big picture and all the details at hand that work together to make an effective emergency management response.

She brings to the DOH an ability to bridge divides and build consensus across agencies, said Dr. Rick Bruno, an emergency department physician and vice president of patient care at The Queen’s Health Systems.

“She’s a straight shooter, straight to the point, she looks at all different avenues to try to accomplish the task at hand — and she wants to make sure that everything is fair,” said Ian Santee, deputy director of the Honolulu Emergency Services Department.

At the helm of the DOH, Char offers a fresh approach to coordinating the state’s public health response — one that embraces collaboration and transparency, said Dr. Mark Mugiishi, the chief executive of HMSA and a member of the House Select Committee on COVID-19 Economic and Financial Preparedness

“I’ll admit openly and freely that I’m biased because we go way back,” said Mugiishi, who was a general surgeon alongside Char at The Queen’s Medical Center in the late 1990s when Char worked in the emergency department. “But I think this kind of long-term relationship gives you really good insight into how a person will operate and she is collegial, she’s a really sound thinker and she takes responsibility very seriously and really cares deeply about Hawaii.” 

“I just have incredible faith, I think more than anything else, that she will take multiple inputs from multiple different stakeholders and synthesize it all into a workable plan,” Mugiishi added. 

House Speaker Scott Saiki said he’s already seeing early evidence of progress as the DOH works to make its contact tracing program more comprehensive and efficient.

“I know people are fatigued. But … if we work together, we can do this.” — Dr. Libby Char

New specialized investigation teams have been 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.

Nearly 260 people are now working on disease tracking. That’s an increase from fewer than 10, according to a whistleblower employed by the agency. The plan is to scale staffing up to 500 people.

“First and foremost, the public is concerned about their health and safety,” Saiki said. “At the same time, we do need to reopen Hawaii’s economy. That’s why it’s critical that the health department build up its public health infrastructure so that in the event that there is a spike in COVID cases that we have the ability to deal with that. I’m pretty confident given the new leadership at DOH that our public health infrastructure will be in better shape.” 

One of Char’s goals is shifting to empower county leaders to operationalize their own COVID-19 recovery plans and policies with guidance from medical experts at the DOH.

A working example of this, she said, is found within Honolulu’s new four-tier COVID-19 recovery framework. Part of the plan is powered by the acquisition of hundreds more isolation and quarantine beds, something the city and the DOH collaborated to secure.

The city bought a hotel and added another 130 hotel rooms to make available in the near term for people who need isolation and quarantine rooms during the pandemic. The Department of Health will operate the facilities.

“The counties are a little bit more nimble in being able to affect change faster and get agreements faster,” Char said. “If the state can help provide the guidance and the public health and medical expertise and the counties that typically don’t have that medical expertise at hand can tap into that so that they can operationalize things, I think that’s a win for everybody — most of all for the people in the community.”

Public Health Critical To Economic Recovery

While Char’s chief concern is curbing the spread of the virus, she said she also considers the toppled local economy to be a public health problem.

As Hawaii moves to launch the long-awaited pre-travel testing program, Char said the best way the state can poise itself for economic rejuvenation is to keep a healthy population.

When the pre-travel testing program begins on Oct. 15, it will for the first time allow trans-Pacific arrivals to avoid the state’s mandatory 14-day quarantine with proof of a qualifying negative COVID-19 test. The state anticipates Hawaii will see between 8,000 and 10,000 daily trans-Pacific arrivals by the end of 2020, up from an average of several hundred arrivals per day since the onset of the pandemic.

Char said she supports a second test for trans-Pacific travelers after their arrival in the islands — as soon as the state has enough testing capacity. A second test is not currently part of the state’s plan, but it’s a feature that critics of the plan, many of whom are medical experts, are advocating for. They fear a one-test program will miss people who caught the virus right before or during their travel to Hawaii.

“I think it’s about building as many layers of safety as we can,” Char said. “And we have to take into account reality — what kind of capacity we have, what kind of resources we have. Right now we don’t have that capacity (for a second test).”

Lone passenger sits in an empty row of chairs at the Daniel K. Inouye International Airport interisland terminal during a COVID-19 pandemic. September 23, 2020
Char says a two-test pre-travel program is better but that the state doesn’t have the capacity to do that yet. Cory Lum/Civil Beat/2020

Char said it’s her understanding that once the state acquires a big enough testing kit stockpile to require a second test, Gov. David Ige is on board with it.

I think if we can keep a really healthy population, that’s going to be the absolute best thing for the community — and that’s going to get the economy up and running,” Char said. “If we have a really, really unhealthy population with uncontrolled disease that’s just running rampant, that’s not going to be healthy for the economy.”

The DOH needs to “step up,” Char said, and provide the public and other state officials with better guidance and leadership. But she also said the DOH can’t do it alone, underscoring the importance that every Hawaii resident adhere to mask-wearing, hand-washing and social distancing protocols.

“I know people are fatigued,” she said. “But I think if we all keep the mindset that, ‘What I do keeps you safe, what you do keeps me safe,’ and if we work together, we can do this.”

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