Public Health Must Come First

A public request to enact stronger measures of social distancing across Hawaiʻi

(Editor's Note: This is the cover story.  The full agenda may be seen >>> HERE and HERE.)

News Release from Hawaiʻi Children's Action Network, March 18, 2020

As public health and medical professionals living and working in Hawaiʻi, we are alarmed by the state’s response to the COVID-19 pandemic. Our Governor must take more decisive action, and he must do so immediately.  Yesterday’s actions were a start, but they are not enough. 

Time is of the essence, so we need to act quickly.  Extreme social distancing measures need to be put in place BEFORE the spread worsens. The health and safety of our most vulnerable residents must come first, which is why we are asking that necessary steps be taken to protect our communities. 

Unless we act immediately, the United States is set to follow in the footsteps of other countries, including Italy, Spain, France, and Germany. The current data shows our outbreak is in line with theirs — meaning tens of thousands will experience infection in an exponential trajectory, lasting for months. Hawaiʻi’s healthcare system does not have the capacity or resources to accommodate the flow of patients that will be needing care.  Other state and city leaders from across the country have already issued comprehensive restrictions to help slow the spread of COVID-19 and protect the public; Hawaii’s leaders can — and must — do the same.  

We have a very narrow window to act: Hawai‘i is fortunate to have a relatively small number of patients right now. However, this number will continue to increase, and we already have our first case of community spread; if we wait to act until the situation gets worse, it will be too late.

Recommended State Efforts to Protect Hawai‘i Residents

For Hawaiʻi’s workers and businesses: 

All non-essential work and businesses, public and private, should be closed if they are unable to work remotely. All non-essential state and local employees should be ordered to stay home; those who can work remotely should do so, effective immediately.  Essential businesses may include but are not limited to: grocery stores, gas stations, pharmacies, healthcare facilities, government facilities, food processing and shipping, utilities, and mass transit.

A clear mandate to limit restaurants, bars, and coffee shops to food take-out or delivery only. Non-essential businesses such as bars, clubs, movie theaters, fitness facilities, hair and nail salons, and entertainment venues must all close. We commend businesses that have done the right thing by closing their doors to protect public health, but it cannot be voluntary.
Close childcare except for emergency/essential personnel. 

Ensure that workers who are ill or caring for an ill or quarantined family member with COVID-19 receive paid leave. 

Allow those who have lost a job or have had hours reduced for reasons related to COVID-19 to receive Unemployment Insurance to be used for temporary leave. Expand Unemployment Insurance eligibility, per federal guidelines, to include workers whose employers temporarily shut down due to COVID-19, workers who are quarantined, and workers who leave their jobs due to risk of infection or to care for family members. Federal law does not require workers to quit to receive benefits due to COVID-19.

For Hawaiʻi’s Families: 

Everyone must stay home.  We have seen other states take bold action and close restaurants and bars, prohibit large gatherings (CDC recommends no more than 10), and essentially shut down their states in an attempt to stop the spread of COVID-19. Hawai‘i must do the same. 

Cancel all travel, events, parties and so on. We must care for our families and elderly population without putting them at risk of COVID-19. 
Work with the state and counties to provide a plan and allow for the operation of emergency child and youth care centers for children of front line health care workers and workers who are unable to work from home, especially our low-income families. 

Work with state agencies and community organizations to establish distribution sites for free meals during school closure for all children and youth.

For Hawaiʻi’s Visitors: 

Issue an advisory on travel restrictions, making recommendations for non-essential travel to and from the state and neighbor islands. 
Anyone entering the state, whether at the airports or by cruise ships, should be screened. 

Airports and ports should have protocol in place to address individual passengers exhibiting COVID-19 symptoms and notify the state health department.

Make hand sanitizers available to all passengers.
The same restrictions applying to Hawaiʻiʻs locals should apply to visitors: practice social distancing and donʻt put others at risk. Any visitors experiencing symptoms should notify hotel management.

Hotels should prevent guests congregating in common areas or dining rooms. Meals should be shifted to room service; if this cannot be adhered to, meal times should be staggered so as to observe recommendations for gatherings of 10 people or less, and appropriate distancing. 

For Hawaiʻi’s Medical Community:

The state needs to have the ability to secure the necessary facilities to accommodate quarantine, isolation, or medical treatment of individuals testing positive for or exposed to COVID-19.

Waive the requirement that primary care physician (PCP) orders are necessary to receive any kind of COVID-19 test such that testing can be expanded without overwhelming our providers. Allow health administrators to use their own discretion to allow individuals without health insurance or access to a PCP to get tested.

Testing sites need to be able to 1) assess clinically, 2) conduct the test, and 3) provide this service without charge to the patient. 

We, the public health and medical community, respectfully submit this written statement and we ask — please, let us rise to the challenge facing our state and take all action necessary without a second of delay. We stand ready to work with our state and congressional leaders in the weeks and months ahead and support our communities through this and to successfully navigate this public health crisis.

Signed:

Dr. Albert Lin, MD, Hospitalist - Wahiawa General Hospitalist (Mid Pacific Hospitalists) 

Dr. Ali Chisti, MD MPH, Queens Internal Medicine Hospitalist 

Amy Peterson, DPT, Executive Director, Pediatric Therapies Hawaii 

Amy Turner RN, University of Hawaii Maui College 

Ann Kiyabu, CDA, BA Kapiolani Community College/Health Science 

Annette Mente, MA

Dr. Arcelita Imasa, MD

Bev Brody, BA, Director - Get Fit Kauai 

Brian Smith RN, BSN, CMSRN 

Dr. Brooke Holderbaum, MPH, EdD 

Dr. Brooke Keliikoa, DrPH

Dr.Bryan Mih, MD, MPH, Pediatrician, Private Practice 

Dr. Casey Tamashiro, DDS

Catherine Taschner, JD

Chelsea Tadena CMA Medical Assistant, Lanai Community Health Center  

Dr. Christopher Tsue Pharm.D.

Dr. Claire Townsend Ing, DrPH, Assistant Professor 

Clifford Chang MPH Clifford Chang Consulting 

Dr. Colette Browne DrPH, MSW Professor, University of Hawaii, Retired 

Dr. Colleen F Inouye MD  MMM 

Cyd L. Hoffeld, CHT, Health Promotions Manager

Danelle Cheng, MA - School Counseling 

Dr. Danielle Ogez MD, MPP OBGYN Resident Physician 

Dr. David Derauf, MD MPH Executive Director KKV 

Dr. David Stupplebeen PhD MPH Junior Specialist, University of Hawaii at Manoa; Epidemiologist/Evaluator, Hawaii Health & Harm Reduction Center (HHHRC)

Dr. Dayton QL Lum, Immediate Past President/Hawaii Dental Association 

Deborah Zysman, MPH, Executive Director, Hawaii Children's Action Network and Past President Hawaii Public Health Association

Dr. Denise Cohen, PhD, APRN Professor-Nursing University of Hawaii Maui College 

Dr. Diana M Shaw PhD, MPH, MBA Exec Dir, Lanai Community Health Center 

Don Weisman BA

Donna Myers, RN,  Queens West ICU 

Doris Segal Matsunaga MPH Save Medicaid Hawaii  

Dr. Joseph Keawe'aimoku Kaholokula PhD,  Department of Native Hawaiian Health, John A. Burns School of Medicine, University of Hawaii at Manoa 

Dr. Sonia Gupta, DMD, Maui Health System Hospital  

Dr. Forrest Batz, PharmD

Gerraine Hignite, RDH

Hali Robinett MPH President, Hawaii Public Health Association 

Heather Lusk MSW Executive Director, Hawaii Health & Harm Reduction Center and Co-Director, Hep-Free Hawaii

Hawaii Henry Curtis B.A. Economics Executive Director, Life of the Land 

Jane Lim BS, BSN, RN UH Manoa JABSOM Dept. Of Native Hawaiian Health 

Dr. Jasmine Waipa MD

Jennifer Baumstark RN, CNM University of Hawaii-Maui 

Jeny Bissell RN Supervisor, Maui DOH 

Jessica Yamauchi, MA, Executive Director, Hawaii Public Health Institute; Immediate Past Vice President  

Hawaii Public Health Institute; Board Chair National Network of Public Health Institutes

Dr. Jesse Hollander DMD, Dental practice owner  

Jill Tamashiro, MPH

Jo Ellen Reynolds, BS, MS, RN, CNM, FP, CDR-ret 

John Seely MA

John Willliam Bickel M.A. President, Americans for Democratic Action Hawaii 

Dr. Joseph Kohn, MD Physician & Founder of We Are One, Inc. 

Judith F. Clark, MPH

Juliet Owens BA, CNA, 

Ka'imi Nicholson M.A. Aloha Movement Project 

Kathleen Hagan, APRN

Kathleen Koga, MPH, Health Educator 

Dr. Kathryn Braun, DrPH President, Active Aging Consortium Asia Pacific 

Kilikina Mahi MBA HIPHI  

Larry Geller BSEE Co-Project Director, GreenWheel Food Hub 

Laura Segaran  OT Occupational Therapist  

Laurie Tanner BA, 

Lisa Kehl MPH, MSW, LSW 

Maile Ketelsen MPH

Dr. Malia Purdy, PhD, MPH 

Marilyn Ruth Seely, MPH

Dr. Marina Hitosugi-Levesque, MD, MPH Geriatric medicine fellow  

Marti Townsend JD Director, Sierra Club of Hawaii

Dr. Maya Maxym,  MD, PhD Pediatric Hospitalist  

Meghan Mcgurk, MPH, Public Health Faculty at UH Manoa  

Mele Look, MBA, Director of Community Engagement, UH-JABSOM, Dept of Native Hawaiian Health  Nancy Partika, RN, MPH, Public Health Consultant 

Ngoc D. Vu, MA

Nikos Leverenz, JD, Drug Policy Forum of Hawaii 

Dr. Nozomu Yamauchi DDS Island Endodontics 

Paul Davis,  MA, MPH

Paula Adams, MS, Hawaii Afterschool Alliance  

Pedro Haro, MPH, SM Hawaii Executive  

Raya Salter, JD 

Dr. Rebecca Delafield, PhD

Rev. Jeffrey M. Lilley M.Div

Ronnie Delos Santos,  Hui Malama Ola Na Oiwi

Dr. Ryan Roth MD, Hospitalist at KVMH, NHCH, Straub 

Dr. Sasha Fernandes, MD 

Selene LeGare, MPH

Solange Patrick, MSN, RN

Stacy Evensen, MS

Dr. Stephanie Yan, MD, Private practice surgeon 

Dr. Thomas Lee, Phd, MPH Assistant Professor/ UH Manoa 

Dr. Travis Hong, MD, Physician, Kapiolani Medical Center for Women and Children  

Tricia Gouveia, LPN

Dr. Tricia Mabellos, DrPH, MS Department of Native Hawaiian Health 

Valerie Chang, JD, Executive Director, Hawaii COPD Coalition 

Vonnell Ramos, MA, MS Executive Director, Hale Opio Kauai Inc. 

Dr. Winona Kaalouahi Lee, MD Department of Native Hawaiian Health, JABSOM 

Dr. Yvonne Lum,  MD, Primary Care Physician, Queen's Healthcare Centers 

Yvonne Replogle, Hui Malama Ola Na Oiwi 

Additional Signatures

Jessie Leialoha Gonsalves

Marya Grambs, Member, Board Of Directors, Partners in Care

Yvonne Mina, RN, Kapiolani Medical Center

Martin Newman, MD, Kaiser Permanente, Dept Ob/Gyn

Liz Sager, President, Hawaii State Parent Teacher Student Association (PTSA)

Dina Shek, JD, Legal Director, Medical-Legal Partnership for Children in Hawai'i

Jordan Smith, Public Health Specialist

Louise Thaell, Masters, Case Manager

Maria Ver, MD, President - Philippine Medical Association of Hawaii

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KITV: Group protests at Maui airport asking for mandatory quarantine for all travelers to Hawaii  (FB Page) 

HNN: Dozens on Molokai protest at airport, urging visitors to go home (organized by Council Staffer Zhantell Lindo)  

KITV: Maui: Anti-Tourism Activists Block Entrance to Iao Valley park

SA: Hawaii medical professionals ask Gov. David Ige to mandate extreme social distancing measures   

TGI: Health care coalition: Stay home

HTH: Healthcare providers: State’s COVID-19 guidelines ‘not enough’