Neal Milner: Another Example Of The State Health Department's Flawed Response To The Pandemic - Honolulu Civil Beat


About the Author

Neal Milner

Neal Milner is a former political science professor at the University of Hawaii where he taught for 40 years. He is a political analyst for KITV and is a regular contributor to Hawaii Public Radio's "The Conversation." His most recent book is The Gift of Underpants. Opinions are the author's own and do not necessarily reflect Civil Beat's views.

Opinion article badge“All you have to do is flush.”

That’s part of the headline on an upbeat New York Times article about New York City’s fully operating Covid-19 wastewater surveillance system. Wastewater monitoring is the state-of-the-art way to keep track of Covid.

Hawaii does not do this wastewater program despite Department of Health promises and missed deadlines. After many delays, what was supposed to happen this summer is now, according to DOH, delayed indefinitely.

Here the tagline is “all you have do is wait.”

And wait and wait. Plus, the plumbers don’t tell you when they will show up. Not even a phone call.

Ho hum, that’s just the way it goes.

Enough with the ho-ing and the hum-ing. The Covid wastewater situation is the latest example of the state Department of Health’s flawed response to the pandemic. It’s way too much like the DOH has often operated.

On an ordinary bureaucratic day, this failure to meet a deadline would be disappointing. In a pandemic it’s dangerous.

When it comes to Covid, DOH should still be in crisis mode, not ordinary mode, because that’s what an acceptable, necessary public health response still requires.

Instead, the DOH response to the surveillance seems too much like business as usual. That needs to change, not just for the pandemic but also to deal with future crises.

The DOH needs to do what the federal government’s Center for Disease Control and Prevention plans to do: admit failure and develop a much better way to respond.

DOH needs to pivot.

“Pivot” is the word CDC director Rochelle Walensky recently used to describe the need for a full-on reorganization of her agency.

CDC has taken an enormous amount of flack about the way it has handled Covid. Public health experts have called the agency’s Covid work a botched response leading to a basic loss of trust.

Too slow, too confusing, and, as an expert on science communication put it, “a culture that was simply arrogant and overestimated their ability to get it right.”

All that goes for DOH also.

CDC director Walensky has called for a basic overhaul. It’s a “watershed moment,” she said.

A view of Waikiki Beach with Royal Hawaiian Hotel during a recent surge in Covid-19 cases. August 22, 2021
The pandemic has exposed the Department of Health’s business-as-usual ways. Cory Lum/Civil Beat/2021

The CDC  must refocus itself on public health needs, she said, respond much faster to emergencies and outbreaks of disease and provide information in a way that ordinary people and state and local health authorities can understand and use.

That’s also exactly what DOH needs to do.

Easier said than done? No kidding. But you can’t do it if you don’t first say it. And you won’t say it if you think that the usual ways of doing things are always the best way of doing things and that if things don’t work out the way they’re supposed to, well, we are doing the best we can under the circumstances.

So, here’s some corrections and adjustments DOH needs to make. This isn’t a blueprint for change. It’s a pre-blueprint to make change possible.

DOH must quit thinking so much in terms of business as usual and best-we-cans. Yes, the agency deserves some sympathy regarding the way wastewater monitoring has played out. Some of the delay was beyond its control. Equipment was scarce, coordination was harder, things like that. The agency was a small part of a totally broken national public health system.

Understood. But within DOH there’s a kind of lackadaisical, let’s-be-patient tone that’s infuriating. The lab head left? OK, we will get another one by and by. Things are more complicated. The public needs to be patient.

That is way too much like the can’t-do stance DOH often takes in other areas. “We don’t have the staff.” “It’s more complicated than we thought.”

True or not, that stance has costs because it validates crippling negative attitudes.

Failure moves from being a problem to being a condition that is the natural order of things.

DOH beginning of the day greeting: “Hey, dude. What’s not happening?”

This is infuriating because a crisis response is not about being patient or accepting the way things are. Crisis requires impatience, workarounds and a refusal to accept things the way they are. It requires being nimble and clear with the public.

It’s the difference between a fire department fighting a fast-spreading fire of unknown origin and the department of motor vehicles checking license applications on an average Thursday afternoon in August.

As for us citizens, don’t be fooled by common terms that enable bureaucracies like DOH to get out of jail free.

Two of these show up in media descriptions of the department’s wastewater project — “poised,” and “work in progress.”

“Poised” gives the impression that we are almost there. A better way of thinking about it is that “poised” is an indicator that we are not there yet, though we should be and might never be.

Work in progress? That’s a term to conceal the fact that the work is really in non-progress.

It’s about moving their okoles rather than saving their okoles.

Better to see these terms as deflections, not reassurance. In fact, it would be better if the media quit using them at all.

Language matters. Who knows whether the CDC will successfully reform itself, but talking about watersheds and pivoting shows that change is at least beginning on the right foot.

DOH needs to think more in terms of pivots and less about poising, more about watersheds and less about tales that deflect responsibility.

It’s about moving their okoles rather than saving their okoles.

Take a look at that New York Times wastewater article. It’s interactive with very cool pictures of scientists at work both in the labs and, be ready for it, in the sewers.

It foregrounds the science, but from the text and the photos you can see how much of this endeavor is about organizational adaptation.

The science is tricky, but in fact the organizational changes necessary to go from stool samples to dependable, average-person friendly numbers is even harder.

Right now, there is no reason to believe that DOH can make these kinds of organizational adjustments because that’s not how the agency thinks about itself and it’s not the way the public thinks about the agency.

It’s time for DOH to prove themselves as well as ourselves wrong.

The first time I heard Gov. David Ige say, “Change is hard,” I laughed. Another rhetorical dud from a smart guy who is not exactly a wordsmith.

But you know, he’s right. Recognizing his simple reminder is one part of the equation along with two other parts: change is necessary, and we’re failing our mission if we don’t achieve it.

So, wish the CDC luck. And be both encouraging and tough about the DOH.


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About the Author

Neal Milner

Neal Milner is a former political science professor at the University of Hawaii where he taught for 40 years. He is a political analyst for KITV and is a regular contributor to Hawaii Public Radio's "The Conversation." His most recent book is The Gift of Underpants. Opinions are the author's own and do not necessarily reflect Civil Beat's views.


Latest Comments (0)

This is a review of all State agencies and government in general, not just the DOH. How about the DPP, DOE, DOL? How do you pivot a failing state and city government? Do you ask the unions to admit it first? "admit failure and develop a much better way to respond."Our bureaucracy fails the people and rewards incompetence and compliance with the status quo. All part of the cost of living and why you bear witness to the crumbling state of the state.

wailani1961 · 1 month ago

Great article picture!

Canoe · 1 month ago

When did we ever trust the state health department? I always viewed them as one of the many check marks you have to get with a set of plans and new building to get building and occupancy permits.

Vandy63 · 1 month ago

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