Winter Surge Ahead For COVID-19, Hawaii Reopens Tourism

By Edwin Quinabo

Waiting for a coronavirus vaccine before business as usual can resume makes sense in a perfect world. But in a perfect world, the virus would not exist.

The reality is that for some there will be no business to return to since lockdowns put a clamp on economic activity to a point of no return.

It’s the same story in cities throughout the U.S. – community spread, lockdown, economic fallout, infections drop, reopen, infections up, lockdown. The only difference from state to state is the timing that governors decide to act on when “enough is enough” of community infections measured against economic health.

Hawaii residents found out they too were no exception to this futile, catch-22 pattern of weighing human loss to capital and financial loss. The state registered stellar numbers in the Spring, only to find a summer bust (10% increase) as regulations eased to help the state’s flailing economy. A second state lockdown was ordered, then lifted.

On Oct. 15 Gov. David Ige launched a new pre-travel testing program that allows Hawaii-bound travelers who provide negative virus test results within 72 hours of arrival to sidestep two weeks of quarantine. But travelers can still elect to quarantine instead of showing a test result.

What this program basically does is it initiates an ambitious reopening of the state’s economy as tourism gets the green light; at the same time, aims to minimize new COVID-19 cases.

After months the state finally has undergone its biggest risk – and at a time when the coronavirus pandemic is expected to reach a peak in the fall-winter surge. Health experts warn there is no room for coronavirus fatigue and no time to let up on wearing a mask or let up on social distancing.

While Hawaii’s new pre-travel testing is not perfect, some say the program at least is an added layer of protection while the state begins to reopen tourism.

Hawaii officials say travelers must get a specific type of coronavirus screening, a nucleic acid amplification test, and load their information onto a state website and mobile app that officials will use to track incoming passengers.

The most glaring problem with the pre-travel testing and quarantine option is – those choosing the quarantine route unknowingly could be COVID-positive, board the plane and infect a passenger who previously tested negative 72-hours prior.

Dr. Anthony Fauci, the nation’s top infectious disease expert, commented on Hawaii’s new pre-travel testing program, “The reality is, no matter what you do, there are going to be infected people who slip through the cracks. It’s inevitable. I can understand the anxiety of people on the islands saying, you know, if you just do a test 72 hours earlier and that’s all you do, then that’s not going to be enough. You’re not going to get everybody, but statistically, you’re going to dramatically diminish the likelihood that an infected person enters.” He also said adding some kind of secondary screening would help.

Aiea resident Jeoffrey Cudiamat, who owns his own engineering company Structural Hawaii, Inc. said he supports the pre-travel testing program and quarantine. “It (pre-travel testing program) will help identify and contain the spread of COVID-19. Safety measures should be implemented to the greatest extent practical, and government should absolutely open the proverbial doors for tourism, even if it’s not at full capacity.”

COVID-19’s Winter Surge
Coinciding with Hawaii’s reopening of tourism is an expected peak of the virus on the horizon.

Dr. Fauci has long advocated for the nation to get the number of infections down before the fall and winter because the cold weather that keeps people indoors for longer hours is bound to spike community spread.

Current status. But that pre fall-winter surge preparation to get infections down has failed.

*As of Oct. 11, there has been 7.9 million confirmed coronavirus cases and 218,746 deaths in the U.S.
*More than half (31 states) of the country are seeing increases in coronavirus cases by at least 10 percent, Johns Hopkins University tracking shows. Ten of 50 states have been reporting record one day rises. States with rising rates have seen upticks for two straight weeks.
*Hospitalization is trending up with nine states near capacity.
*The U.S. has broken records for daily COVID-19 cases six times in the past two weeks. The nation recorded its highest-ever daily count on July 8: more than 60,000 infections.

Dr. Fauci said “The models tell us if we don’t do what we need to in the fall and winter, we could have 300,000- 400,000 COVID-19 deaths.” That is potentially double the current COVID-19 deaths in just three to four months, compared to almost the same number of fatalities spread along nine months.

He said the fall-winter surge is not considered a second wave of the pandemic because the nation had yet to see a considerable drop of the virus nationally.

Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, said “I do think the fall and the winter of 2020 and 2021 are going to be probably one of the most difficult times that we’ve experienced in American public health.”

He expressed particular concern for the coronavirus infections coinciding with flu cases.

A coronavirus-flu convergence, often called a “twindemic,” is a nightmare scenario for health officials and medical systems. Doctors worry they’ll have to deal with flu epidemics on top of the COVID-19 pandemic.

The projected surge is grimmer when considering that a vaccine would not be available sooner than mid2021. Dr. Fauci says even when a vaccine is available, it would take a while before the U.S. is back to normal. He said “normality will be maybe the third quarter or so of 2021.”

Research suggests that colder temperatures could boost coronavirus transmission, but the greater threat is hospital overcrowding during flu season.

Flu season in the U.S. typically arrives in October and then peaks from December to February. An estimated 12,000 to 61,000 Americans die of the flu every year. Influenza cases could place further strain on hospitals already stretched thin by COVID-19.

“Flu vaccines will not prevent COVID-19, but they will reduce the burden on our health care system due to flu-related illnesses, hospitalizations and deaths. Getting your flu shot helps conserve scarce medical resources for the care of people with COVID-19.”

— Ron Balajadia
Immunization Branch Chief, the State of Hawaii Department of Health (DOH)

Flu Season and importance of getting a flu shot
Dr. Seema Yasmin, director of the Stanford Health Communication Initiative said “having one of the two viruses (flu/influenza or COVID-19) can make you more vulnerable to getting infected with the other. Your defenses go down, and it makes you vulnerable to getting the other virus.”

Having both would be catastrophic to your immune system.

Health professionals say getting a flu shot this year may be more important than ever.

Lorna Reyes, Kapolei, said she has never gotten a flu shot but plans to this year. “I’ve been very fortunate not to get the flu in a very long time. I’m in my 50s and I can’t remember when was the last time I got the flu. So, I never felt the need to get the flu shot. There have been several times that I never had health insurance while in between jobs which is another reason why I avoided it.

“But this year, I need to be safe and get it, no matter how much it costs. We have a household of four people, myself, my husband, daughter and her fiancée. We all plan to get shots. We are doing it for our own safety and for each other. We know that living under the same roof means if one of us gets infected with COVID or the flu, the chances are high for all of us to get infected,” said Reyes.

Health experts say getting vaccinated with the influenza vaccine (flu shot) can help lesson symptoms, shorten the time of sickness to 1-2 days, prevent serious complications (pneumonia, dehydration, inflammation of the heart and brain, multi-organ failure and death).

The State of Hawaii Department of Health (DOH) is recommending people get their flu shot early, by the end of October.

Immunization Branch Chief Ron Balajadia said, “Flu vaccines will not prevent COVID-19, but they will reduce the burden on our health care system due to flu-related illnesses, hospitalizations and deaths. Getting your flu shot helps conserve scarce medical resources for the care of people with COVID-19.”

People at high risk for the flu are young children, older people, pregnant women and people with chronic health conditions.

Cudiamat got his flu shot early this year. He says he doesn’t always do it each year, “but it seems wise to do it, especially now under these conditions. With COVID-19, the additional threat of the flu can easily compromise one’s health.”

Cost and where to get your flu shot
Flu shots are free for Medicare enrollees, for veteran and military families. Most Kaiser Permanente members have nocost for flu shots; most health plans also offer free-to-discounted flu shots.

Flu shots are available at most big-box pharmacies, Costco, CVS, Target, Walgreens, Walmart, Rite-Aid by appointment or walk-ins.

For those without health insurance, the average cost of a flu shot at a big-box pharmacy is $40, at some Urgent-care clinics $25. Some federally funded health centers and state departments have flu shots for free or at a low cost to the uninsured, depending on income.

“We can prevent both influenza and COVID-19 together by continuing to follow safe practices to prevent the spread of germs,” added Balajadia.

“Remember to also avoid touching your eyes, nose and mouth with unwashed hands, and to frequently clean and disinfect commonly touched surfaces and objects like doorknobs, light switches and cell phones.”

How do you know if you have the flu or coronavirus?
Both illnesses share the same common symptoms, including fever and chills, cough, shortness of breath, fatigue, sore throat, runny or stuffy nose, muscle pain, body aches, headache, vomiting, and diarrhea. The key difference between the two illnesses concerns the sense of smell, the CDC points out. The sudden loss of smell and taste is associated with COVID-19, not the flu.

Other ways to protect yourself in the fall-winter
Health experts want to clarify that the cold in winter itself does not raise a person’s chance to get infected, but the extended hours spent indoors because of the cold weather. Hawaii temperatures do not drop very low, but winter is Hawaii’s rainy season and could increase time spent indoors.

*Hold events outdoors. Vanderbilt University Medical Center’s Division of Infectious Diseases recommends that interactions at indoor venues be kept to a minimum or avoided. If a gathering must take place, it should be held outdoors with heated lamps.

On expected rainy days in Hawaii, outdoor gatherings could be in held in garages or patios, or in public spaces where there is a roof covering but open space.

*Wear a mask. Health experts say that wearing a face mask is one of the easiest and most effective ways to prevent exhaling viral particles.

For the projected fall-winter surge, if 95 percent of Americans wear a mask, it could be a difference from 3,000 daily deaths in late December down to 1,000.

• Avoid or keep traveling to a minimum.
• Visit family and friends sparingly.
• Try virtual holiday celebrations.
• Act like you’re contagious. Many who are infected are asymptomatic so following all CDC safety guidelines like wearing a mask and social distancing should be a practice for everyone.

While pandemic fatigue is common, which is another reason health experts predict a surge in the fall-winter, others keep disciplined. “I am still cautious during this pandemic situation. I have many friends who are in healthcare, and they have seen the outbreak firsthand. I wear my mask in public and observe social distancing,” said Cudiamat.

Who to blame with the handling of the coronavirus?
Local government. Cudiamat said while he is not fatigued with the pandemic (practicing CDC safety guidelines), as a small business owner he is frustrated with the government’s handling of the coronavirus.

“I feel that local government should relax its stranglehold on small businesses. If big box stores can open for business with many people in close proximity, then small businesses should be able to do the same also. I think mandates such as wearing a mask and other precautions can be implemented fairly simply. I also think the government should allow families to attend the beaches, dine in, play at a park, and do other things together without having to be limited to 2 or 4 people. Being able to live together but not being able to go to a public place together just doesn’t make sense.”

While Gov. Ige, who is not up for reelection in this General, would be the person to hold accountable in the way government is handling the virus locally, political analysts say voters might take out their frustration on the Democratic party, because in Hawaii’s case the state’s leadership is Democratic.

Placing accountability on state and local leadership holds true anywhere– Democrat-led or Republican-led. State governors whether they are up for reelection or not represent their political party. Political analysts say if voters are not happy with their state’s leadership in handling the coronavirus, their governor or governor’s party could be held responsible at the polls.

Federal government. But more commonly voters are looking to the President for accountability of COVID-19. A typical example of missed opportunity by the President is his inaction on a recent CDC proposal.

The Centers for Disease Control and Prevention last month drafted a sweeping order under its “quarantine powers” that would require all passengers and employees to wear masks on public and commercial transportation in the United States, from airplanes to buses to rail and trains.

The New York Times reported that the White House blocked that order which what would have been the toughest federal mandate to date to help stop the spread of the coronavirus.

Health experts say the lack of implementing federal regulations as this latest one is just one area where the president’s leadership has failed. State and local government arguably have the last authority to decide how to combat COVID-19, but critics say that shouldn’t be stopping the President from uniting governors to come up with uniformed policies, uniformed safety guidelines and better coordination among states.

This is what leadership is, making the difficult possible. And the president hasn’t delivered on that — Trump’s detractors commonly say.

A local RN who works at a military hospital in Hawaii, Letty (requested last name be withheld) said the President should be held accountable this election. “The President keeps ignoring recommendations from public health professionals, even those on his own Coronavirus task force. Hot spots keep popping up in one state, go down, then flare up again. How can we get over the virus when people travel and move around?

“Each local government have their rules. Policies across the country are patchwork, and enforced on different time schedules. It’s just chaos after another from state to state, and why, because there is chaos coming out of the White House. Look, the White House is now a hotspot. If the President cannot control the virus from spreading in his own home and office, it’s no wonder why we’re in this crisis. Why were other countries able to control the virus but not us? It’s because they don’t have our leader. It’s Trump’s fault,” said Letty.

As a health professional, Letty admits to being partial as she sees public health experts being ignored by Trump. She says hospital employees cannot speak freely about COVID-19, especially since her employer is the military.

“Sure we can talk among ourselves, but we have to be careful with what we say publicly. I know the situation as bad as it is could get worse, definitely on the mainland this winter like what I hear in the news. But just like Trump always does, he’s not warning people to prepare. He’s acting like everything is ok. He’s had this same attitude of underestimating the virus, and lying about it, too. All he’s doing now is campaigning, not talking about the number of infections on the rise all around us or how it could get worse,” said Letty.

She said she’s already gotten her flu shot and maintains proper safety rules.

As for Hawaii’s cautious approach to handling COVID-19, Letty said, “As a health care professional, maybe I’m biased again because for me safety comes first, and I have a secure job. I don’t live in a bubble so I do understand our local people are hurting and want to open tourism and relax regulations a bit because of money. I get it.

“But we cannot just point the finger at the governor. We live on an island so he is right to be extra, extra careful. I notice the people always complaining are the ones who don’t follow the rules. Try respecting the rules and everyone around you and maybe we can get back to normal faster,” said Letty.

Public health experts attribute Hawaii’s summer outbreak to low testing per capita and not having enough contact tracers. Hawaii still has one of the fewest coronavirus deaths per capita.

Since the state’s second lockdown, numbers have improved slightly and stabilized from consecutive triple-digit new infections daily to under a hundred. The total infections in Hawaii (as of Oct. 11) is 13,472 and 169 deaths.

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