Public health nurses and members of the National Guard have been knocking on doors in public housing in hopes of reaching people at high risk of coronavirus who might not otherwise seek testing or medical attention.
“There’s quite a bit of stigma with COVID-19,” said Dr. Elizabeth MacNeill, a preventive medicine doctor employed by the Hawaii Department of Health. “We’re going door to door to make it easier for families to ask questions, and to maybe have testing done discreetly.”
The goal is to approach people in a non-threatening way. They’ve visited almost 20 neighborhoods and housing complexes since May.
Health department nurses, along with medical professionals from local clinics and the Hawaii National Guard, say they are trying to connect with communities that are among the most affected by the pandemic, including low-income and Pacific Islander families. Data shows COVID-19 case rates among Pacific Islander and Filipino communities are disproportionately high when compared to their population size in Hawaii — Pacific Islanders, for instance, make up 4% of the population but 27% of cases.
The department intends to use federal coronavirus relief funds to hire more vendors to expand testing for vulnerable populations, according to Dr. Sarah Kemble, acting state epidemiologist.
A proposed COVID-19 Community Surveillance and Outbreak Response Unit would conduct on-site test specimen collection at public housing complexes and other sites such as homeless shelters, food processing plants, prisons, and long-term care facilities, but as of last month, the unit was still not created.
For now, the eclectic mix of doctors, nurses and social workers from the National Guard, nearby clinics and Hawaii Medical Reserve Corps volunteer group have stepped in to play that role.
On a recent excursion into Aiea, they formed teams, each with a public health field nurse, a couple of National Guard medics prepared to collect test samples, and other volunteers who held multilingual pamphlets and plastic bags with donated fabric face masks meant for children.
So far, the teams have reached at least 1,150 households and tested more than 200 people with symptoms or who live in high-risk situations at public housing and other low-income housing complexes on Oahu.
Those involved say the effort is paying off, both in terms of screening and spreading the word about how to prevent COVID-19.
“They’re hearing from a public health nurse, and think, ‘OK it’s not the landlord, it’s for your own good,’” said Hakim Ouansafi, executive director of the Hawaii Public Housing Authority.
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Outreach teams suit up in scrubs, gloves, masks and face shields and knock on doors. Lerishane Enriquez was among them on a recent visit to Puuwai Momi public housing complex in Aiea. Each time someone answered the door, she dove into a list of questions.
“How many people in your household?” she asked from behind her mask, clipboard in hand. “Are you sick right now, ma’am? Any coughing? Do you know the symptoms?”
Enriquez serves on the Hawaii Air National Guard’s Fatality, Search, and Recovery Team, but these days she’s been involved with testing and education missions, most recently on neighbor islands and the Oahu Community Correctional Center, the site of one of the most severe outbreak of cases on Oahu to date.
Her colleagues hovered behind her with a cooler of testing supplies.
Some people say they’re concerned because they work in the food or retail industry and interact regularly with the public.
There is still widespread confusion about how to properly wear masks and which ones are most effective, said Col. Mark Young, the task force medical commander for the Hawaii National Guard.
Others do not speak English fluently, so providing educational materials about the virus in their own language is crucial, said Gloria Fernandez, the quality assurance coordinator at the DOH Public Health Nursing Branch.
Some of the DOH public health nurses are bilingual and speak Tagalog, Ilocano, Marshallese, Chuukese or Vietnamese. Other translators who tag along on missions can fill in language gaps or speak with residents by phone.
Nearly everyone they speak with says they worry about not having enough space in their home to properly distance anyone who falls ill, Fernandez said.
“If someone tests positive, and they only have a two-bedroom house but there’s 11 people in that home, how do they isolate?” she said. Depending on the situation, Fernandez and the team can help make referrals.
The Hawaii Public Housing Authority has units reserved at each complex for people infected with COVID-19 to quarantine or for people who need to be isolated while they await test results.
Some residents have utilized the city and state funded quarantine program at some Hawaii hotels.
As of Oct. 28, there were just nine people with active infections who live in four different HPHA properties among the housing authority’s 40,000 residents statewide.
Public housing officials are aware that many families have unauthorized household members, but say they do not have the capacity or resources to enforce tenancy violations. If evicted, most would not be able to afford to live elsewhere and could become homeless.
“Our concentration right now is to keep them safe,” Ouansafi said.
The agency has held an ongoing moratorium on evictions during the pandemic, but families are still struggling because of the pandemic’s economic repercussions. Jobs have been lost and expenses such as groceries and WiFi are harder to cover. Internet access among public housing tenants was already sparse, underlining another barrier to accurate information about the disease.
Ouansafi said he has noticed improved compliance with mask-wearing, distancing and no visitor policies, which he attributes to the outreach effort.
Community health centers are also engaged in this kind of public health outreach, but they need more support, MacNeill said.
“We know the National Guard won’t be with us forever, and everybody on this team has other regular day jobs,” she said. “We think this is going to be an effort needed for the long haul.”