“You need to make a decision to be proactive”

KAILUA-KONA — The gloves have come off in a battle to get a more dedicated response to dengue on the Big Island.

Two West Hawaii lawmakers are taking the state Department of Health to task for saying it is beyond the agency’s purview to launch mobile dengue testing units that could go deep into rural areas and ferret out the disease. Even if it costs millions of dollars, the DOH must step up its involvement in quashing the disease before it becomes endemic, say Kona Sen. Josh Green and Naalehu Rep. Richard Creagan.

“They don’t understand how fragmented and fragile our medical system is here,” Creagan said. “A lot of people are poor. A lot of people don’t want to come out and get tested.”

“If we have to spend $10 million to knock this down, we’d be saving $500 million over 10 years and a lot of hardship for the island,” said Creagan. “If dengue becomes endemic here, our island will be screwed economically.”

There have been 38 confirmed cases in Hawaii County, a tally that inches upward daily. From tests so far, no one has had an onset of symptoms since Nov. 2, but the lawmakers believe the cases are under-reported because some with the disease are not coming forward.

“Josh and I hopefully will meet with the governor next week,” Creagan said. “I’d like an emergency declaration. My message to the governor will be: You need to make a decision to be proactive.”

Green said that if the outbreak had happened on Oahu, resources would have been thrown at the disease and there “would be health personnel on every corner testing anyone who asked.”

On Friday, state epidemiologist Sarah Park told West Hawaii Today that the DOH’s role is that of a facilitator of access to health care, but that the agency should not be directly involved in doing assessments and drawing blood. Instead, that direct medical care should be done by the patient’s health care professional, she said.

In an email to West Hawaii Today on Saturday, state health director Virginia Pressler stressed that the DOH is continuing to mobilize resources to make sure those who need testing and treatment receive it.

“We are working out the details to dedicate several emergency medical services teams to proactively, systematically reach out to the homeless, coffee pickers, and others at risk as identified by the county, and to assess if any are sick and to assure their access to health care,” Pressler said. “We will continue to do whatever is needed to bring this current dengue fever outbreak to an end.”

In another email the the lawmakers, Pressler said that an additional epidemiologist from Maui will be on the Big Island two to three days a week, starting next week. All epidemiological investigators on Oahu are supporting Big Island operations by investigated suspected cases, answering phones and coordinating specimen shipments, she said.

DOH personnel from around the state are assisting the Big Island with mosquito assessments and spraying, Pressler said. So far, 54 sites have been sprayed. Application of the pesticide will continue in Napoopoo, Honaunau, Captain Cook, Ookala, Papaaloa, Keaau and Mountain View, according to Hawaii County Civil Defense.

As to mobile testing units, Pressler wrote: “This would be very resource-intensive. We are looking into the possibility of using EMS personnel as a safety net. It’s imperative that healthcare providers assess suspect cases. The tragedy would be if a case of leptospirosis were missed and someone died.”

In a sharply-worded email on Saturday to Pressler, Green called for easy access to testing and “total transparency on all efforts to eradicate this outbreak.”

“I have to be candid and strongly disagree with Sarah’s comments in the paper, and yours to me and Richard in your email about the intensity of effort required to get deep into the community,” Green wrote. “These comments suggest a fundamental lack of understanding about the access to healthcare on the Big Island and will result in a failed approach to this outbreak on two levels: We will never have an accurate or realistic assessment of the scope of the outbreak, and the virus will by default become endemic.”

Green called for the DOH to scramble idle teams from around the state or contract with local health care providers for a four to six-month period to do home visits to those who have — or think they have — the virus.

“You don’t want infected people traveling through the community to get help,” Creagan said. “You’re the DOH. This is your kuleana.”