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HONOLULU (AP) – Health care workers in Hawaii say a lack of government action is worsening an already crippling surge in coronavirus cases in the islands, and without effective policy changes, the state’s limited hospitals could face a dire crisis.
“Soon we will be in a situation where we will ration health care,” said Dr. Jonathan Dworkin, an infectious disease specialist in Hawaii.
Dworkin said mandates were unpopular, but rationing of Hawaii’s limited health resources was becoming “far uglier.”
“It’s about making decisions about who lives and who dies,” he said. “I hate the idea of having to make a decision about who gets oxygen.”
Dworkin said another home stay order may be required.
“I don’t like the idea, but we are in a situation where the hospitals are very tight, where the care of non-COVID patients becomes very difficult, where we are running out of oxygen. ”
Doctors across the state have made recommendations that they say could help Hawaii contain the spread of the Delta variant.
They say the state failed to implement a variety of measures that officials agreed on last year, including speeding up rapid tests, installing better air filtration systems in schools and businesses, and improving contact tracing.
Some believe that a more robust screening process for travelers that includes two tests, one before travel and one after arrival, could also help slow the spread of disease.
“For an island nation, it is an epidemiological crime, in my opinion, not to take border controls seriously,” added Dworkin. However, the best effect for strict border control would have been a few months ago.
Prior to July, Hawaii reported a seven-day average of 46 daily cases. On Friday that number was 881.
And even as hospitals fill up and morgues bring portable containers for corpses, leaders have made virtually no major policy changes.
The state recently announced that groups of more than 10 people indoors and 25 outdoors could not get together, but a party of more than 300 people that was broken up by police on a beach last weekend went without charges of COVID -19 violations.
A vaccination pass has been announced for restaurants, bars, and other businesses in Oahu, but that program won’t begin for several weeks and gains from vaccine incentives could be months away.
The governor recently proposed that people stop traveling to Hawaii by the end of October, but he didn’t change any official travel rules.
Governor David Ige did not immediately respond Thursday to a message from The Associated Press about the concerns of healthcare workers.
The governor posted a video on social media urging people to act responsibly over the holiday weekend.
“The state of Hawaii is grappling with an unprecedented and catastrophic spike in COVID-19 cases,” Ige said. “Our hospitals are being pushed to their limits.”
Ige urged travelers to voluntarily test upon arriving in the islands and people to set their own nightly curfews, avoid crowds and wear masks.
The governor also tacitly signed an order this week exempting health workers and hospitals from liability during the surge.
Hospitals and medical personnel “are immune from civil liability for any death or injury allegedly caused by any act or omission of the health facility,” the order states, with legal reservations, including malpractice and negligence.
Officials say only a small fraction of the cases have been directly linked to tourists.
But hundreds of thousands of visitors and residents started traveling in July when travel rules were relaxed. Hotels and beaches were full, local families gathered for birthday parties and reunions, and tourists flocked to luaus and restaurants.
“Travel increased and we saw our cases increase,” said Dr. Kapono Chong-Hanssen, medical director of the Kauai Community Health Center. “And from there, you’ve really just seen that skyrocketing increase in cases.”
Dr. Libby Char, director of the Department of Health at the U.S. Department of State, said visitors who may not have had a test while on vacation are likely to have cases missing.
“Are we counting travelers who arrive or who later get sick? Yes, we probably are, ”said Char. “If they don’t test, these people are really difficult to identify.”
And now the Delta variant has torn its way through Hawaii’s unvaccinated residents. Although the state is among the highest vaccination rates in the country, the surge since the pandemic began has repeatedly set records for the highest number of cases and deaths. Approximately 75% of Hawaii residents eligible for the vaccine are fully vaccinated, according to the state dashboard. Children up to the age of 11 cannot register yet.
Hawaii had one of the lowest infection, death, and hospitalization rates in the country prior to the Delta outbreak.
On the island of Kauai, where officials put strict rules in place, including a two-test screening process, the virus was virtually non-existent before the trip resumed.
Kauai State Health Officer Dr. Janet Berreman said contact tracing on the island has proven travel causes local outbreaks, and this applies to both visitors and residents.
“When residents travel and come home, they often live in multigenerational households. They go to work, they go to school, they see their friends. So many, many, many transfers from one or two people in the household, ”Berreman said.
Another problem for hospitals is that now that hotels are full of tourists, the state has ended a program of making rooms available for patients in need of quarantine.
“We were able to help coordinate discharge to hotel rooms, where they could be safely quarantined until the end of their quarantine period, greatly reducing the risk of transmission, infection and disease for their family members,” said Jennifer Tucker, a nurse all in one of the largest hospitals in the country. “We no longer have this option. We send people home. “
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