Ramping up virus quarantine may stretch islands’ capacity

Hawaii still has no confirmed cases of the COVID-19 coronavirus, but the number of people in voluntary isolation is rising. Always Investigating asks: Will Hawaii be able to handle it if there’s a virus outbreak or more people require official quarantine?

A total of 56 people are in isolation – up 20 since yesterday — all because they recently traveled to China. Of those, 51 are on Oahu, 4 on the Big Island, and 1 is on Maui. No one has been tested for the virus, not even the one person in official quarantine at Pearl Harbor through Monday.

Always Investigating found the state’s quarantine capabilities depend largely on the numbers — how many and how fast any infectious disease takes hold. Lawmakers want more answers about how a coronavirus response would scale up.

It’s been just a few weeks since federal officials surprised the state announcing Honolulu was among a handful of airports they’d be funneling flights from China through after the coronavirus outbreak in Wuhan.

After a scramble about where they’d go for quarantine — even hotels mentioned as an option — a facility at Pearl Harbor was readied the following week. Flights from China had already stopped, but as the disease counts spike in Japan and South Korea where flights are still frequent, Hawaii remains on edge.

Always Investigating asked the governor: What will be done now, whether it’s coronavirus or a future outbreak, to quarantine and house people on each and every island more promptly?

“Clearly the emergency response plan that we have in place for any of these medical emergencies, every hospital in the state on all of the islands are prepared to isolate and deal with patients who need to in in quarantine,” Gov. David Ige told KHON2.

The publicly accessible portion of the state’s emergency response plan — a federally required document — does not show how many would go where. And it has red flags about insufficient infrastructure here for high-number medical incidents. The State Emergency Plan warns: “Hawaii’s medical infrastructure is not sufficient to handle an incident involving a high number of critical casualties or mass fatalities. Hospital bed space, which is normally at or near capacity, staffing and aero medical transport would all be insufficient. There is a statewide shortage of doctors, especially pronounced on neighbor islands.”

“The Healthcare Association of Hawaii, which represents all the hospitals, indicated that they would have the capability of quarantining people if need be on Oahu or the neighbor islands,” explained Rep. John Mizuno, chairman of the state House Health Committee. “The question is, can they effectuate this at the drop of a hat? That I don’t know, and that’s why I think it’s good to circle the wagons and see where we’re at, how close are we from addressing this pandemic

Mizuno is calling for a second legislative briefing next Thursday on the coronavirus to get answers about that and to ask about getting testing ramped up in the state.

“The reason why there’s no current confirmed cases in Hawaii is because they haven’t tested anyone,” Mizuno said. “We need to be testing right away now, because it’s a peace of mind issue.”

According to the State Department of Health: “To date, there have been no samples sent to CDC from Hawaii since no individuals meet the CDC criteria. Per CDC guidelines, testing is only conducted on individuals who meet the criteria as a Person of Interest, who exhibit symptoms of respiratory illness (cough or shortness of breath) and have traveled to China within the past 14 days.” 

The department adds: “Currently, all laboratory testing to confirm COVID-19 is being conducted at the CDC laboratory in Atlanta, Georgia. The test kits sent to state laboratories, including Hawaii, had an issue with negative control primer probe sets included in each kit. New test kits are being developed by the CDC. It is estimated that Hawaii may receive test kits in early to mid-March. DOH has offered to be a beta-tester for the new kits to ensure they work properly. If Hawaii becomes a beta-tested, it means our state may have earlier access to the testing process.”

Meanwhile, the governor says emergency expansion of quarantine and care could take place quickly.

“We are prepared, and there is part of the (emergency response) plan that allows us to stand up a hospital that would be in response to any kind of situation,” Ige said. “So if we needed 100 people in isolation and it was more than any specific facility would be able to handle, we can stand up an instant hospital. We do have all the equipment and all the procedures in place today, they are on island, that would allow us to do that.”

“We really ought to see their game plan in black and white, on paper,” Mizuno said, “and then the next question is the hard question: How are you going to execute, how many people can you accommodate, and how fast can you do this? It could be a logistical nightmare. It’s not going to be easy.”

The state already deals with isolating more than half of the average 120 active tuberculosis patients every year, for 1 to 3 weeks at a time. The majority go willingly, but the state says they’ve had to do a couple of court-ordered tuberculosis isolations in the past decade.

“Most people are very cooperative, they understand the seriousness of their illness and the risk they expose others to,” said Dr. Elizabeth MacNeill, chief of the Department of Health Tuberculosis Control Branch.

Always Investigating asked: Even if each and every one of the TB patients had to go into a hospital facility, do we have enough appropriate facilities in the state to handle it?

“We do,” MacNeill said. “Our local hospitals taking care of acutely ill people are able to very effectively control infection spreading to other patients or employees.”

Following any period of hospitalization, most TB patients spend the rest of their treatment and isolation period at home. But whether due to being homeless, a visitor, or having vulnerable people at home such as children or others with weakened immune systems, the state sometimes has to help find and pay for another place they can wait out their isolation. A recent procurement request seeks more than $14,000 — all of it federally reimbursable — for rent for a TB patient whose treatment is taking unusually long and who does not otherwise have access to suitable housing.

“You want to do the least restrictive isolation,” MacNeill explained. “You’re not going to send somebody to jail. And for most folks that are actually doing pretty well, they don’t need to be in an acute hospital; that’s a very, very expensive way and an unnecessary use of hospital resources.”

KHON2 asked Mizuno, given our history and practice with quarantine in the state, wouldn’t we be more ready to deal with coronavirus now, or something else later?

“Absolutely, and I think it’s prudent that we have an excellent game plan in case a pandemic hits,” Mizuno said.