Coronavirus Case of Former Miss Hawai‘i Highlights State Response to Pandemic, And How It’s ChangedApril 11, 2020, 6:09 PM HST (Updated April 11, 2020, 6:26 PM)
Much of America has become akin to a ghost town as mandatory and voluntary lockdowns have swept the country in efforts to curb the spread of coronavirus, which has ravaged the United States worse than any other nation in the world.
It’s a phenomenon that’s followed Jeanné Kapela from the East Coast to Hawai‘i, where she became one of the first confirmed cases of COVID-19 on the Big Island. The shape of life has changed drastically since then, illustrated by Kapela’s experiences in mid-March in contrast to grim realities less than one month later.
“I think there’s a lot to be said about the state of where things are at,” Kapela said. “The coronavirus has shown us there are serious gaps in our healthcare system — a huge doctor and nurse shortage, a lack of access to basic health and healthcare, and a lack of coverage.”
Kapela left her home in South Kona to travel to New York City on March 2. The former Miss Hawai‘i and candidate for Hawai‘i Island’s District 5 seat in the State House of Representatives traveled to the mainland to try out for the Flight Crew, the official cheerleading squad for the New York Jets NFL franchise.
“When I was there, that’s when everything started to hit,” Kapela said. “Within the scope of maybe three or four days when I was in New York, that’s when everything started to shift. New York was empty.”
The subways went from full to scarcely used. Panic began to unfold.
“It’s gotten a lot worse now,” she said. “I have a lot of friends who are there and they just talk about how terrible it is in New York. It’s almost like ground zero for the entire country.”
Conscious of how the disease had gripped the largest and most prominent city in the country, as well as the fact that she may have been exposed, Kapela said she tried to reach out to a number of people before her return to Hawai‘i on March 14.
The results she found disappointed her.
“There really was no information,” she said. “I think, even today, there is still a lack of information that breeds the fear a lot of people are feeling. I reached out to the statewide hotline in Hawai‘i, 2-1-1. They gave me information that was false.”
Kapela was told she’d be tested when she landed — that everyone would be screened. No screening occurred, however, when she boarded her plane in New York or when she disembarked in Kailua-Kona.
“There was no temperature check,” Kapela said. “No one was asked a single question.”
“I tried to talk to a worker at the gate,” she continued. “The Hawaiian Airlines representative had no idea what I was talking about in relation to screening or being tested.”
Screening for COVID-19 at Daniel K. Inouye International Airport for travelers with relevant travel history — at the time from places like China — began in late January, according to reports from the state Department of Health.
Screening has been expanded in the time since. According to the DOH website, the following is protocol as part of an emergency proclamation signed by Gov. David Ige on March 21, which went into effect on March 26.
“All visitors and residents arriving through Hawaiʻi’s airports will be required to complete a Hawaiʻi Department of Agriculture form that will be distributed onboard their flight. They will retain the form when disembarking the aircraft. Upon arrival, they will go through a checkpoint and present the completed form with a valid identification. Checkpoint staff will validate the form and issue documentation that certifies they cleared the checkpoint. The form also includes information on the mandatory requirements for the 14-day quarantine along with penalties.”
News of the governor’s quarantine, and the resulting decisions to cut flights by airlines hemorrhaging money due to public fear and worldwide travel restrictions, sent air arrivals in Hawai‘ plummeting. The average daily arrival numbers topped 30,000 in late March of 2019. On April 10, only 424 people flew into a Hawaiian Island, and just over 100 of them were visitors.
Hawai‘i Department of Transportation spokesperson Tim Sakahara said in late March that all arrivals are appropriately screened and informed. He admitted enforcement is much simpler as arrival numbers have fallen between 98 and 99%.
However, officials like Major General Kenneth Hara, Incident Commander at the Hawai‘i Emergency Management Agency, have indicated quarantine guidelines are proving difficult to enforce once people leave airport terminals.
“Most of them that are flying in, I’m quite certain that they’re not following quarantine,” he told state senators last week.
On the Big Island, Mayor Harry Kim’s rule that shut down all vacation rentals, timeshares and bed & breakfasts should take an even bigger bite out of possible exposure from arrivals by cutting their numbers even further. It goes into effect Monday.
Only hotels, considered essential in some capacities by the state and thereby exempt from some aspects of mandatory quarantine and stay-at-home orders, are still accepting new arrivals. However, several have pledged to use their rooms to house healthcare workers short on supplies and fearful of infecting their families. Others, like the Kailua-Kona Holiday Inn Express, are using their space to help house the high-risk homeless in the community.
The change in measures the state has taken, and which the public has become more inclined to follow since Kapela’s return in mid-March, reflects the seriousness of the pandemic, as well as the extent to which basic functions of society have disintegrated under its weight.
Kapela posed that onerous conditions now a daily reality may have had a shorter half-life, and the numbers of confirmed cases and deaths related to coronavirus may be smaller today, had protocols been designed better and enforced more quickly.
As of Saturday at noon, 484 cases of the virus had been confirmed statewide and nine individuals had died as a result of infection.
Procuring a test for herself was paramount to Kapela upon her return, as she works with groups of children frequently in her capacity as a dance instructor in South Kona.
But getting one took her days, during which she self-quarantined on her own.
“It was a source of panic for me,” she said. “I was calling everyone to find out what I could do. There was such a lack of information on where tests were being given.”
Because her symptoms were mild enough that they proved difficult for a medical doctor to define, Kapela tried and struck out on getting OK’d for a test until March 17. It was then she walked into Kona Community Hospital (KCH) off the street and inquired about a coronavirus test for a lack of other options.
While there, Kapela witnessed in realtime the environment adapting to a deadly foreign invader.
“I walked into the emergency room and there was no clear layout on how people were going to be tested,” she said. “It seems they were still trying to figure out the best way to receive test patients.”
By the time she left, only about an hour later, KCH had “blocked off the entrance to the emergency room and had possible COVID patients coming in through a fully separate entrance that was screened and taped.”
A few weeks later, testing is now far more widespread and available. It is conducted by state and private labs and drive-up sites are available across the islands. On April 8, public testing occurred in Keauhou. On April 11, it was happening for seven hours in Hilo.
Stringent guidelines of relevant travel history, confirmed contact with a positive case and experiencing an array of symptoms have been relaxed to allow more potentially infected to receive COVID-19 swabs.
To date, Hawai‘i has one of the largest testing ratios per capita in the United States.
LABORATORY TESTING DATA
Total Number of Individuals Tested
by Clinical and State Laboratories
State officials on Wednesday said a transition to contact-testing would be implemented in Hawai‘i. The form of testing tracks all individuals who’ve had contact with a positive case and tests them, whether they are symptomatic or not.
DOH’s decision to only test those who were in contact with a positive case and developed symptoms has drawn widespread criticism, culminating in a call from Congresswoman Tulsi Gabbard on Wednesday for the governor to fire DOH Director Bruce Anderson and State Epidemiologist Sarah Park.
Health officials said the choice to test only those with symptoms was made due to a lack of testing supplies. DOH walked back its commitment to contact-testing later Friday citing the same reason. Despite having tested more than 17,000 individuals to date, officials say the supplies simply won’t warrant comprehensive contact-testing.
One thing that is similar between the testing experiences now compared to those of mid-March when Kapela became one of the first in the Big Island to receive a swab is the turnaround time.
She was tested on March 17. The hospital sent her sample to a lab in Dallas and returned her results on March 20, indicating she was positive for COVID-19. Those who attended free drive-through testing in Keauhou Wednesday, April 8 were told to expect a turnaround time of 3-5 days.
It was the weeks in between — as the supply of tests failed to keep pace with demand and labs struggled to establish efficient collection and testing methods — when testing times varied. Several Big Island residents reported turnaround times of 10-14 days in late March and early April.
DOH contacted Kapela and assigned her a caseworker, which is standard practice for all those who test positive for coronavirus. They interviewed her about anyone she may have had close contact with and told her she needed to remain in quarantine for seven days from the date of her test or until she went three full days without experiencing fever or any other symptoms.
It’s unclear if symptom tracking remains part of official quarantine policy, as many people are asymptomatic after contracting COVID-19 and are still capable of spreading the virus to others.
“I never had a fever,” Kapela said. “I could have gotten it a lot earlier, or it could have been at the airport.”
Kapela’s caseworker never offered her an explanation on whether she remained susceptible to re-infection after her seven-day self-quarantine expired and she was allowed to rejoin society.
Emotional and community stress
Even with mild symptoms, Kapela said learning she’d tested positive was overwhelming as she spent the next several days in isolation — her food and other essentials delivered by friends to her doorstep.
“Shock was the main emotion,” she said. “I think I may have been the first local case on the Big Island. There was a lot of concern for my community and my family. There was also that initial fear because there was such a lack of understanding and a lack of information.”
“Thankfully, my symptoms were very mild.”
Kapela decided a couple of days later to come forward publicly and announce she was positive for coronavirus. The decision was made, in part, because of encouragement from some public officials who felt the state hadn’t taken enough proactive measures to protect the public from the coming pandemic, she said.
The result of her Facebook post was an outpouring of both support and criticism. Some told her she deserved the infection because she’d traveled. Others accused her of bringing coronavirus into Kona, though health experts say it’s possible cases of the disease were popping up across the islands as far back as 2019.
“The reality is I was just one of the first people who got tested and there were probably a lot of people in Kona already,” Kapela said.
Reaction to Kapela’s announcement, which included the details of a legal travel itinerary and her proactive approach to seeking out protective testing before and upon her return, offers a more mild mirroring of the anger people are expressing today at those who openly refuse to comply with social distancing practices.
Social distancing, health officials continue to say, is the best defense against mass COVID-19 infections terrorizing public health and overwhelming hospital resources statewide.
On Friday afternoon, police arrested a group of 16 people consuming alcohol at a Pohue Bay party in Ocean View for criminal trespassing and breaking the shelter-in-place order.
Such enforcement will continue islandwide and statewide, police have said.
In retrospect, and looking to the future
The state, with time, has addressed many of the shortcomings Kapela observed weeks ago as she traveled from New York back to Kona.
Airport screenings are universal, testing availability and efficiency has improved, and lockdown and quarantine orders have been issued across Hawai‘i with backup from law enforcement.
But Kapela feels the pandemic has also highlighted some painfully obvious holes in existing state law that need to be remedied. They are concerns she said she hopes to address as a state representative, an office she is running for again in 2020 following a narrow defeat to District 5 incumbent, Rep. Richard Creagan, two years ago.
“Two laws that need to be passed are paid sick leave for all of Hawai‘i’s employees and a paid family leave program,” Kapela said. “Even when not in the middle of pandemic, it should be a basic human right that we allow people to get better.”