Coronavirus in Hawai‘i: How Hospitals Prep for a Pandemic

Before the rest of us knew enough to worry about something called a coronavirus, Hawai‘i’s top hospitals had quietly begun planning. Here’s how some of the state’s largest health care providers got ready for what could be the biggest, deadliest disease threat our community has faced.
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photos: courtesy of the queen’s health systems

 

Dr. Scott Gallacher knew planning for a pandemic would be different from any other disaster he’d encountered.

 

“A normal disaster is just a moment in time. It’s usually a single event,” like a hurricane or plane crash, says Gallacher, who’s worked in intensive care units and helps run operations at The Queen’s Medical Center. “This is multiple events happening over a longer period of time. There’s no clear beginning to this nor is there a clear end.”

 

Gallacher says Queen’s, as the state’s primary trauma center, was already gearing up for flu season late last year. Temperature screening points were at hospital entrances by the time COVID-19 became our daily companion. Next, triage tents were set up outside the ER so staff could test people for the disease without risking contamination inside. When the case count climbed, officials closed all but two entrances: the main lobby and the emergency room.

 

By mid-March, Gallacher says the hospital had scaled back elective medical procedures and diagnostic tests and shifted walk-in doctor visits to telemedicine to protect against the disease—described as three times more infectious than the flu, with no vaccine and no proven treatment. Queen’s also created a medical surgical unit specifically for COVID-19 patients, along with an ICU with a dedicated and specially trained staff.

 

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Scenes from The Queen’s Medical Center.

 

Looking at what happened in hard-hit Italy, New York and Washington state, Queen’s and Hawai‘i Pacific Health assessed critical equipment such as ventilators and personal protective equipment, as well as staff, to determine where they needed more help.

 

Dr. Melinda Ashton, Hawai‘i Pacific Health’s chief quality officer, says communication and coordination are critical among hospitals and government leaders: “We report ICU beds, ventilators every day, how many patients and what kind, so they know if one hospital is becoming overwhelmed.” Ashton, a pediatrician with expertise in infectious disease, is the clinical lead for COVID-19 for the hospital network that includes Kapi‘olani Medical Center for Women & Children, Straub Medical Center and  Pali Momi Medical Center on O‘ahu and Wilcox Health on Kaua‘i. She says HPH also discussed which medical centers could handle certain specialties best if many people were to require care at once. So, for example, Kapi‘olani could take on delivering more babies or admit sick kids from other hospitals. Those hospitals could then accept more sick adults.

 

When Queen’s asked the public for medical-quality donations of N95 masks, surgical masks and more, Gallacher says the response was tremendous, coming from scores of private medical offices that were closed or people who had ordered supplies early. “We’ve had local companies help to make face shields. We’ve seen a lot of creativity.” Even the tents outside the ER were donated by local businesses, he says.

 

Ashton says HPH and other local hospitals have adequate protective gear for normal operations, but they also have no idea when they will receive more. That means examining what gear can be reused: “These are things that we would never have done before,” she says. “It’s such a mind-shift for everyone in health care to reuse something we would always throw away.”

 

So how ready was Hawai‘i? “I think at this point we’ve used the lead time that we have as best we can,” Gallacher said in late March.

 

Both doctors emphasized the value of people staying put in their houses as much as possible. “This virus has a lot of attributes as to how it’s able to affect people,” Gallacher says. “The one thing it doesn’t have is legs. We give it legs.”

 

This story was written in late March, in time to meet our May print deadline. Please keep up with the latest developments on our website here.

 

Read more stories by Robbie Dingeman