Coronavirus in Hawai‘i, ‘Only a Matter of Time’February 3, 2020, 6:09 PM HST (Updated March 12, 2020, 6:22 PM)
No cases of coronavirus have been confirmed, or are even suspected, in Hawai‘i. However, state officials said Monday it’s all but an inevitability the deadly illness is on its way.
Leadership from the Departments of Health and Transportation, the Governor’s Office, and medical and fire personnel from the Daniel K. Inouye International Airport (HNL) convened before the House Committee on Health Monday afternoon for a sprawling briefing on the status of coronavirus in Hawai‘i, as well as the state’s response to it.
Hilton Raethel, president and CEO of the Healthcare Association of Hawai‘i, said he’s been told “…it’s just a matter of time before we get a case here in Hawai‘i.”
Raethel attributed those comments to DOH Director Bruce Anderson and State Epidemiologist Dr. Sarah Park, both of whom also spoke to lawmakers Monday and confirmed they will proceed as though the arrival of coronavirus on Hawaiian shores is imminent.
Currently, more than 20,000 cases of the virus have been confirmed in China, where the death toll stands at 425. As of Monday afternoon, there were 11 confirmed cases in the US, including two instances in which the disease was spread through person-to-person contact.
Coronavirus has been identified in 26 countries and is suspected in as many as 36 US states.
What coronavirus will look like in Hawai‘i
In all likelihood, officials won’t know the virus has entered the state until it’s already crossed Hawaiian borders.
“None of 11 (US) cases were caught at airports or harbors … they were self-reported,” Anderson said. “The most likely scenario we have here is the same.”
This isn’t reason for panic, however, Anderson said.
The last direct flight from China landed at HNL Sunday, and Chinese nationals are currently not allowed to travel to the US because of the outbreak. That means only US citizens or permanent residents who’ve visited China are potential threats.
The incubation period before coronavirus presents ranges up to 14 days, with symptoms typically developing at around five days. Broad travel restrictions around the Hubei Province, the epicenter of the outbreak, were set in place 12 days ago. As such, by Wednesday any travelers passing through HNL who visited the hot zone in China will have cleared the incubation period.
Indirect flights originating in China and routed through additional international terminals before heading to HNL will pass through Hawai‘i, but Park said there is a plan to track those flights and screen the individuals who require it.
Those residing in Hawai‘i who have visited any part of China and are experiencing symptoms of coronavirus, which are eerily flu-like, will be moved to a quarantine site at Pearl Harbor for a period of two weeks.
Park said the Centers for Disease Control and Prevention (CDC) has not released a standard timetable for quarantines. Thus, the current state standard is 14 days, the believed incubation period of coronavirus.
Military bases are preferred quarantine sites because they offer secure facilities, have limited public access and are equipped with support facilities offering meals and other wraparound services those in quarantine will require over a protracted stay, Anderson said.
Federal and CDC officials who conduct airport screenings will determine a person’s condition. The City and County of Honolulu will provide transport from the airport to the quarantine site if necessary, where the state would work with the military to manage patient care and monitoring.
“We’re probably talking about a handful of people that are going to require this mandatory quarantine,” Anderson said.
All people returning or visiting from China will be placed on home quarantine with daily monitoring, even if they’re not symptomatic. Anderson said some cases may demand home visits from healthcare professionals to stop exposure risks.
“We probably would also quarantine family members or people they’ve been in close contact with,” Anderson said. “That’s how we normally handle these situations.”
Anderson added if anyone is non-compliant with quarantine orders of any kind, he has the authority through a court order to force compliance.
“Believe me, I will,” he said.
Hospitals on all islands are equipped with negative pressure isolation rooms and protective equipment for everyone coming in and out of the facility, Raethel said.
All fire fighting staff at HNL has been trained to help federal health and CDC officials screen and monitor incoming passengers. HNL Fire Chief Glen Mitchell said the same training will be extended across the state, first to Ellison Onizuka Kona International Airport on the Big Island, then to airports Maui and Kaua‘i.
Anderson said the state should receive coronavirus test kits in roughly a week, which will allow a much quicker turnaround for testing results. Currently, labs are shipped to CDC facilities on the mainland and processed — a procedure that requires several days.
Who’s at risk?
Park stressed Monday that the disease is considered contagious only through close interpersonal contact.
“Sitting next to someone for 10 minutes or walking past them doesn’t put you at risk,” she said.
Coronavirus is respiratory, and therefore exposure to respiratory droplets is the only way to contract the disease. Those most at risk are an infected patient’s family members, caretakers and health workers.
The public can minimize risk of transmission by washing their hands frequently and thoroughly, avoiding touching their faces if possible and sneezing into the crook of an arm to mute the expulsion of contagious biological materials.
Park also encouraged people to get flu shots, as early symptoms of coronavirus present almost identically to those of the flu. This will help physicians treat the broader population.
Some have questioned why the coronavirus is getting so much attention, while this year’s flu season has been one of the worst ever — already resulting in a US death toll topping out at over 10,000.
Lieutenant Governor Josh Green said it’s because the flu generally kills one person in 1,000. Based on current numbers, coronavirus kills two or three people in every 100 who contract it.
“That’s why we get more concerned about these kinds of infections,” Green said. “It’s unpredictable if this will become a pandemic.”
“It’s very likely that the outbreak internationally will last for several months,” he continued. “We’ll be following it every day with the CDC.”
Why was Hawai‘i chosen as a point of entry?
State officials acknowledged Monday that the selection of HNL last week as one of seven initial ports of entry for flights from China upped the risk to Hawai‘i’s entire population. However, they said they were as surprised as everyone else to hear the news.
Green said the decision to route the flights in question through the state was made by the federal government. No one in the state government was contacted before the decision was announced.
“Our eyebrows raised just like everybody else’s,” Green continued.
He added that state officials pushed back against the decision in an immediate phone call with federal authorities but were overruled.
The federal government has also undertaken an effort to repatriate roughly 1,000 US citizens from China, bringing them back stateside. Hawai‘i was initially considered as one of four mainland locations to house at least 200 of those citizens during their quarantine periods.
Anderson said that was an argument with the feds the state was able to win.
“The reason we’re not home for individuals being repatriated is because I said it was inappropriate to put these people up in hotels,” Anderson explained. “We don’t have a facility to handle that number (of people).”
Hawai‘i continues to be a port of entry for international flights with potentially infected passengers and will remain so until the coronavirus outbreak subsides. There are now 11 ports of entry in the US, up from seven during the initial announcement last week.
Added to the list were Dulles International Airport in Washington, as well as airports in Dallas, Detroit and Newark.
A disease of the mouth
Park said one of the greatest challenges facing the state is the spread of misinformation.
“I see the rise of social media as honestly a real challenge for those of us working in the field of public health,” said Park, adding she’s heard colleagues calling the reckless way people communicate about serious health issues an ‘infodemic.’
She implored the public to fact check information they see on social media, and not to share or post any information that hasn’t been independently verified.
For general questions about coronavirus, Hawai‘i residents are encouraged to dial 211. Any and all questions will be accepted.
The public can also check out the DOH website, which is typically updated once or twice daily.