Thermal Stress, Skeeters and Salmonella: Hawai’i‘s 2020 Health Forecast

On the eve of the second Hawai‘i Climate Change Conference, a talk with Health Department director Bruce Anderson on what climate change could have in store for us this year, and in years to come.


Bruce Anderson

Photo: Courtesy of Bruce Anderson


For our November story on Hawai‘i’s doctor shortage, HONOLULU talked to a wide spectrum of health professionals, including several in the Department of Health and doctors, insurers and nurse practitioners. Almost all mentioned the role climate change is going to play in our Island future. Here, just before the second Hawai‘i Climate Change Conference kicks off next week, we talk to health director Bruce Anderson to get a broad view on the role climate change is already playing in our state.


HONOLULU Magazine: When did the health department become aware, or perhaps worried is the better word, about climate change?

Bruce Anderson: Climate change wasn’t thought to be a major public health issue until recently. Today it is a top priority. We received a federal grant of over $15 million that we used to develop response programs and to help make people more aware. That was after we had two near misses from Hurricane Lane and Hurricane Olivia and other numerous severe weather events.


SEE ALSO: Spares—and Strikes: Climate Change is Opening a Fast Lane for Hurricanes


HM: Looking at the short term, what are the biggest concerns on your short-term horizon? 

BA: The most obvious are injuries and deaths. But sea level rise and temperature rise also have health impacts. First of all, there’s thermal stress. Respiratory illness and cardiac illness are exacerbated by increasing temperatures. We’ve seen that happen in Chicago and other cities where dozens of people died due to high temperatures. We anticipate that we will see more and more people affected.


HM: What other ways are people going to feel the change?

BA:  We anticipate an increase in bacteria, particularly salmonella. I anticipate seeing more food poisoning and other related problems. And we’ve already seen some of the effects in outbreaks of dengue and other mosquito-borne diseases. We had dengue outbreaks in 2001 that affected Maui, in Hanā, that we stopped through very aggressive mosquito patrols. The outbreaks lasted for many months and eventually burned themselves out. We’re lucky that we haven’t had Zika here; it’s a big problem in Tahiti and other places in the Pacific, a serious disease with unborn children at most risk. But it can cause long term health problems in children affected early in life, too.


I think there’s a premonition among experts that as it gets warmer we’re developing more habitat for mosquitoes and also habitat for the kinds of mosquitoes we don’t normally see, such as the aegyptai, that spread certain diseases like Zika, dengue, chikungunya.


HM: Does ocean temperature rise play a role?

BA: We haven’t had toxic algae blooms here, so I’m cautiously optimistic about that. But we have seen coral bleaching in the near-shore environment. It’s had a devastating effect on West Hawai‘i, where 50% of corals were killed. That certainly has a direct impact on health. You would expect a proliferation of algae when you have bleaching. Eventually, algae cover the reefs and then you have a whole change in biota, on many of the fish that are suitable for consumption.


HM: How does that manifest?

BA:  We may see more people with ciguatera fish poisoning. Once you get more algae, it’s possible we’ll see more of the dinoflagellate microscopic organism that will produce toxins build up in the food chain. There will be more ciguatera poisoning in the food chain, and a chain of different impacts.


HM: What about rat lungworm disease? Any premonitions?

BA: It’s been around a long time, carried by a slug called a semi-slug. It’s now all over the Big Island, and is on all Islands now. The semi-slug is particularly effective in transmitting the parasite in the cycle between rats, soil and slugs. Part of the recent visibility of the issue is that it’s now more easily diagnosed and recognized. Typically, people would have flulike symptoms and if they didn’t go to a hospital no one would know what they had. It was not often life-threatening; people often weathered the storm. The symptoms, stiff neck and pains, well, we all have those as we get older. So unless it was a serious case it was rarely diagnosed. Now it’s more recognized by physicians and they know to ask patients if they have a history of eating raw vegetables.


HM: Is the semi-slug becoming more prevalent due to climate change?

BA: It’s hard to say if that’s climate change. Semi-slugs may do better in warmer climates; we’re still trying to figure that out, how exactly it’s transmitted and why it’s becoming more widespread. Rat lungworm has been around 50 years and we had six cases this year and I’m sure that’s just a fraction of the actual number of cases.


HM: On the Mainland, warmer weather is part of what made Lyme disease explode. Deer ticks, right?

BA: I went to Yale for graduate school and did the original research at Old Lyme, Connecticut. I was out there collecting ticks and they’d just identified a possible vector. I met with my counterpart in Virginia and we had ticks all over our legs after walking through a field—three or four on my legs. Casually, I said I noticed all these ticks. He said: We’re seeing far more now than we ever saw before, because it’s warmer. More ticks, more diseases.


HM: Does Hawai‘i have deer ticks?

BA: We don’t. But that may change.


HM: Rat lungworm gets a lot of attention because it’s so creepy, like something out of Alien. But what health effects of climate change are people overlooking?

BA: The thing that people don’t talk at all about is the mental health and stress issues. First, we’ll expect to see a lot of Pacific Islanders displaced as their homes will be underwater. Many will come to Hawai‘i and they’ll bring diseases we don’t see here often, such as tuberculosis. And many don’t have the means to live comfortably in Hawai‘i so that will put stress on our health system and infrastructure.


We saw a lot of that in the volcanic eruption. People who went through it are still recovering today. Although it’s hard to measure, those who were displaced were traumatized and many of their lives were disrupted to the point that it’s taking years to recover.


We also saw that in Kaua‘i where the flooding caused a lot of mental health stress. And a lot of behavioral health problems.


HM: What about the debate over how to treat all the people with mental health issues on the streets? Some say involuntary commitment is the only way to go for some of them.

BA: Today at the state hospital in Kāne‘ohe we’re at overcapacity. Yet we are ordered to accept court-committed patients, typically the very mentally ill who need a secure environment. We’re just now building a new secure facility. We broke ground in November [2018] and expect it to be competed in May 2021. We’re very pleased to have more capacity here, but we haven’t made a lot of progress in building out the continuum of care needed for patients discharged and those who don’t really need to be in state hospital.


These are patients who are seriously mental ill, many schizophrenic. We don’t really have the hospitals and community-based programs for these patients. We need a place to send those people and it simply doesn’t exist. Often, they end up in emergency rooms. They’re in the streets and the police get a call, then they need to be hospitalized and examined. And if the ER people don’t think they need that level of care, many are discharged within hours or a day—and many end up right back in the ER.


Not having short-term treatment is a big gap.


HM: It can’t be good that people are losing their homes and we’re in the middle of an affordable housing crisis.

BA: There will be a lot of attention to sea level rise and the impact on housing and infrastructure.


HM: To sum up, what do you see in your and our 2020?

BA: We can’t do much about climate change here. The truth is, there are going to be big impacts and we need to be prepared for them.


The most immediate worries are the severe weather events. For extreme weather events, we need to make residents more weather-aware so they prepare accordingly. We need to educate people on some of these other issues, such as stress and mental health. We can prevent some of the infectious and chronic diseases that can occur by anticipating them.


These are the kinds of issues that we worry about. They weren’t on our radar 10 years ago.