Transition from Pandemic to Endemic explained as Hawaiʻi’s COVID surge continues
Honolulu Mayor Rick Blangiardi today announced a temporary limit on capacity at large indoor events on Oʻahu as the island deals with the rapid spread of the omicron variant and a record number of COVID-19 cases.
Calling it a “very fluid situation,” and “unprecedented circumstances,” Mayor Blangiardi said the decisions were made amid a surge in COVID-19 case counts to record highs over the course of the pandemic.
Today, there were 2,611 cases across the state, including 1,934 on Oʻahu. On other islands, Maui saw 303 new cases today, Hawaiʻi Island had 156, there were 111 on Kauaʻi, 33 on Molokaʻi, 18 on Lānaʻi, and 56 out of state.
Coexisting: Learning to live with COVID
During his news conference announcing the cut in gathering capacity, Mayor Blangiardi welcomed four health care leaders who spoke about the current trends, including Dr. Mark Mugiishi, president and CEO of HMSA, who outlined the steps forward as the shift is made from a pandemic to an endemic environment.
“We felt it [was] really imperative that we hear from our most senior people in the state–men and women who are running our top health care organizations–to add today some perspective on where they think we are and whatʻs ahead,” said Blangiardi.
“It’s 2022. This is the third calendar year that we’re dealing with COVID. And that might sound terrible and kind of depressing, but it actually can be viewed in an optimistic, positive way. And the reason for that is if you look across the history of mankind and respiratory pandemics, typically respiratory pandemics become endemic, meaning that we learn to live with them or coexist with these infections, about the third year. And this is now the third year,” said Dr. Mugiishi.
Dr. Mugiishi outlined three things that happen for a virus to go from a pandemic to an endemic:
- The virus changes.
- Medical science advances.
- People adapt.
“What we have now is we have a virus mutation. We’re dealing with omicron. That means right now for this virus, it’s more transmissible, a little less virulent… so it’s exposing more people. It’s mutating and it’s becoming less novel. It’s not as new to the human immune system because more people are exposed or infected. So we can get used to it in future iterations of this virus our body will remember and know how to fight it. That, plus vaccinations [are] really a big help,” said Dr. Mugiishi.
Dr. Mugiishi said the most important medical advance with this virus is the mRNA vaccine. It was “developed at incredible speed,” he said, and “is protecting us in incredible ways, especially if we get boosted.”
He said, other things have helped including rapid tests for population screening. “We’ve gotten better pharmaceuticals that make sure people don’t get severe infections if they get infected,” he said.
“The third thing is people adapt. That’s where I think we can all continue to do our part to make that piece better. So the first part at adaptation is vaccines have to become routine and not political… Think MMR (measles, mumps, rubella); think DTaP (diphtheria, tetanus, and pertussis); think polio; think of hepatitis–all these vaccines that we just get routinely without worrying about what party we are affiliated with. That’s what we need to have happen with vaccinations and boosters,” said Dr. Mugiishi.
He also said, “common sense has to become common.”
“Infectious diseases will always be infectious. No matter what. So the bottom line is, if you’re sick, stay home. If you’re in a high risk situation, wear a mask. If it’s peak season, try to avoid high risk situations. These kinds of things are common sense,” he said.
“The last think is–and this is really in line with the mayor’s call for personal responsibility–I think it’s really great that he called for that because we just have to learn to use the tools that we have in our arsenal to learn to live with this disease and mitigate the impacts it can have on our lives,” said Dr. Mugiishi.
“We’ve gone three years now–going on three years–sacrificing our mental health and well being because we’ve had to give up things we love. Our children have sacrificed two years of development because they’ve had to stay home from school. It’s kind of time where we say, let’s figure out a way that–we have all these tools, let’s use them so we can move on,” said Dr. Mugiishi.
“Let’s heed the call of personal responsibility to make sure that we are doing what it takes to turn this into something that we live with,” he said.
Current challenge is keeping workforce healthy
Another healthcare leader, Raymond P. Vara, Jr., President and Chief Executive Officer Hawaiʻi Pacific Health, also spoke of a transition to an endemic environment.
“In many ways, the way we’re seeing this variant present itself shows progress,” said Vara. “It shows that it’s part of what I would consider the course of moving in terms of living in an endemic environment, versus a pandemic environment. So as we see it evolve like this with this variant, and likely with future variants, that what we’ll see is our ability to continue to coexist and live with this get greater with each step of the process, as long as we all do our part.”
“We know that this variant is highly transmissible. We know that so far, what we’re seeing is the symptoms tend to be more mild. We know from a hospital standpoint, we’re seeing fewer people ending up in the ICU. And we know… the greatest defense is to make sure that we’re all vaccinated, and more importantly, we’re getting boosted,” said Vara.
“Also continuing to wear our masks, and making sure we’re managing our connectivity–those that we’re gathering with and the size of our gatherings. If we do those three things, we will absolutely make progress in terms of bringing this current surge to an end and combatting the future variants as they come forward,” he said.
While Hawaiʻi is seeing hospitalizations with COVID continue to grow during the course of this current surge, it is still a fraction of what Hawaiʻi saw during the delta surge–especially when given the number of positive cases that we’re seeing, according to Vara.
“But the hospitals are very busy, even with that fraction of the COVID hospitalization, just because of the fact that we have a lot of non-COVID type patients,” said Vara, including trauma patients, illnesses as a result of defer care, and patients in the hospital with COVID, but not because of COVID. “They are there for other medical reasons and happened to have discovered COVID as a result of their hospitalization.”
“Today the greatest challenge that we have as a hospital is keeping our workforce healthy and making sure that we have a workforce that has the ability to care for our community,” said Vara.
Hospitalizations under current surge could peak in next two weeks
Today, there are 226 COVID-19 patients in Hawaiʻiʻs hospitals, including 18 on Maui. The Maui hospitalizations include seven vaccinated and 11 unvaccinated individuals. One unvaccinated Maui patient is in the ICU.
During the delta surge in August and September of 2021, we reached a peak of 448 COVID-19 hospitalizations, according to Lt. Governor Josh Green.
Hilton Rathel, president and CEO of Health Care Association of Hawaiʻi said hospitals in Hawaiʻi anticipate reaching a peak in hospitalizations within the next two weeks, during the current omicron surge, noting that the peak may be higher than what Hawaiʻi experienced during the delta surge.
“The infection rate and positivity rate from omicron, as we know, are far greater than that of delta. Even with breakthrough infections, most of the people with COVID in the hospital are not vaccinated or boosted,” said Rathel. “Hospitals and other health care organizations in Hawaiʻi have many hundreds of clinical and other staff off work because of exposure to COVID or a positive test. And we know that many businesses in Hawaiʻi, and especially on Oʻahu are impacted as well,” he said.
According to Rathel, the Health Care Association of Hawaiʻi is working with the hospital members, the state Department of Health, HI-EMA, and FEMA to bring in more than 700 health care staff from out of state to help with this surge. “Weʻre also assessing everything from our supplies of PPE, ventilators, and liquified oxygen. While we have some additional capacity in our hospitals and we are taking care of everyone who needs care, our most acute need is adequate staffing,” said Rathel.
“No pill or other therapy will save every COVID patient. We do have shortages, unfortunately, of the monoclonal antibody therapies, and the recently approved oral antiviral pills. However, we can protect ourselves, our kupuna, our keiki, and our friends and neighbors just as every speaker up here has talked about today. Your actions can make a difference,” said Rathel.
Capacity limits placed on large gatherings on Oʻahu
Mayor Blangiardi discussed how the City and County of Honolulu will respond to the current surge in the way of restrictions.
“The only restriction that we’re going to do, effective Monday, [Jan.] 10, has to do with indoor large gatherings. We’re going to simply require 50%, and this starts at 1,000. You’re going to have 1,000 people, if you’re in a venue that holds 2,000. If you’re going to have 3,000-4,000, the venue has to be twice the size of that,” said Mayor Blangiardi.
“In our case here… we want to govern past this in a broader context because there is a greater day ahead–was what would be feasible, what makes sense, what’s responsible–and it comes down to under these circumstances, in our fight against time right now, in trying to overtake omicron and hoping full well with respect to the models–many of which all indicate that this is going to peak some time in January–that we encourage people to take boosters, take personal responsibility, and we’re going to limit large gatherings to 50% of the venue,” said Mayor Blangiardi, noting that outdoor venues are not impacted by this new restriction.
“The other thing that we’re going to do… is we are going to mobilize our unit. We’re going through some quick procurement things here, but we’re going to take our burn trucks–at least one of them–and we’re going to take it to various neighborhoods,” said Mayor Blangiardi, saying the units will be used to make the booster as accessible as possible.
“At the end of the day, this is about voluntary behavior,” said Blangiardi. “We need the public to respond accordingly with good decisions and getting those boosters.”
Maui County announced a booster mandate last week that goes into effect on Jan. 8, 2022. The move made Maui County the first in the state to mandate booster shots for entry to high-risk businesses.
Despite the current surge, Honolulu Mayor Blangiardi said, “Weʻre not ready to add on the third booster if you will to Safe Access Oʻahu.” He continues, “Thereʻs a real inconsistency there if in fact thatʻs not a mandate with the travels by the CDC, and for us to do it locally… Weʻre not ready to mandate boosters.”
“Lean in” to living healthy
Queen’s Medical Center CEO and president, Jill Hoggard Green, PhD, RN, offered some guidance on how to transition forward as well.
“We all know, it’s been two years that we have worked together and have battled a pandemic. And as a community, when we’ve leaned in–and we have–we have been able to navigate all of this safely and effectively,” said Dr. Hoggard Green. “We are battling the omicron variant with COVID, and this is a little different than the ones we’ve seen in the past. This variant is interesting in that it can spread really fast. All the reports say it’s less severe in terms of being an illness, but the fact that it moves so rapidly, some individuals could be impacted.”
Dr. Hoggard Green shared some thoughts on things that people could do to stay safe and healthy. “First is to be vaccinated with a booster… the data are very, very clear. You must be vaccinated, and you must have boosters. So we’re going to do everything in our power to expand access to vaccinations.”
“With the support of the mayor, he was imploring us–ʻCan you double; Can you increase the number of vaccinations?ʻ So I’m happy to tell you we are going to increase those vaccination rates by 50% today going forward, and we’re on target to make sure we’re going to double by next week,” said Dr. Hoggard Green, calling vaccinations and boosters “the single most important thing you can do.”
Other recommendations she said, are to wear a mask, keep groups small, and keep physically distanced.
Queen’s Medical Center serves the largest number of trauma patients, according to Dr. Hoggard Green. “We’ve noticed something that’s also very important in terms of your safety. We’re seeing a 7% increase in traumas over 2019. Many of those traumas are motor vehicle accidents, and it goes back to our basic principals of keeping ourselves safe. Please do not drink and drive. Please ensure that you are following all of the safety protocols and driving within the speed limit. Right now we are seeing traumas and we want you to be safe and well.”
“So please all lean in. This is not just about COVID. It’s about living healthy and having a great community to care for our families,” said Dr. Hoggard Green.
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