Hawaii Nursing Homes Receiving Nearly $40 Million to Stay Operational, Cover Cost of Staff, Testing, PPE

Senator Brian Schatz today announced that 39 nursing homes across Hawai‘i will receive nearly $40 million in new federal funding to stay operational during the COVID-19 pandemic. The new federal funds will cover lost revenue at nursing homes and additional expenses attributable to the coronavirus, including staffing, testing, treating patients, and purchasing personal protective equipment (PPE).

“Residents of nursing homes and long-term care facilities are some of the most vulnerable to COVID-19, so we need to make sure we are doing all we can to protect them,” said Senator Schatz, a member of the Senate Appropriations Committee. “This new federal funding will give Hawai‘i nursing homes additional resources to prevent the spread of COVID-19 in these facilities and keep residents and workers safe.”

Certified skilled nursing facilities with six or more certified beds are eligible for this funding. Each facility will receive $50,000 plus $2,500 per bed. The new funding is part of the $175 billion Provider Relief Fund provided by the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act.

Earlier this month, Schatz called on Hawai‘i Governor David Ige to take additional steps to protect Hawai‘i residents living in long-term care facilities.

COVID-19 Testing Capacity Up to Total of 3,620 Tests Daily in All Four Counties

In-state COVID-19 testing capabilities have been a top concern throughout the pandemic, but an assessment of statewide testing capacity this week shows there are ample supplies of tests that can be conducted in Hawai‘i. 

It means Hawai‘i residents can breathe a sigh of relief. Healthcare providers can now consider testing patients whom they suspect may be infected to ensure rapid identification of cases. This is a shift in the Hawai‘i Department of Health’s earlier guidance that required specific symptoms and epidemiological criteria before testing.

In the past three weeks, the number of sites conducting tests has increased from five to 11, and testing is now available in all four counties, including on all of the Neighbor Islands.

One of the critical requirements for the state to confidently and safely continue its path to fully reopen is readily accessible COVID-19 tests for all who meet recommended testing criteria, with test results available within 48 hours.

According to data compiled by DOH, as of Monday, May 18, Hawai‘i has more than 38,300 tests on hand for COVID-19 tests and is performing an average of 690 tests each day, with test results available the same day or by the next day. The maximum turnaround time is three days. The number of staff trained to perform the tests has also doubled, jumping from 68 to 135 within the past month.

“The compilation of data provides a realistic snapshot of the state’s overall testing capacity,” said Dr. Edward Desmond, State Laboratories Division (SLD) administrator, who compiled the data. “If necessary, the state has the capability to cumulatively ramp up to 3,620 tests a day, and this number is expected to significantly increase over the next three weeks.

In addition to the SLD, 10 laboratories (three public health and seven private sector) and healthcare facilities on O‘ahu and the neighbor islands currently are testing collected specimens. Private laboratories include Clinical Labs of Hawaii, Diagnostic Laboratory Services, and S&G Labs in Kona. Healthcare facilities include Kaiser Permanente and Adventist Health Castle.

Desmond added Hawai‘i initially sent tests to mainland labs to determine if individuals were COVID-19 positive and there was a backlog and results could take up to a week to receive.

“As a state, we’ve come a long way in a relatively short time to become more self-sufficient,” he said. “We initially had several hundred specimens waiting to be tested at mainland labs. That number has dropped to just 60 outstanding, untested specimens because our need to send samples to the mainland has been greatly reduced because of our in-state capabilities.”

Legislature Approves Financing for Hilo Medical Cardiac Center

Today, the Hawai’i State Legislature agreed and passed HB 2725, the Capital Improvement Project (CIP) budget for Fiscal Years 2020 and 2021.

Sen. Kahele

Sen. Kaiali‘i Kahele extends his thanks to the Senate Ways and Means and House Finance committees for approving the CIP funding for the Hilo Medical Center’s (HMC) Cardiac Center and Hawai‘i Pacific Oncology Center in the 1st Senatorial District.

A total of $3.5 million will go to the construction and equipment for a second catheterization laboratory for the medical center’s cardiac unit, and $6.5 million for plans, design, equipment and construction for the expansion and improvement of the clinic at the oncology center.

“When I took office in February 2016 after my father’s passing from a heart attack,” said Sen. Kahele, “I made it one of my top priorities to bring a cardiac catheterization unit to Hilo. Our community knows how vital specialty health care is on Hawai‘i Island.

“With the initial legislative funding in 2018 and permanent cardiologists now on staff at HMC, funding for a second catheterization lab will allow HMC to meet the demand for these services and ensure the availability of critical lifesaving equipment,” he said. “In addition, the expansion of the oncology center will improve the general oncology clinic, treating cancers and hematology, as well as blood cancers and disorders.

“This critical funding will undoubtedly save lives and keep families together. Mahalo to my colleagues for their support,” said the senator.

HMC’s interventional cardiac program began service on January 1, 2019, with initial funding from the State Legislature in 2018. Since July 1, 2019, interventional cardiac catheterization for the treatment of heart attacks has been made available 24/7 for the residents of East Hawai‘i.

Just in the last year, over 40 heart attacks have been treated in the catheterization lab with an additional 181 patients who were electively treated with stents for heart blockages, preventing future heart attacks.

Hawaii to Receive Over $62 Million for COVID-19 Testing

The Department of Health and Human Services (HHS) is delivering $11 billion in new funding to support testing for COVID-19.

Hawaii’s total share of this funding is $62,676,098.

The Centers for Disease Control and Prevention (CDC) will provide $10.25 billion to states, territories, and local jurisdictions through CDC’s existing Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) cooperative agreement.  The Indian Health Service (IHS) will provide $750 million to IHS, tribal, and urban Indian Health programs to expand testing capacity and testing-related activities. A detailed allocation and distribution methodology will be announced for the IHS funds in the coming days. This funding is part of the Trump Administration’s broader effort to ensure that states, territories, and tribes have the resources necessary to meet their testing goals as they begin to reopen.

This funding from the Paycheck Protection Program and Health Care Enhancement Act will provide critical support to develop, purchase, administer, process, and analyze COVID-19 tests, conduct surveillance, trace contacts, and related activities. These funds, along with the previous funding support CDC and IHS provided, will help states, tribes, and territories with their efforts to re-open America.

“This funding secured by President Trump for state, tribal, and local public health activities is a historic investment in America’s ability to track and control the spread of the virus, which is essential to a safe reopening,” said HHS Secretary Alex Azar. “For the sake of all Americans’ health and well-being, we must help Americans get safely back to work and school, and that requires continued expansion of testing, surveillance, and contact tracing. The Trump Administration stands ready to support and guide states in their life-saving work to combat the virus and reopen our country.”

“As the Nation cautiously begins the phased approach to reopening, this considerable investment in expanding both testing and contact tracing capacity for states, localities, territories and tribal communities is essential,” said CDC Director Robert R. Redfield, MD. “Readily accessible testing is a critical component of a four-pronged public health strategy – including rigorous contact tracing, isolation of confirmed cases, and quarantine.  As communities move toward a blended mitigation and containment strategy, I encourage all Americans to continue to embrace powerful public health measures – social distancing, hand washing and face coverings. We are not defenseless in the battle against this pandemic.”

“These resources will greatly expand testing capacity at federal, tribal, and urban Indian organization facilities throughout the Indian health system,” said IHS Director Rear Adm. Michael Weahkee. “Testing is critical to our public health response as we work to defeat this pandemic.”

Each Governor or designee of each State, locality, territory, tribe, or tribal organization receiving funds shall submit to HHS its plan for COVID-19 testing, including goals for the remainder of calendar year 2020, to include:

  • Number of tests needed, month-by-month to include diagnostic, serological, and other tests, as appropriate
  • Month-by-month estimates of laboratory and testing capacity, including related to workforce, equipment and supplies, and available tests
  • Description of how the resources will be used for testing, including easing any COVID-19 community mitigation policies

Jurisdictions will use the funding they receive to meet the testing goals laid out in their COVID-19 testing plans, including purchasing supplies (such as test kits and other testing supplies, as necessary).

To view the list of funding recipients, visit herepdf icon.

For more information about CDC’s ongoing support to States, visit this CDC website: https://www.cdc.gov/coronavirus/2019-ncov/php/open-america/index.html

For more information about how IHS is responding to COVID-19 in Indian Country, visit this IHS website: https://www.ihs.gov/coronavirus/external icon

COVID-19 Drive-Through Testing Next Week

Premier Medical Group, with the support of The County of Hawai’i, Hope Services and the Hawaii National Guard, will offer free drive-through screenings and testing clinics at Hilo’s Civic Auditorium on Monday, May 18 from 9 a.m. until 1 p.m. Access through the Manono Street entrance. They will also offer them at the Pāhoa District Park on Wednesday, May 20 from 9 a.m. to 1 p.m.

These clinics are open to the public; however, individuals must first undergo a screening to determine if they meet the criteria to be tested. Clinic physicians on site will make the determination regarding testing. The screening criteria will be based on guidance of the CDC and the State’s COVID-19 Response Task Force.

People who visit the screening clinic will be asked to show photo ID. Additionally, people are requested to bring their own pen, and any health insurance cards they have, although insurance is not required. 

Antibody Testing

Antibody testing will also be available at the Pahoa testing clinic. Antibody testing can determine if you have previously had COVID-19. Drive-through antibody testing is available nowhere else in the state. 

Antibody testing will be offered only to those previously identified as having had the Coronavirus, or those with high risk exposures, including healthcare workers, first responders, and family members or those with close contact to known positives. A simple blood draw detects the presence of SARS-Cov2 IgG antibodies in your system. 

Note: there is a $43 out-of-pocket cost to people whose medical insurance plans do not cover the antibody test. Call your insurance provider to find out if you’re covered.

For further information, please call Premier Medical Group at 808-304-9745 or Hawaii County Civil Defense at 935-0031.

DOH Reports First Rat Lungworm Disease Case in 2020 on Maui

The Hawai‘i Department of Health (DOH) has confirmed a case of rat lungworm disease (angiostrongyliasis) contracted on Maui. The individual is a resident of Maui and is the first person this year to test positive for angiostrongyliasis in Hawai‘i. In 2019, there were a total of 9 reported cases.

The individual sought treatment and was hospitalized at Maui Memorial Medical Center. The investigation was not able to identify an exact source of infection.

“In the midst of the COVID-19 situation, we need to also be mindful of other diseases such as rat lungworm,” said Dr. Lorrin Pang, Maui District Health Officer, “With many people starting their own home gardens for self-sustainability, we’d like to remind everyone to thoroughly inspect and rinse all fresh fruits and vegetables under clean, running water. For added prevention, cooking food by boiling for 3 to 5 minutes or heating to an internal temperature of 165 degrees Fahrenheit for at least 15 seconds can kill the parasite that causes rat lungworm disease.”

Angiostrongyliasis, commonly known as rat lungworm disease, is caused by a parasitic roundworm and can have debilitating effects on an infected person’s brain and spinal cord. In Hawai‘i, most people become ill by accidentally ingesting a snail or slug infected with the parasite Angiostrongylus cantonensis (A. cantonensis).

Symptoms vary widely between cases, and the most common ones include severe headaches and neck stiffness. The most serious cases experience neurological problems, severe pain and long-term disability. 

How to prevent rat lungworm disease:

  • Control snail, slug, and rat populations around homes, gardens and farms. Get rid of these vectors safely by clearing debris where they might live, and also using traps and baits. Always wear gloves for safety when working outdoors. 
  • Inspect, wash and store produce in sealed containers, regardless of whether it came from a local retailer, farmer’s market, or backyard garden.
  • Wash all fruits and vegetables under clean, running water to remove any tiny slugs or snails. Pay close attention to leafy greens.

Pang added, “We have been routinely monitoring slug populations in vegetable gardens at a sentinel site on Maui since the earlier part of this year. The counts have remained moderate to high and we are setting up a field intervention study to control the slug population.”  

The Governor’s Joint Task Force on Rat Lungworm Disease is in the process of updating guidelines for Hawai‘i physicians, which provide clear diagnosis, treatment, and management guidance for timely identification and care for patients who have contracted the disease. The current guidelines are available at: https://health.hawaii.gov/docd/files/2018/08/RLWD_Preliminary_Clinical_Guidelines_FINAL_082918.pdf

For more information about rat lungworm disease and how to prevent its spread, visit:

DOH website: http://health.hawaii.gov/docd/disease_listing/rat-lungworm-angiostrongyliasis/
HDOA website: http://hdoa.hawaii.gov/blog/main/rat-lungworm-information/
CTAHR website: http://manoa.hawaii.edu/ctahr/farmfoodsafety/rat-lungworm/
CDC website: https://www.cdc.gov/parasites/angiostrongylus/index.html

Student Nurses’ Association Earn National Award

The School of Nursing and Dental Hygiene’s Student Nurses’ Association (SNA) at the University of Hawaiʻi at Mānoa received the Stellar School Award from the National Student Nurses’ Association (NSNA) in April. After much hard work and collaboration, the SNA board documented five years of effort to build a strong student-led nursing organization. SNA was one of three school chapters recognized nationally this year and is now one of only 39 nursing schools with the national recognition. 

The 2019–2020 SNA executive board members

The NSNA Stellar School Chapter Recognition Program recognizes school chapters that demonstrate ongoing involvement in NSNA, including a strong commitment to shared governance and professional development of their students and faculty.

The UH Mānoa chapter was praised for their strong collaborative relationship with the school and the many significant ways that members contribute. Additionally, UH Mānoa SNA members have provided meaningful service to the community by supporting community health promotion and cultural events, as well as coordinating blood and bone marrow drives on campus.

“Receiving the Stellar School award really is a highlight of the legacy this executive board will leave behind,” said Miki Matsuoka, SNA president, who will earn her BS in nursing this spring. “This award is a testament to the hard work and the dedication we have all invested into SNA. Our board members know SNA is a solid organization and we look forward to seeing where the organization grows in the future.”

SNA’s goal is to provide students with opportunities to develop leadership skills and enhance their professional nursing identity. Members of this student-led organization participate on school committees and plan various community service social and scholarly activities for students. 

“The Stellar School award recognizes the high-caliber of our Student Nurses’ Association and student leadership,” said Gary Glauberman, SNA faculty advisor. “The process of preparing the application took more than a year and a remarkable level of commitment. Student leaders of the SNA have really cultivated a spirit of compassion and excellence within their organization. It’s so exciting that the students’ efforts have now been recognized nationally, and the award is something that all UH Mānoa Nursing students can be proud of.” 

Learn more about the Student Nurses’ Association.

UH & DOH Partner on Contact Tracing Training Program

The University of Hawaiʻi (UH) is partnering with the Hawaiʻi Department of Health (DOH) to create a program to train personnel and community health workers to support DOH in conducting COVID-19 contact tracing. Health experts say extensive contact tracing is a key component to prevent the spread of the virus while relaxing stay-at-home-orders and restarting Hawai‘i’s economy.

DOH at the peak of the first COVID-19 wave had over 100 contact tracers, including at least 30 volunteers from UH and other DOH divisions with backgrounds in public health, epidemiology, medicine, and nursing. This one-year, $2.5 million program will leverage UH faculty expertise and existing courses across the 10-campus system to quickly develop content for the contact tracing training.

“This has been a brainchild of State Epidemiologist Dr. Sarah Park and UH’s own Dr. Aimee Grace, who leads our UHealthy Hawaii Initiative at the UH System,” said UH President Lassner. “We believe that these programs to expand the number of contract tracers and community health workers will really help protect all of Hawaiiʻs communities,”

The plan is to then train approximately 300 contact tracers in two to three days, or two to three months, depending on their educational backgrounds, as well as increase the university’s capacity to prepare 100 community health workers each year. DOH can then activate the trained individuals as needed, including as emergency hires, in the event of a surge in COVID-19 cases.

“With 300 staff to extend the capacity for monitoring and investigation, we expect to build the capacity up to at least 1,000 cases a day,” said DOH Director Bruce Anderson at a May 13th news conference with Governor David Ige. “Hopefully, we will not be approaching anything close to that, but we are planning for the worst and building up our capacity, accordingly.”

The university will offer two tracks for contact tracing training: a course for clinical professionals (approximately two to three days to complete for those with at least an undergraduate degree and a clinical health background) and an intensive contact tracing program (approximately two to three months for those with undergraduate degrees, health sciences preferred). All training content and materials will be approved by the DOH.

Support will be provided to trainees that complete the appropriate program and join the DOH’s volunteer Medical Reserve Corps.

The UH Community Colleges will add capacity in the community health worker programs and update curricula so that community health worker graduates will be prepared to support COVID-19 contact tracing as needed.

Community health workers are a critical component to contract tracing with their special community-based training and ties to work effectively with identified high-risk populations. Those populations include Native Hawaiian/Pacific Islander communities, which are disproportionately affected by COVID-19, along with the unemployed and homeless.

The course for clinical professionals will be led by Kristine Qureshi, Associate Dean for Research and Global Health and emergency preparedness expert at the UH Manoa School of Nursing and Dental Hygiene. The intensive contact tracing program will be led by Ricardo Custodio, Associate Professor of Health Science at UH West Oahu.

Anyone interested in the contact tracing or community health worker training can contact Sunja Kim in the UH System Office of Strategic Health Initiatives at sunja.kim@hawaii.edu.

Rep. Gabbard Introduces Bill to Prevent Forced Furloughs for Nurses During Coronavirus Crisis

Today, Reps. Tulsi Gabbard (HI-02) and Rodney Davis (IL-13) introduced the Nurse Workforce Protection Act, which would prevent a healthcare provider from laying off a significant portion of its nursing workforce or significantly reducing their hours during the coronavirus crisis as a condition for receiving federal emergency relief funds. Reps. Gabbard and Davis are leaders of the bipartisan Congressional Nursing Caucus and May 6-12 is National Nurses Week.

In April, 1.4 million health care workers, including many nurses, lost their jobs. Congress has appropriated $175 billion to help health care providers respond to COVID-19 and address lost revenue because of the virus. To be eligible for federal funding, the Nurse Workforce Protection Act requires a health care provider to retain at least 75% of its nurses and cannot reduce their pay or hours by more than 25%. Additionally, the bill prohibits providers from forcing nurses to take paid or unpaid leave.

“Nurses are our frontline heroes, putting their lives on the line during this public health crisis every single day. They deserve the support they need to do their jobs. Budgets should not be balanced on the backs of these vital workers who are saving people’s lives. This is the very reason Congress created the Provider Relief Fund in the CARES Act,” said Rep. Tulsi Gabbard. “So many of our nurses are working under extreme conditions, suffering through major shortages of personal protective equipment, being separated from their families, and working sustained emergency hours and conditions. They have our backs. We must have theirs.”

“Nurses are the backbone of our health care delivery system and if a provider is receiving federal funding, they should not be furloughing nurses,” said Rep. Rodney Davis. “Congress is providing $175 billion to our health care providers and they should be using this funding, in part, to maintain staff. This bill simply asks the same of health care providers as we have of the small businesses participating in the Paycheck Protection Program: if you’re receiving taxpayer dollars that will not be paid back, you should be using it to keep people employed.”

County Announces More COVID-19 Drive-Through Testing Locations

Premier Medical Group, with the support of the County of Hawai‘i, Hope Services and the Hawaii National Guard will offer a free COVID-19 drive-through screening and testing clinics at the following locations and days:

  • Pahoa District Park, 15-3022 Kauhale Street, Pāhoa, on Wednesday, May 13 from 9:00 a.m. until 1:00 p.m.
  • Waimea District Park in Kamuela on Friday, May 15 from 9:00 a.m. until 1:00 p.m. 
  • Kamehameha Park in Kapa‘au, North Kohala, on Saturday, May 16 from 10:00 a.m. until 2:00 p.m. 

These clinics are open to the public; however, individuals must first undergo a screening to determine if they meet the criteria to be tested. Clinic physicians on site will make the determination regarding testing. The screening criteria will be based on guidance of the CDC and the State’s COVID-19 Response Task Force.

People who visit the screening clinic will be asked to show photo ID. Additionally, people are requested to bring their own pen, and any health insurance cards they have, although insurance is not required. 

Antibody Testing

Antibody testing will also be available at the North Kohala testing clinic. Antibody testing can determine if you have previously had COVID-19. Drive-through antibody testing is available nowhere else in the state. 

Antibody testing will be offered only to those previously identified as having had the Coronavirus, or those with high risk exposures, including healthcare workers, first responders, and family members or those with close contact to known positives. A simple blood draw detects the presence of SARS-Cov2 IgG antibodies in your system. 

Note: There is a $43 out-of-pocket cost to people whose medical insurance plans do not cover the antibody test. Call your insurance provider to find out if you’re covered.

For further information, please call Premier Medical Group at 808-304-9745 or Hawai‘i County Civil Defense at 935-0031.

Senators Call for $2 Billion in Funding to Help Providers Expand Services During Pandemic

Today, U.S. Senator Brian Schatz led a bipartisan group of senators to urge the leadership of both the Senate and House of Representatives to include $2 billion in the next coronavirus relief package to help health care providers expand telehealth services by improving their access to broadband.

“The coronavirus pandemic has dramatically increased the need to expand telehealth,” the senators wrote in a letter to Senate Majority Leader Mitch McConnell (R-Ky.), House Speaker Nancy Pelosi (D-Calif.), Senate Minority Leader Chuck Schumer (D-N.Y.), and House Minority Leader Kevin McCarthy (R-Calif). “It is imperative that Congress act to ensure our front-line responders have the tools they need to combat this deadly virus.”

Telehealth allows health care providers to treat patients safely without putting themselves or their patients at risk of contracting COVID-19 and has been recommended by the Centers for Disease Control and Prevention. However, many providers – especially in rural and hard-to-reach communities – lack the resources to handle this increase in demand for telehealth services.

The senators are calling for $2 billion in additional funding to the Rural Health Care (RHC) Program, the only federal program that supports broadband deployment at urban and rural health care provider locations. These new funds would expand the RHC Program to support non-rural and mobile health care providers, eliminate administrative red tape slowing down the process of obtaining broadband connectivity, and provide more resources to help providers increase their broadband capacity.

Expanding telehealth is critical to keeping people safe during the current public health emergency. The coronavirus response legislation has included multiple provisions from Schatz’s bipartisan CONNECT for Health Act (S. 2741). These measures have helped increase access to Medicare telehealth services during the current public health emergency, allowing more patients to receive care at home, while freeing up health resources and limiting the spread of infections in emergency rooms and hospitals.

In addition to Senator Schatz, the letter was signed by U.S. Senators Lisa Murkowski (R-Alaska), Angus King (I-Maine), and John Boozman (R-Ark.).

The full letter is available here.

COVID-19: Updates for Hawaii Clinicians, Concerns Regarding Antibody Testing

The following letter was sent to Hawaii Senators from Dr. Steven Hankins, Lead Coordinator, Public Health and Medical Services Emergency Support Function (ESF-8) Hawaii Emergency Management Agency:

May 7, 2020

Dear Senators Donovan Dela Cruz, Jarrett Keohokalole, Michelle D. Kidani, Donna Mercado Kim, Sharon Moriwaki and Kurt Fevella

Thank you for your letter dated April 22, 2020, asking us to provide the Hawaii Emergency Management Agency (HI-EMA) communication plan, timing, and copies of the messages to be distributed related to concerns about COVID-19 testing in the private sector.

The State’s Joint Information Center (JIC) manages the interfaces with media and legislature to convey the Department of Health guidelines, recommendations and concerns regarding the use of information individuals might obtain from testing. Our subject matter experts have helped to craft guidance language for the Public Information Officers (PIOs) and the JIC (see below).

The Department of Health has already provided several communications for multiple audiences regarding testing. Dr. Sarah Park, the state epidemiologist, provided a “Grand Rounds” to providers on April 29, 2020 (see below), a legislative briefing on April 30, 2020 and released a medical advisory on May 1, 2020 (see below).

The Department of Health has also produced a general testing strategy for the state in response to COVID-19 (see below).

If there is additional information or communication you require, please let me know how we may provide it.

Sincerely,

Dr. Steven Hankins
Lead Coordinator
Public Health and Medical Services Emergency Support Function (ESF-8) Hawaii Emergency Management Agency

Basic Messaging for the Public and Concerns regarding antibody testing:

Most available antibody tests have not been sufficiently tested to understand how accurate or inaccurate they are. It will be a while before we know how to interpret them.

  • Some may be good and others junk.
  • Mistakes could be made by trusting these test too much before they are proven. One antibody test alone should not be used to make health care decisions.

There are a variety of tests from many companies. Each of these tests are different, so we cannot assume one test will be as accurate as another.

  • Tests from mainland China that have not been examined by the FDA should be used with caution (if at all).
  • New tests should be checked out carefully to understand what the results actually mean. A positive antibody test means the person has been exposed to a coronavirus, but it doesn’t tell you much about the timingIt means he/she was exposed 10 or more days ago.
  • It probably takes at least 10 days after exposure for antibodies to develop, but could takeseveral weeks to turn positive.
  • We do not yet know how long these antibodies stay around.
  • We do not yet know if these antibodies protect you from re-infection.
  • Different antibody tests may measure different antibodies and give varying results. Some antibody tests may turn positive even if the person was not exposed to the COVID- 19 virus.
  • There are many other coronaviruses besides the COVID-19 virus that cause respiratory symptoms in humans.
  • Other coronaviruses may cause the COVID-19 tests to be falsely positive. Coronaviruses havecommon parts so sometimes antibodies may recognize those parts instead of what’s unique to the virus of concern. This needs to be determined.
  • One positive antibody test does not mean a person is free of infection, and he/she could still be infectious.
  • Some infected patients will still be infectious for several days after their antibody test turns positive.
  • We need more data but a person may have been infectious perhaps 2-4 days after antibodies appeared based on one study. A positive antibody test does not guarantee immunity.

It is still unknown what degree of protection from future infection exists for recovered individuals and how long such protection might last.

  • Someone with a negative antibody test may still be infectious, because immunity can take 10 or more days to develop.
  • Single antibody tests cannot be used by itself to diagnose COVID-19 infection. The diagnosis is made by a clinician looking at multiple factors.
  • At present we do not have enough information to be able to use a single antibody test to decide who could return to work.
  • It may be possible that two positive tests 1 week apart would indicate that a person is non- infectious.

In the future there may be better antibody tests that would indicate someone is non-infectious

Limits and Concerns regarding PCR testing:

  • A positive PCR test with symptoms is a good indication the person has COVID-19. The person is infectious and needs to isolate.
  • Persons with symptoms are presumed to be infectious to others.
  • A positive PCR test without symptoms may mean the person has a mild infection, and may be able to spread it to others. These individuals should isolate.
  • A positive PCR test does not necessarily mean the person is still infectious to others.
  • The PCR test may stay positive for days to weeks after a person is no longer infectious. This is because the test can detect small fragments left over from dead viruses.
  • A negative test after recovering from illness is probably good evidence the person is no longer infectious.
  • A negative PCR test could be due to a poorly collected specimen—the swab must collect enough cells from the back portion of the nose and throat to detect the virus.
  • A negative PCR test could be seen early in infection.
  • One could have a negative PCR test during the early stages of infection, only to have a positivetest a day or two later.
  • There is a period of about a couple days between exposure and development of a positive test.

Click here to view all the documents: RESPONSE HIEMA (Email of April 22, 2020)

DOH: No New Cases of COVID-19 Likely Just a Lull

Today is the first day since mid-March that the Hawai‘i Department of Health (DOH) has not reported any new cases. While this is good news, it does not mean, in any way, the end of the COVID-19 crisis.

Hawai‘i State Epidemiologist Dr. Sarah Park

Hawai‘i State Epidemiologist Dr. Sarah Park said, “We have seen a steady decline in new cases over the past several weeks, although today we’re at zero, we want to maintain these declines. As businesses reopen, as people become more active and travel more freely, we will inevitably see an increase in cases.” Health experts indicate that while Hawai‘i is fortunate to have this pause, it should be used to reassess response capacity, preparedness plans, and to ensure the state is ready for a second and potentially larger wave of the disease.

Of particular concern now, is Hawai‘i residents resuming travel to the mainland, particularly to COVID-19 hotspots. Dr. Park explained, “Travel continues to pose a risk for the spread and reintroduction of the coronavirus. This risk is not just posed by visitors. Residents can actually pose a greater risk by unknowingly infecting others. When people travel for entirely appropriate and necessary reasons (work, healthcare, significant family events) they can inadvertently bring the infection home.” Park and other health experts say this is why it is critically important for everyone (visitors and residents) to observe the mandatory traveler 14-day self-quarantine. It protects our community.

The State is again emphasizing that Hawai‘i is not a “me first” culture, but a culture of “we.” This philosophy is what’s allowed control of the COVID-19 pandemic up until this point. Hawai‘i residents particularly respect our kupuna and others who may be more susceptible to this serious disease.

For that reason, DOH says the strongest defense we have against future, rapid increases in COVID-19 cases is dependent on everyone’s consistent observation of safe practices.

  • Wear a mask when you are outside your home.
  • Wash your hands frequently.
  • Keep a distance of 6 feet from non-household members.
  • Clean frequently touched surfaces often.
  • And stay at home when you are sick.

Nurses Receive Excellence Awards

Two nurses have been awarded Nursing Excellence awards at Queen’s North Hawaii’ Community Hospital (QNHCH) as the nation celebrates National Nurses Week.

Cecilia Currier

Cecilia Currier, a nurse in the Family Birthing Unit, was presented with the Nursing Excellence Award for New Knowledge, Innovations and Improvements. Cece is described by her peers as, “a woman of action.” Cece is committed to improving nursing processes and bringing education to the Family Birthing Unit. She has been a preceptor to new nurses and always advocates for what is best for patient care. Recently she was instrumental in acquiring better electronic fetal monitor bands for improved patient comfort.

Tobi Hoff

Tobi Hoff, a nurse in the Medical-Surgical Unit, was presented with the Nursing Excellence Award for Mentorship and Professional Development. Tobi is described as, “a very hard worker with a kind heart, willing to teach anybody and help her co-workers any way she can.” As a nurse preceptor, Tobi displays patience and attention to detail, and combined with her warm personality, she gives the new nurses at QNHCH a great start.

“We had the privilege to review numerous compelling nominations describing the great work done by nurses at QNHCH,” said QNHCH President Cindy Kamikawa. “These Nurses of Excellence embody the QNHCH mission by always putting patients first and pursuing excellence in clinical, educational, leadership and service. These nurses demonstrate a commitment to providing the best possible care for every patient.”

“These two awardees represent over 100 talented nurses at QNHCH devoted to excellence in patient care. Presenting these awards allows us to illuminate the talent, passion and professionalism demonstrated in action by our nurses every day,” said Kamikawa.

Big Island COVID-19 Antibody Testing Friday, Saturday & Monday

Premier Medical Group and the County of Hawai‘i are offering antibody testing at their Waimea, North Kohala and Hilo testing clinics. Antibody testing can determine if you have previously had COVID-19. Drive-through antibody testing is available nowhere else in the state. 

The next clinics that will offer antibody testing are:

• Waimea District Park — Friday, May 8 from 9 a.m. to 1:00 p.m.
• North Kohala (Kamehameha Park) — Saturday, May 9 from 10 a.m. to 2:00 p.m.
• Hilo (behind the Civic) — Monday, May 11 from 9:00 a.m. to 1:00 p.m.

Antibody testing will be offered only to those previously identified as having had the Coronavirus, or those with high risk exposures, including healthcare workers, first responders, and family members or those with close contact to known positives. A simple blood draw detects the presence of SARS-Cov2 IgG antibodies in your system. 

Note: there is a $43 out-of-pocket cost to people whose medical insurance plans do not cover the antibody test. Call your insurance provider to find out if you’re covered.

People who visit the screening clinic will be asked to show photo ID.  Additionally, people are requested to bring their own pen.

For further information, please call Premier Medical Group at 808-304-9745 or Hawai‘i County Civil Defense at 935-0031.

Hawai‘i Health Centers to Receive $3.8 Million to Expand COVID-19 Testing, Contact Tracing

 U.S. Senator Brian Schatz announced that 14 health centers across Hawai‘i will receive $3.8 million to expand COVID-19 testing and contact tracing.

“Ramping up testing is critical to reopening our economy,” said Sen. Schatz, a member of the Senate Appropriations Committee. “This new federal funding will give our local health centers additional resources to test more people for COVID-19, conduct contact tracing, and help stop the spread in our state.”

The new federal funding, which was part of the latest relief package passed by Congress, will be used by health centers to expand the range of testing and testing-related activities to best address the needs of local communities, including the purchase of personal protective equipment, training for staff, procurement and administration of tests, laboratory services, notifying identified contacts of infected health center patients of their exposure to COVID-19, and the expansion of walk-up or drive-up testing capabilities.

  • Bay Clinic on Hawai‘i Island will receive $418,489
  • Community Clinic of Maui will receive $283,774
  • Hamakua Health Center on Hawai‘i Island will receive $182,389
  • Hana Community Health Center on Maui will receive $126,904
  • Hoola Lahui Hawai‘i on Kauai will receive $153,049
  • Kalihi Palama Health Center on Oahu will receive $434,254
  • Kokua Kalihi Valley Comprehensive Family Services on Oahu will receive $270,199
  • Koolauloa Community Health and Wellness Center on Oahu will receive $185,809
  • Lanai Community Health Center will receive $130,714
  • Molokai Ohana Health Care will receive $134,119
  • Waianae District Comprehensive Health on Oahu will receive $678,814
  • Waikiki Health on Oahu will receive $236,704
  • Waimanalo Health Center on Oahu will receive $171,844
  • West Hawai‘i Community Health Center on Hawai‘i Island will receive $356,314

VASH Distributes Face Masks Across Big Island

With a $2,700 grant from Hawaii Tourism Authority, Visitor Aloha Society of Hawaii (VASH) Hawaii Island has made and distributed 500 masks across the island to police officers and 160 to other non-profits. All masks were created with specs provided by Kaiser Permanente and made by volunteer seamstresses around the island.

The organization spent over 550 hours sewing and delivering these masks to the community.

Volunteer seamstresses include Garrett Hennings, Kristina Lilleeng, Patti Millington, Deborah Stern, Dede Sutherland, and Beckie Marshall. VASH also made and delivered over 160 for other non-profit organizations including, Full Life-Empowering People with Disabilities, Special Olympics-West Hawaii, and The Children’s Justice Center-Kailua-Kona. 

“We are proud to support our community partners during this difficult time,” said Rachelle Hennings, Executive Director for VASH, Hawaii Island. “We feel it’s important to help our first responders as they risk their lives every day to help the visitors and residents of Hawaii Island.”

To donate to VASH click here.

Hawaii Part of Consortium to Better Map SARS-CoV-2 Transmission

The Center for Disease Control and Prevention (CDC) has kicked off the SARS-CoV-2 Sequencing for Public Health Emergency Response, Epidemiology and Surveillance (SPHERES) consortium, which will greatly expand the use of whole genome sequencing (WGS) of the COVID-19 virus.

This national network of sequencing laboratories will speed the release of SARS-CoV-2 sequence data into the public domain.

SPHERES will provide consistent, real-time sequence data to the public health response teams investigating cases and clusters of COVID-19 across the country. It will help them better understand how the virus is spreading, both nationally and in their local communities. Better data, in turn, will help public health officials interrupt chains of transmission, prevent new cases of illness, and protect and save lives.

“The U.S. is the world’s leader in advanced rapid genome sequencing. This coordinated effort across our public, private, clinical, and academic public health laboratories will play a vital role in understanding the transmission, evolution, and treatment of SARS-CoV-2. I am confident that our finest, most skilled minds are working together to help us save lives today and tomorrow,” said CDC Director Robert Redfield, M.D.

Tracking the COVID-19 virus as it evolves

Genomic sequence data can give unprecedented insight into the biology of SARS-CoV-2, the virus that causes COVID-19, and help define the changing landscape of the pandemic. By sequencing viruses from across the United States, CDC and other public health authorities can monitor important changes in the virus and use this information to guide contact tracing, public health mitigation efforts, and infection control strategies.

The SPHERES consortium is an ambitious effort to coordinate SARS-CoV-2 genome sequencing nationally, organizing dozens of smaller, individual efforts into a single, distributed network of laboratories, institutions and corporations. The consortium combines the expertise, technology, and resources of 40 state and local public health departments, several large clinical laboratories, and over two dozen collaborating institutions across the federal government, academia, and the private sector.

SPHERES will establish best practices and consensus data standards, accelerate open data sharing, and establish a pool of resources and expertise to help bring cutting-edge technology to the national COVID-19 response.

SPHERES data open, shared

Consortium members share a commitment to rapid open sequence sharing. They plan to submit all useful sequence data into public repositories at the National Library of Medicine’s National Center for Biotechnology Information (NLM/NCBI), the Global Initiative on Sharing Avian Influenza Data (GISAID), and other public sequence repositories. This will help ensure that that viral sequence data from across the United States is rapidly available for public health decision making and freely accessible to researchers everywhere.

Consortium members include:

Federal agencies and laboratories

Centers for Disease Control and Prevention, Office of Advanced Molecular Detections, Argonne National Laboratory, National Institute of Allergy and Infectious Diseases, Office of Genomics and Advanced Technology, National Institute of Standards and Technology, National Library of Medicine’s, National Center for Biotechnology Information and the Walter Reed Army Institute of Research

State/local public health laboratories

Arizona, California, Delaware, District of Columbia, Florida, Hawaii, Massachusetts, Maine, Maryland, Michigan, Minnesota, North Carolina, New Mexico, North Dakota, Nevada, New York, Utah, Virginia, Washington, Wisconsin and Wyoming.

Academic Institutions

Baylor University, Cornell University, Fred Hutchinson Cancer Research Center, Mount Sinai School of Medicine, New York University, Northern Arizona University, University of Buffalo, University of California, Berkeley, University of California, Davis, University of California, Irvine, University of California, Los Angeles, University of California, San Francisco, University of California, Santa Cruz, University of Chicago, University of Maryland, University of Minnesota, University of Nebraska, University of New Mexico, University of Washington and Yale University

Corporations*

Abbott Diagnostics, bioMérieux, Color Genomics, Gingko Bioworks, IDbyDNA, In-Q-Tel, Verily Life Sciences, LabCorp, One Codex, Oxford Nanopore Technologies, Pacific Biosciences, Qiagen and Quest Diagnostics

*Names of corporations are provided for information purposes only, and their inclusion here does not constitute an endorsement of the corporations or any of their commercial products or services by the U.S. Centers for Disease Control and Prevention.

Non-profit public health or research institutes

Association of Public Health Laboratories, Bill and Melinda Gates Foundation, Broad Institute, Chan Zuckerberg BioHub, J. Craig Venter Institute, Public Health Alliance for Genomic Epidemiology, Scripps Research, The Jackson Laboratory, Translational Genomics Research Institute – North and the Walder Foundation

For the past six years, CDC’s Office of Advanced Molecular Detection program has invested in federal and state public health laboratories to expand the use of pathogen genomics and other advanced laboratory technologies for infectious disease surveillance and outbreak response. The current consortium investment aims to save lives in the SARS-CoV-2 pandemic and prepare the United States and the world for future pandemic response.

To learn more about genomic sequencing or CDC’s work in advanced molecular detection, visit https://www.cdc.gov/amd/

Rapid Response Program Launched to Flatten Eviction Curve

The COVID-19 pandemic has left a significant number of Hawai’i’s employees without work, wondering how to cover rent or mortgage while they wait for unemployment benefits, SBA loans, and other financial assistance to arrive.

In order to flatten the eviction curve, a multi-sector stakeholder team convened to develop a Rapid Response Landlord Tenant Mediation Program. The program will be offered through West Hawai‘i Mediation Center and Ku‘ikahi Mediation Center, with the goal of providing timely conflict prevention and resolution services to commercial and residential landlords and tenants.

“Everyone is concerned about meeting their financial obligations in these tough economic times,” said Council Member Ashley Kierkiewicz. “There is incentive for everyone to work together. By encouraging communication on the front end and finding ways to work it out, we can ensure some level of stability and prevent a tsunami of evictions and foreclosures.”

Under the Rapid Response program, WHMC and KMC mediators will assist both landlords and tenants by brokering frank dialogue about finances before bills pile up and situations escalate.

Eric Paul

“We know from the 2008 recession that economic downturns lead to an overwhelming influx of housing related challenges that often rely on our judicial system to manage,” said Eric Paul, Executive Director of WHMC. “We don’t want to wait for the courts to reopen. We want to help our community members get ahead of these challenges now.”

Governor David Ige issued a moratorium on evictions through May 31. There is a temporary moratorium on eviction filings through July 25 for residential properties that participate in federal affordable housing programs including properties with Section 8 vouchers, or are financed by federally backed mortgage loans from HUD, the VA, the USDA, Fannie Mae, Freddie Mac.

“There is a lot of confusion about the state proclamation and the federal CARES Act regarding eviction moratoriums,” said Kehau Costa, Executive Officer of Hawai‘i Island REALTORS®. “Despite the moratoriums, rent still accrues for tenants and mortgage payments still accrue for landlords. We encourage proactive conversations to prevent misunderstandings, explore available options, and create agreements to avert further financial hardship or the need for later legal action.” 

Mediation looks for mutually satisfying solutions for all parties. The Rapid Response program is geared towards providing education about available resources to assist both landlords and tenants, and helping negotiate positive outcomes for all involved. 

“I’ve heard several real-life stories of people in some touch and go situations,” said Julie Mitchell, Executive Director of KMC. “One is a usually self-employed friend who is now relying on a rental home for income. When one of her tenants lost his job, she creatively suggested a 3-month temporary agreement cutting the rent in half. The tenants got to stay in place and she got to keep getting much-needed partial rent.”

“Another story I heard was of a colleague’s mom, who has been in business over 40 years. Due to the closure of all non-essential businesses in Hawai‘i, she had to shut her doors and lay off her staff. She reached out to her landlord to ask for rent forbearance or reduction. The landlord told her if she didn’t pay, she was going to have to face the consequences,” said Mitchell. “An alternative would be for our mediators to act as a go-between to help this businesswoman and her landlord talk it out.”  

The mediation centers are offering the Rapid Response program free of charge to any commercial or residential landlord or tenant in Hawai‘i County. While social distancing remains in place, all mediations take place via phone or video conferencing.

In East Hawai‘i, call Ku‘ikahi Mediation Center at (808) 935-7844 or visit hawaiimediation.org. In West Hawai‘i, call West Hawai‘i Mediation Center at (808) 885-5525 or visit whmediation.org.

The Rapid Response Landlord Tenant Mediation Program is supported by initial funding from the County of Hawai’i, Hawai‘i Community Foundation, Hawai‘i Island REALTORS®, and West Hawai‘i Association of REALTORS®.

STUDY: Native Hawaiian & Pacific Islander Communities Hardest Hit by COVID-19

A new study from the University of Hawaiʻi at Mānoa John A. Burns School of Medicine (JABSOM) reports that the highest rate of COVID-19 positive cases in several U.S. states, including Hawaiʻi, are among Native Hawaiians and Pacific Islanders (NHPI) more than other racial and ethnic groups.

The research showed as high as 217.7 cases per 100,000 in NHPI residents in at least five states—Hawaiʻi, California, Oregon, Utah and Washington. The rates of COVID-19 positive cases within these states are greater than those reported for African Americans and American Indians, two racial/ethnic groups that have been receiving much of the national attention regarding COVID-19 risk.

Indigenous peoples share similar concerns that put them at an increased risk for COVID-19 and other related problems. These include limited access to healthcare services, more chronic and infectious diseases and poorer economic and living conditions. 

Keaweʻaimoku Kaholokula

“These are all long-standing health concerns for indigenous people that predate the arrival of COVID-19, but they are even more concerning now,” said Keaweʻaimoku Kaholokula, professor and chair of JABSOM’s Department of Native Hawaiian Health, who has been tracking and analyzing the data.

Issues linked to higher risk

According to Kaholokula, the higher risk of infection among NHPI is linked to preexisting and underlying inequities in the social determinants of health across racial and ethnic groups that are ubiquitous in the U.S. These include:

  • High rates of chronic disease. NHPI have among the highest rates of these chronic medical conditions, and associated mortality rates, compared to other ethnic groups in Hawaiʻi as well as the larger U.S.
  • High rates of smoking and vaping. NHPI, especially adolescents and young adults, have the highest rates of smoking and vaping compared to other racial and ethnic groups. Poor access to quality health care. About 20 percent of NHPI are uninsured compared to 11.4 percent of non-Hispanic whites.
  • Overrepresentation in the category of essential workers. A large percentage of the NHPIcommunity is comprised of essential workers, with heavy representation in the military, security, service and healthcare industry.
  • Lower wages and poorer economic and living conditions. Service-related jobs often do not provide a livable wage. NHPI are more likely than many other ethnic groups to have fewer financial resources and live in larger multi-generational households and densely populated neighborhoods.
  • Overrepresentation in the incarcerated and homeless population. Native Hawaiians alone comprise 43 percent of the prison population and, on Oʻahu alone, 39 percent of the homeless population.

Kaholokula said, “Despite the higher COVID-19 risk among NHPI, it is important to remember and recognize the resiliency and fortitude of NHPI, communities and their cultural assets that can be leveraged to reduce the adverse impact of COVID-19. NHPI communities continue to flourish while maintaining their unique cultural values, perspectives, practices and aspirations.”

Read more about the research on the JABSOM website.