![]() ![]() Most of his family members were told to isolate. Park’s team scrambled to figure out who in the state the individual had spent more than 10 minutes in close contact with. “They’re not going to our potlucks or our beach barbecues or hanging out in someone’s garage, where they’re in close contact with other people for a sustained period of time.”Īs if to prove the point, on March 6, Hawaii got its first case-a resident returning to Honolulu on the Grand Princess cruise ship. “We realized that, unlike residents, travelers stick mostly to themselves,” Park says. The friend isolated himself for two weeks and never developed symptoms. The investigators ultimately determined that, with the exception of the coffee date in Honolulu, all of his encounters were too brief to have transmitted the virus. Park’s team also dialed around to all the people the infected Japanese man had interacted with while on Maui and Oahu. A few were, but not enough to warrant testing, which in February could be done only at the CDC’s lab in Atlanta with a week’s turnaround time. Then, every day, Park’s team called to see if the travelers were complying, and whether they were feeling sick. Using flight information given to them by the CDC, they contacted anyone arriving in Hawaii who had recently spent time in China and informed them that, for the next 14 days, they couldn’t leave their houses or wherever they were staying. In early February, well before the state had a confirmed case, Park’s team of six began their detective work, just as they had for the emergence of hepatitis A and rat lungworm a few years earlier. Like many states, Hawaii’s department of health had on hand a skeletal staff of investigators to respond to any outbreaks of infectious diseases. As a medical doctor and former disease detective with the Centers for Disease Control and Prevention‘s elite Epidemic Intelligence Service, Park hunted down West Nile infections in the United States in 2002 and SARS cases in Taiwan in 2003. It’s interesting to me that everyone wants to talk about it now,” she said recently from her 4th-floor office at the state department of health in Honolulu. “We’ve been doing it forever, any time there’s a disease outbreak. “Old hat” is how Sarah Park, Hawaii’s top epidemiologist, describes contact tracing. “But with the Pacific Ocean guarding our borders and an early lockdown, we built the plane while flying it and got extraordinary results.” “We didn’t really have a fully proactive or decisive plan at the outset,” says Mark Mugiishi, CEO of HMSA, the state’s largest health insurer. With arguments still flaring up across the country about the most effective way to manage the coronavirus response-often divided between those who want a heavy government hand and those who don’t-Hawaii’s experience shows that sometimes what works best is a multipronged, even redundant approach. In the background was a low-key governor who listened to the voices around him and made quick decisions when he needed to. Hawaii’s success came at the hands of several medical doctors: Green, the outspoken lieutenant governor, along with an enterprising private physician, both of whom pushed for aggressive testing while clashing with the state’s top epidemiologist, who ran a tireless contact tracing program that has managed to track all of the state’s confirmed cases to date. That it didn’t, and that Hawaii has continued to keep cases low, is a function not of the usual dynamics-the top-down operation helmed by a high-profile leader, as in states like New York and Michigan or countries like New Zealand and China. ![]() In the weeks before the arrival quarantine went into effect in late March, many expected the virus to have spread far more widely through the population than it did. It also benefited from being able to enforce a mandatory 14-day self-quarantine for arrivals in ways other states couldn’t. In those critical early weeks, when cases were manageable, the state set into motion all the steps that experts across the globe have identified as crucial. Hawaii, at least, has past experience to fall back on now. In early June, Hawaii’s streak of single-digit daily cases ended with three days of new infections in the teens. It also reveals the enduring challenge of trying to shake Covid-19: Since businesses and parks reopened in late May, the state has seen a recent, noticeable spike in cases, similar to other parts of the country. But as America tries to navigate its way out of the first wave and considers the possibility of a second in the fall, Hawaii’s experience offers hope that, with the right efforts taken at the right time, the virus is containable. Few people look to the United States for coronavirus success stories, instead singling out South Korea, New Zealand, Iceland or Germany. ![]()
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