KAILUA-KONA — Friday was day two of the state Department of Health defending its response to the dengue outbreak on the Big Island, with the agency and Civil Defense working to paint a more complete picture of the steps planned and already taken.
KAILUA-KONA — Friday was day two of the state Department of Health defending its response to the dengue outbreak on the Big Island, with the agency and Civil Defense working to paint a more complete picture of the steps planned and already taken.
The House Committee on Health and the Senate Committee on Commerce, Consumer Protection and Health held the joint meeting as the tally of people sickened by the disease reached 88.
The Centers for Disease Control and Prevention is sending mosquito traps and an entomologist to the Big Island, and health workers will now be trying to identify areas with high numbers of aegypti mosquito — a primary carrier of dengue — for strategic spraying, state epidemiologist Sarah Park said.
Park has also met with the chief medical officers at all community health centers to make sure the disease is being properly responded to. Coordination has been close with Hawaii County Civil Defense and the CDC, as the DOH actively seeks out acute cases to help pinpoint hot spots for the disease, Park said.
“It has been a very collaborative, aggressive effort,” said Civil Defense chief Darryl Oliveira, speaking to lawmakers by telephone.
Oliveira said the county is also creating multidisciplinary teams, spearheaded by EMS personnel but also involving Hope Services Hawaii and other agencies to try to reach the homeless and those less likely to come forward if they are sick. Additionally, the county will be working with the owners and operators of farms to get information down to the workers. As part of that effort, Comunidad Latina de Hawaii and the DOH were scheduled to hold a community meeting for South Kona farm workers at Konawaena High School on Friday evening.
Oliveira said that Hookena Beach Park will likely be closed for several months to wait out the lifecycle of dengue-infected mosquitoes in that area.
The Hawaii National Guard is ready to assist, and has aided in the airlift of spraying equipment from other islands. The Guard could deploy personnel to help spread awareness, but for now it will defer to Oliveira for direction, said Adjutant Gen. Arthur Logan, who noted that a proactive community is its own best defense.
“It’s all about the citizens themselves taking responsibility to do what it takes to curb the outbreak,” Logan said.
The officials continually stress the point that residents must reduce their exposure to mosquitoes and getting rid of standing water where the insects breed.
“I think there is a very good chance we can stop this if we pull from our values,” Park said. “I’m asking everyone to try to get the word out to everyone.”
Toby Clairmont, director of emergency services for the Healthcare Association of Hawaii, explained that the state is in the midst of a new campaign aimed at getting pertinent dengue outbreak information to each of the island’s medical professionals — especially those which are hands-on with patients — by the end of the month.
Answering to lawmakers
Puna Sen. Russell Ruderman questioned why it has taken so long to reach this point. Park responded that, while more general advisories had gone out to hospitals and clinics, a comprehensive list of medical professionals has been lacking.
Ruderman also pointedly asked Park if she had ever asked the Centers for Disease Control and Prevention to come help with the outbreak. Park responded that she has been in contact with the centers from the beginning of DOH involvement, and has received CDC lab and technical support and advice on an ongoing basis, as well as affirmation that the state is handling the outbreak properly.
“Is there a threshold, say 150 cases, when efforts will be stepped up?” asked Hilo Sen. Gil Kahele.
“The efforts have been stepped up,” Park responded. “We’ve engaged every partner we possibly can across the state as well as outside.”
In sometimes tense exchanges with the Big Island lawmakers, Park made it clear that the island shouldn’t look to have the weeklong wait time for dengue tests sped up by creating its own laboratory. The facilities on Oahu are not mobile, she said.
“From a technical standpoint, it’s not possible,” she told Ruderman.
“I don’t think there is a technical barrier,” Naalehu Rep. Richard Creagan shot back. “If there is a financial barrier, we can address that.”
DOH director Virginia Pressler also made it clear there will not be a CDC mobile unit on island to draw blood and ferret out cases in remote areas.
“I spoke to Lyle Petersen, the director of the Division of Vector-Borne Diseases at the CDC,” Pressler said. “He verified that they would not send out a team. As far as boots on the ground, we’re better off with local folks who know the community than a team from the mainland.”
West Hawaii lawmakers told the DOH they want spraying at all leeward schools. Kona Rep. Nicole Lowen questioned why Hilo schools were on the priority list for spraying when other West Hawaii schools like Kealakehe High and Intermediate schools are in a higher risk area but are not scheduled for treatment. Lowen pointed out that a number of students travel from the high-risk South Kona areas to attend school in North Kona.
The schools are chosen for spraying based on proximity of confirmed and suspected dengue cases, Oliveria said.
“Ideally, we would like to treat all campuses,” said Oliveira, who said Civil Defense is in discussions with the Department of Education to expand efforts.
Rain makes the insecticide ineffective, so wet weather could hamper the planned spraying of schools over the weekend, Hawaii District Health Officer Aaron Ueno said.
Mobile support
The directors of two rural health clinics on the Big Island indicated to West Hawaii Today that they would support a mobile testing van. Dr. Hart Miller of the Puna Community Medical Center said the center’s mobile van is set to be engaged in unrelated clinics in lower Puna in December, but that the van at some point could serve as a platform for county EMS personnel who could do the blood draws.
“As a physician, I can do the blood draws, and I have an RN,” Miller said. “But we don’t have staffing for a mobile unit and probably would need extra funding.”
In an email, Richard Taaffe, director of the West Hawaii Community Health Center, said the center would be willing to get behind a mobile unit.
“In general, we would look to participate,” Taaffe said Thursday. “We did participate with the county and others today in outreach to homeless folks. We are also planning to do outreach and education to farm workers. We have diagnosed quite a few people already and will continue to do so. Many people don’t and won’t come in, so it is important to reach out into the community.”
Sandi Alexander, vice president of the Ocean View Community Center, said a more local response would be welcomed. Several Ocean View residents have likely been sickened by dengue, but have declined medical help, she said.
“We have offered money from the community center, if they can’t afford,” she said. “We’ve even offered to drive them to public health in Naalehu — no takers. I believe they are afraid because they don’t really understand this issue, and may be afraid to find out. We have had no one come back to the community center after our offers. We now have fliers and pamphlets also in Marshallese that we will be distributing.”
Acting on repeated requests from Ocean View, state health and county officials will hold an additional informational meeting at the Ocean View Community Center on at 6 p.m. Nov. 27.
During a press conference on Thursday, Gov. David Ige backed the DOH and said there does not appear to be a resource shortage in addressing the outbreak.
“The White House is monitoring this and is engaged,” Ige said. “We are keeping them informed of the situation. The county, state and federal government are working together. We are applying the resources necessary to contain this.”
Ige’s remarks and the briefing on Friday didn’t satisfy Kona Sen. Josh Green, nor Creagan, both of whom are physicians and have insisted not enough has been done quickly enough.
“I’m hoping the governor’s team takes to heart our Big Island perspective that we must have more support and resources in place to stop the outbreak,” said Green. “Deploying the National Guard now to aid in removing standing water, spraying and even health care if appropriate would be a good start.”
Creagan noted that pregnant women are especially vulnerable to dengue. He said he is impressed with the response of the county, but noted that a CDC group from Puerto Rico came to Maui for the 2001 outbreak.
“Why aren’t they here?” he asked.
“I am very disappointed that the governor has not declared an emergency declaration,” Creagan said. “The reluctance to form medical teams to go out to houses of suspected individuals and evaluate them medically is very disappointing. We send large groups of medical volunteers to the Philippines after disasters. Why can’t that be done for the Big Island?”