COVID-19 - Hawaii Update and Beyond

Officially, there are no confirmed cases of Coronavirus (COVID-19) currently in Hawai’i. However, up until recently Hawai’i has not been able to test for COVID-19 for reasons outside of the State’s control. Over the last week, COVID-19 has been spreading outside the epicenter of China, including confirmed cases on the West Coast of the United States, while slowing inside of China. This post looks at the events of the past week and how the virus has spread, and offers a look into the island’s now improved testing capabilities. “All countries need to be doing some assessments in terms of what will be needed should they start to see cases”, said Dr. Maria Van Kerkhove with the World Health Organization. “We do know that 80% of those infected will have mild disease and recover, we do know that there is approximately 15% that will be severe, and another 4-5% that will be critical - which will require oxygen support. There are some estimates coming from the clinical teleconferences which would give some indication of 30-40% of those hospitalized will require oxygen support” (WHO, 3.2.2020) — The Spread Of Novel Coronavirus COVID-19 has been able to spread between dozens of countries in recent weeks, primarily due to the high percentage of people it infects that have only mild symptoms, and some that are asymptomatic. When such large percentage of the population are capable of transmitting the virus without knowledge, it becomes very difficult to contain COVID-19 without extreme measures like those seen in China. While the virus will transmit among any demographic, the elderly are disproportionately at risk of serious illness, as the mortality rate increases exponentially in documented patients over the age of 40. (See Graph) — Hawai’i Coronavirus Testing Hawai’i has been lucky so far, as our ability to test for the COVID-19 virus was previously constrained to sending samples the Center for Disease Control (CDC) in Atlanta - IF patients met the defined criteria of travel to China, and showed symptoms (i.e., a temperature of 100.4°F or higher). Nobody met the CDC’s strict criteria in Hawai’i, although there were potential candidate patients (KHON, 2.25.2020). On February 26th, the criteria for testing for COVID-19 was loosened, and the State of Hawai’i Department of Health (HDoH) issued revised criteria to healthcare providers islandwide. Now, the criteria are assessed on a case-by-case basis, and includes travel history to areas recognized by CDC as having ongoing community transmission (HDoH, 2.26.2020). —Mainland Cases And Testing The mainland US has started to see community based transmission of COVID-19 in Washington state, where the newly infected persons did not visit China or have direct contact with a previously infected individual. As of Monday, six people have now died in Washington, and there are many more mild cases. Genomic evidence suggests that COVID-19 has been circulating Washington State since January 15th, but went undetected due to lack of testing. (Trevor Bedford, 3.2.2020) The United States as a whole has only run 472 tests for the novel coronavirus as of March 2nd, meanwhile South Korea has run 109,591 tests, and the United Kingdom has run 13,525 tests. In the UK there were only 40 positive results returned. (worldometers, 3.2.2020) — Information From The State of Hawaii COVID-19 Joint Information Center Back on the islands, the test kits for COVID-19 that have now been made available are located at the State Laboratories Division on O‘ahu. District Health Officials currently do not have the capability to test for COVID-19 independently, according to the State of Hawaii COVID-19 Joint Information Center. Testing persons for COVID-19 is done on a case-by-case basis by the HDoH. State-wide, there are 91 people self-monitoring with HDoH supervision as of March 2nd, 2020, with 83 of them on O‘ahu, and 5 on Hawai‘i Island. These people are not in quarantine. There are also 2 individuals designated as Persons Under Investigation by the HDoH. They met the criteria to be tested for COVID-19, and the tests returned a negative result (HDoH, 3.2.2020). — Vice President Pence Daily Update On COVID-19 Yesterday, Vice President and “Coronavirus Czar” Mike Pence stated that all flights out of South Korea and Italy traveling to the United States will receive screenings for COVID-19, which would include flights that would then come into Honolulu International Airport (White House, 3.2.2020) — My Thoughts Considering that the outbreak in Washington can be traced back six weeks, and deaths have only started to climb this week, and that Hawai’i is not really testing, does that mean experts don’t know the current situation here? I think experts do know more about the status in Hawai’i than is let on. From my observations, the viral epidemiology models being leveraged by experts, like those at the CDC and John Hopkins University, are more believable than the official worldwide reported cases in many instances. Official diagnoses and statistics from many countries are often struggling to play catch-up to an outbreak, and miss many mild and asymptomatic cases, particularly in the early stages of an outbreak. Singapore is a good example of how a small region can successfully deal with an outbreak of COVID-19, with 108 confirmed cases identified, of which 78 have since recovered. Most importantly, Singapore has had zero deaths, so far (John Hopkins CSSE, 3.3.2020). —Tips The State of Hawaii COVID-19 Joint Information Center has some tips to help prevent the spread of respiratory illness with everyday actions.” • Wash your hands often with soap and water for at least 20 seconds. • Avoid touching your eyes, nose, and mouth with unwashed hands. • Avoid close contact with people who are sick. • Stay home when you are sick. • Cover your cough or sneeze with a tissue, then throw the tissue in the trash. • Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.” “Travelers from other areas where there is confirmed widespread community transmission should self-monitor their health for 14 days after they left that location.” (HI-JIC, 3.3.2020) If you need medical care, call ahead to your doctor’s office or an emergency room and let them know about your travel history and symptoms. Final words: Keep calm, and wash your hands. --------------------------------------- — SOURCES (WHO, March 2nd) - https://youtu.be/Wih_8w-LEIU (KHON, 2.25.2020) - https://www.khon2.com/top-stories/hawaii-doctors-flagged-8-for-coronavirus-symptoms-none-tested/ (HDoH, 2.26.2020) - https://health.hawaii.gov/docd/files/2020/02/MedAdvisory-Update-COVID-19-02-26-2020.pdf (Trevor Bedford, 3.2.2020) - https://bedford.io/blog/ncov-cryptic-transmission/ (worldometers, 3.2.2020) - https://www.worldometers.info/coronavirus/covid-19-testing/ (HDoH, 3.2.2020) - https://health.hawaii.gov/news/corona-virus/covid-19-daily-update-march-2-2020/ (White House, 3.2.2020) - https://youtu.be/ol2KO2I3E6c (John Hopkins CSSE, 3.3.2020) - https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 (HI-JIC, 3.3.2020) - https://health.hawaii.gov/news/covid-19-updates/