Ahead of the Curve?

COVID-19 testing at North Hawai’i Community Hospital. (PC: Lynn Scully, NHCH)

Lieutenant Governor Josh Green played a high stakes round of the “on the other hand” game at a press conference Monday — encouraging Hawai‘i residents that the state could see low COVID-19 mortality rates if people follow the rules, but warning that a failure to do so would still lead to a public health catastrophe.

“This is how fast it goes bad for us. If people don’t listen (and practice social distancing), there will be 8% more cases in two days,” Green said of the infection curve the state is currently following. “Four days later, it will be 15% more cases. On the sixth day … it could be 43% more.”

“Those 43% more cases will represent hundreds of people who will test positive for COVID-19, and they themselves will spread (the disease)” he continued. “That is how we lose. That is how people die in the state of the Hawai‘i.”

Hawai‘i is now capable of conducting 1,500 tests for COVID-19 every day, the third-highest rate in the country. As of Monday, public and private labs had tested more than 8,700 COVID-19 swabs.

That’s part of the reason Department of Health Director Bruce Anderson said the state has seen an upswing in positive results over the last five days, with between 2–3% of those tested coming up positive.

Since Gov. David Ige’s stay-at-home Emergency Proclamation went into effect on March 26, the number of confirmed cases in Hawai‘i has risen to the following totals:

• March 26: 95
• March 27: 129
• March 28: 151
• March 29: 175
• March 30: 204

The most recent day’s tally saw 29 new positive results. One case was a child, meaning now four cases in the state have been reported in children 16-years-old or younger.

Of Hawai‘i’s 204 cases, 165 are residents and 19 are visitors. Arrivals at Hawaiian airports have plummeted to roughly 3% of typical passenger flow last year, as fewer than 900 people flew into a Hawaiian Island Sunday.

“We’ve essentially eliminated cases we’ve seen with travel,” said Anderson, adding that all but cutting off that avenue of infection has now ushered Hawai‘i into the phase of the curve where community spread is the paramount concern.

Anderson said consecutive days of 29 confirmed cases, 26 confirmed cases and 29 confirmed cases of COVID-19 over the weekend indicate the public is now “…seeing some signs of localized community transmission.”

Officials don’t believe there’s widespread community transition yet, however, as the state’s sentinel surveillance program has tested 254 random samples of patients from different islands who reported flu-like illnesses but tested negative for the flu virus. None of those tests have come back positive for COVID-19.

Green and Anderson both reiterated that right now is the time when social distancing will matter the most, with Green saying he believes that roughly three weeks is a reasonable timeline for Hawai‘i to see peak infection rates.

The governor’s stay-at-home proclamation and the 14-day, mandatory self-quarantine for all travelers — visitor, resident or anyone who takes an inter-island flight starting Wednesday at midnight — remain in effect until April 30.

“The very best thing you can do … to save the lives of our kūpuna, is to please stay at home and listen to what the governor has asked us to do through April 30,” Green said. “Only go out when you absolutely need to.”

“We will be able to get out of this alive.”

External triage center set up outside West Hawai’i Community Health Center for COVID-19 testing. (PC: Tiffany DeMasters)

So far, everyone infected with COVID-19 in Hawai‘i has gotten out alive. As of noon Monday, only 12 of the 204 confirmed cases had required hospitalization. However, Green said six of those individuals are in intensive care units (ICUs) and two are on ventilators.

Currently, only 37% of the state’s 338 ICU beds are occupied. Only 11% of its 534 ventilators are in use.

“If we do not quarantine at home, those numbers go up very fast,” Green said. “Just 400 of 500 people needing a ventilator will exceed our capacity to keep people alive.”

If a surge of hospitalizations does come, which Green suggested would most likely occur in late April or into May, the state is working on technologies to expand its healthcare capacity.

Researchers at the University of Hawai‘i at Mānoa are collaborating with technical experts across the country to expand ventilator capacity and possibly split one machine so it can keep two people breathing simultaneously.

If necessary, alternate sites are being examined for use as healthcare facilities. Bed overflow could extend to the Hawai‘i Convention Center, for instance. Green noted that the state believes it might be able to bring several hundred more hospital beds online if necessary.

But if people follow social distancing mandates, he hopes Hawai‘i won’t have to.

“We’re capable of beating this,” Green said.