‘It’s Still Out There’: Despite Lifting of Restrictions, Shift in Approach, The COVID-19 Pandemic Isn’t Over

You might have noticed a few changes lately.

Cruise ships have returned. Restaurants and markets have more guests. You can fly freely. Tourists are returning in what seems like droves. The 59th annual Merrie Monarch Festival just ended after a week of events that drew hundreds, if not thousands.

But one aspect of life that hasn’t changed, one that’s wreaked havoc around the globe — mentally, socially, physically, financially and politically — for more than two years, remains the same.

The COVID-19 pandemic is still here.

Case counts have even spiked during the past several weeks. State Epidemiologist Sarah Kemble on Wednesday, April 27, during a press conference hosted by Gov. David Ige, said the state’s average daily number of reported infections has increased four-fold since the middle of March.

Hospitals also are still seeing and treating COVID patients and have kept restrictions in place to keep their patients, staff and communities safe.

“Thankfully, our COVID-19 case numbers remain low, both inpatient and in the ER,” Lynn Scully, marketing and communications manager at Queen’s North Hawai‘i Community Hospital, told Big Island Now in an email. “We are continually monitoring the numbers so we will be prepared should we see the start of another surge, although this is not expected.”

The Waimea hospital allows patients to have one visitor per day with proof of vaccination and requires masks to be worn while on the hospital campus. Scully said policies continue to be evaluated based on conditions in the community and within the hospital.

Since April 1, Kona Community Hospital has tested a daily average of 20 patients who were symptomatic for COVID, according to hospital spokeswoman Judy Donovan. KCH has had 32 patients test positive since the beginning of the month.

“These numbers reflect both in-patient and outpatient data,” Donovan told Big Island Now in an email. “The April in-patient COVID patient census has ranged from zero to two patients per day.”

The hospital dismantled its designated COVID unit, but has not changed how it manages COVID patients. Donovan added that KCH also is gradually easing visitor restrictions.

KCH continues mandatory masking in all indoor areas. Visitors also must wear a mask at all times while in the hospital, including while at a patient’s bedside, and only two visitors per patient are allowed per day and they must visit one at a time. Visitors are screened prior to entering the hospital and must be vaccinated, “with compassionate exceptions being made on a case-by-case basis,” Donovan said.

The Kona hospital is ready should another major wave of COVID happen.

“Our staff remains prepared to manage a surge as we have not scaled back COVID-related infection prevention protocols or policies,” Donovan said.

Elena Cabatu, spokeswoman for Hilo Medical Center, told Big Island Now that the hospital has seen a steady uptick in cases during the past 5-6 weeks, which is representative of what’s happening throughout the state. She said the highest number of hospitalizations HMC has seen since the last surge in January is five, and that was earlier this week.

She added that there also has been an increase in COVID-related ER visits, which is typical during a surge.

“They want to come and verify their home tests results,” Cabatu said about those ER patients. “But if they come into our ER and they have a positive home kit result with symptoms, we’re just going to fall on the side of caution and assume they are positive.”

While the hospital is no longer offering vaccinations, it still encourages people to get vaccinated and boosted and check in with loved ones to help them do the same. HMC also has tools to help those who need treatment for COVID, with about seven different options.

“So we’re well-equipped to take care of folks coming to us needing help,” Cabatu said.

HMC, like the island’s other medical facilities, is keeping an eye on the most recent increase in case numbers, and Cabatu said hopefully this surge will be similar to the previous one in January that resulted in higher contagiousness and but less severe illness.

“Which equates to more ER visits but less hospitalizations,” she said.

The hospital has dropped its proof of vaccination requirement and loosened limits for visitors. In the general units, patients can have six visitors at a time. On specialized floors, such as obstetrics, patients are allowed to have three visitors at a time. In the emergency department and for behavioral health short stays, patients can have one visitor at a time and the ICU is still only allowing two visitors at once.

HMC’s mask requirement also remains in place when in a patient’s room and in hallways near medical units, but in other areas of the hospital, such as when someone is eating in the cafeteria or in nonclinical areas, masks are optional.

The state expected an increase in case numbers after ending restrictions, including the indoor mask mandate and Safe Travels program, and counties easing gathering limits. Ige said Wednesday that while Hawai’i will shift from emergency mode to battling the coronavirus with a more traditional public health approach, the state Department of Health will continue measures to monitor the pandemic and adjust accordingly as conditions change.

Ige said the state will now handle COVID more like other diseases — something health care providers diagnose and treat, like the flu.

State Health Director Elizabeth Char said during the press conference Wednesday that the DOH has three main goals moving forward, mirroring federal guidance: protecting against COVID, detecting and preparing for new variants and enhancing community resilience. The state also will continue to provide the information necessary, including where and how to get tested and vaccinated, for people to take more personal responsibility for coping with COVID.

The governor, Char and Kemble each stressed measures people can take to protect themselves and others from the disease — the same message that has been drilled into the public lexicon for months, if not years.

Stay at home and isolate if you are sick or were exposed to COVID. Get tested or take an at-home test if you feel ill. And mask up when inside, in places where there are lots of people and when you are around people at high risk for severe illness if they contract the virus.

“We all know what works. We all know what we can do to help fight against COVID-19,” Ige said.

Get vaccinated. Get a booster shot, and if you’re eligible, get a second booster.

“We are still strongly encouraging people to receive the COVID vaccine as a preventive measure,” Donovan said, adding that vaccination rates in Hawai’i and nationwide have been effective in keeping infection numbers down, as well as lessening the impact of symptoms on those who do contract COVID. “Overall, this is great. However, COVID is not over. We need to remain aware that it is here, and take precautions to avoid spreading infection. The best precautions are vaccines and masks. They work.”

Since its approval, hundreds of second booster shots have been provided to people 50 and older by Queen’s North Hawai’i Community Hospital, Scully said; however, the number provided to those younger than 50, including keiki ages 5-11, is still fairly low.

“What we hear from the people getting their second booster is that they want to protect themselves and feel safe whether they are at home or traveling, and that they are very thankful to receive the second booster,” she said.

One aspect of the pandemic that has changed is the development and availability of medications that can help treat COVID — before and after infection, as long as it is identified quickly.

“One change in the care of our COVID-19 patients is the increased availability of medication for pre-or post-exposure,” Scully said, that includes medications such as Paxlovid and monoclonal antibodies, among others.

Char said during Wednesday’s press conference that there is a good supply of those therapeutic treatments throughout the state. They should be readily available by prescription. She warned, however, that treatments do not replace vaccines.

“But they really can help for those who are at highest risk should they get infected with COVID,” Char said.

Despite the recent uptick in cases, a mixed sense of relief and anxiety and maybe some disparity among places, events, businesses and organizations as far as when and where masks are required now in a restriction-free new normal, officials — state and local — are confident that the people of Hawai‘i have what they need to weather the pandemic moving forward.

“I think we knew that these restrictions were going to be lifted, so what we’re seeing now is kind of what we expected,” Cabatu said.

She said people do risk assessments for themselves all the time, so in preparation for restrictions being removed, people really had to sit down and talk to their families and decide their level of comfort and adjust accordingly. Cabatu also coaches a youth basketball team. Players and coaches didn’t unmask until two weeks after the state lifted its indoor mask mandate, erring on the side of caution. Now, some still mask up while others don’t — it’s just a personal choice.

The latest phase of the pandemic and transitioning to a more public health approach means people need to really think about and assess the risks in their everyday lives.

“The more we do that for ourselves and each other, the safer our community will be and healthier,” Cabatu said.

Hawai‘i County Councilman Tim Richards, who represents much of North Hawai‘i, including a portion of his hometown of Waimea, said people are aware of the risk and being careful when they need to be. In his neck of the woods on the Big Island, he sees people continuing to social distance and wear a mask when they are out and about. They aren’t just abandoning those practices.

Councilman Holeka Inaba, who represents District 8 in West Hawai‘i, said deciding to mask up should be left up to the individual or place.

“I support organizations doing what they feel is safe for them, and individuals patronizing the organizations they want to support,” Inaba told Big Island Now in an email.

As a veterinarian, Richards has spent a lifetime studying disease and disease management in animals, including herd animals such as cattle, and has always supported masking, social distancing and vaccinations. He also is on the same page as the state when it comes to how to manage the pandemic now.

“I’m of an age that we had mandated smallpox vaccines, we had mandated polio vaccines, and our society is better for it,” the Councilman said. “So I see this as a thing further down public health. We saw this as a true risk to our society, and we managed it well. Not perfectly, but pretty well.”

Hawai’i County spokesman Cyrus Johnasen said the county knew there would still be many who would continue the practices people have become accustomed to during the past two years — in large part because they work.

“We continue to encourage everyone to do what feels right for them and to respect the decisions of others who may act differently,” Johnasen told Big Island Now in an email. “So long as folks remain respectful of others and act mindfully of others, we do not see the need for additional guidance.”

That includes when large events happen — such as Merrie Monarch.

“Merrie Monarch was a huge success for our community,” Johnasen said. “As communicated many times, the festival remained steadfast in their COVID mitigation protocols on their own accord, and as such, was one of the safest places to be on our island.”

From the craft fairs to the hula competition itself, he said everyone was required to wear a mask and show proof of vaccination to enter, inside or out.

“The COVID teams did an excellent job in ensuring compliance with aloha, and was met with nothing but positive response,” Johnasen said. “If there is any spread, we are confident it would be from private events happening throughout the week and not from any official function of the Merrie Monarch Festival. That said, we are also confident that our community, again, acted in the best interest of our community, and if there is any spread that it would be minimum.”

He added that throughout the pandemic, the island has relied on people making the right choices in the best interest of their family, friends and neighbors.

“We provided guidance, but in the end, it came down to kuleana and sense of community belonging,” Johnasen said. “Overall, our community responded in a way that allowed us to slow the spread and begin our return to a new normal.”

Kemble said Wednesday during the press conference that she doesn’t have a magic date for when the pandemic will be finished and it could still be a concern through the next winter respiratory disease season. But Ige’s message, and that of other officials, is that we are now in a different phase of the pandemic.

“It’s not as big of a calamity as it was before,” Cabatu said.

“It’s still out there. We’re not through the whole thing yet,” Richards said. “We’ve come a long way, but we still have a little more ahead of us.”