Hawaiʻi is on the verge of a critical situation with the healthcare system. Each island is struggling with how to reduce the number of COVID-19 cases and hospitalizations.

Officials continue encouraging more vaccinations and expanding COVID-19 testing. Hawaiʻi County has an uneven vaccination rate with East Hawaiʻi up and West Hawaiʻi down — the latest COVID-19 count reports 87 new cases.

The Conversation talked to Hawaiʻi County Mayor Mitch Roth on Wednesday morning about the latest hospital capacities and possible restrictions if hospitalizations continue to increase.

Queen's North Hawaiʻi Community Hospital was operating at capacity Wednesday morning. At Hilo Medical Center on Monday, all 11 intensive care unit beds were occupied — six by COVID-19 patients, Roth said.

"What a lot of people don't realize is it's more than just COVID. When you have people waiting in the emergency rooms, that slows down service," he said. "We're right there at the edge."

"We're not where they've been on national television in places like New York where you have ambulances waiting for 20 minutes at a time outside just to get into the ER, but with the numbers going the way they are, it's very easy that we could be at that state fairly quickly," Roth told Hawaiʻi Public Radio.

Below are excerpts from Roth's interview with The Conversation's Catherine Cruz, edited for length and clarity.

On how Hawaiʻi Island hospitals are faring with COVID-19

ROTH: Up until the last couple of weeks, our hospitals were doing pretty well. But we've started to see that the numbers have been going up in the hospitals. I actually went and visited the Hilo Medical Center and Kona Community Hospital. I'm going over to the Waimea hospital (Queen's North Hawaiʻi Community Hospital) to see how they're doing over there. What we're seeing there is pretty alarming, their numbers are going up, people have been waiting in the emergency room to get into the ICU. That has us very concerned, and saying, "Hey, we need to do something and we need to do it pretty quickly."

On the strain on the healthcare system and its workers at this point in the pandemic

ROTH: I was talking to one of the ER physicians. What he said to me was: where we're at now, if we were to have a major crisis — for example, if a hurricane was to injure a bunch of people, or if you had a massive crash on the freeway in Honolulu or something where there's a lot of cars and injuries, not just the Hilo and Kona and Waimea hospitals — it would take down the entire system.

You see the people who are working a lot of overtime in the hospitals, they're tired. There's a lot of concern. Luckily, yesterday and the day before, we started receiving some workers through FEMA — nurses and respiratory therapists — to help lighten that load. But you got to remember on Hawaiʻi Island, prior to COVID, we had a 50% shortage of healthcare workers, doctors and other key service providers. After COVID, those numbers haven't gotten any better. They've actually gotten a lot worse. So we have to really be mindful on the Big Island about what happens with our health industry — our doctors, our nurses, the people that are working at the hospital. We need to do everything we can to protect them so they can protect us.

Our doctors, our healthcare workers, they're doing everything they can. Matter of fact, one of the doctors told me it's like a three-legged stool. What happens at the hospital, the hospitals are doing what they can. Then you have what's going on in the community and that's kind of where we're looking. People getting vaccinated, people doing the right thing: socially distancing, wearing their masks, not putting themselves in dangerous situations. That leg is not really holding up so well. And then the third leg is the rules that we have in place and we've had a lot of rules. Nobody wants to close down. We expect that people do the best they can to keep themselves safe, healthy, so they're not overwhelming our medical system.

On reinstating COVID-19 restrictions and safety guidelines

ROTH: We're having conversations on a statewide level because we can make recommendations to the governor, the governor still has to approve those things. But we're looking at the places where people haven't been necessarily as responsible. One of those is at our parks and beach parks. We've seen people just crowded together, packed in like sardines. We are looking at possibly closing those, we're looking at the bigger events that we have. While we've had restrictions either 10 and 25, or 25 and 75 indoors and outdoors. We've also had the ability to approve larger gatherings. Those safety protocols that the hotels and other businesses, that the wedding planners and others, they've taken them very seriously. And we have not seen a lot of spread from those events — taking the temperatures, they've spaced people out, they've required wearing masks. It's difficult to penalize people who have been acting responsibly. But I think we're also looking at some of those bigger events and saying, you know, this isn't the time. We ask you guys to take a pause and maybe think about doing it a little bit differently. ...

There's the physical health and safety, then there's the mental health and safety. And then there's more, even the financial health and safety. When people are put into situations where they can't work, and they can't pay their rent, they can't pay for food, that's a whole nother thing that we have to be taking into consideration. We look at what's happening at the hospital, we look at what's happening to our businesses and to our economy because that does affect people's health and safety as well.

On the vaccination rate being lower in Kona than in Hilo, and the broader effects

ROTH: The reason for the gap, it's really difficult to put a reason for that — just different segments of the community. But one of the things that we've been doing with pretty much all of our testing sites is that we've been adding vaccination clinics as well. Recently with the governor's orders and with the numbers coming up, we started seeing some more people coming on board and getting vaccinated. I think we'll get another bump pretty soon when the FDA approves the different vaccines. We need to all realize that this is all our responsibility. There's a lot of mistrust and a lot of false information.

I was talking to one of the doctors in the ICU and her message was this: these vaccines, they're doing exactly what they were made to do. They were made to prevent death and prevent serious medical consequences. And if you look in our hospitals, 95% or more of the people that are in our hospitals are unvaccinated. The other thing that the doctors told me was people who are vaccinated and end up with COVID and in the hospital, which again is very few, are generally there for maybe three to five days — versus people who are unvaccinated are staying in our hospitals on average four weeks.

This interview aired on The Conversation on Aug. 18, 2021.





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