State Transitioning to Public Health Management of COVID

While the state is transitioning from emergency response to a more traditional public health approach to managing COVID-19, health officials and Gov. David Ige stressed Wednesday, April 27, during a press conference that the pandemic is not over.

“We are still in the pandemic,” said state Department of Health Director Dr. Elizabeth Char, responding to a question from the press. “We are not in an endemic phase yet, as noted by our numbers going up again.”

The latest data provided Wednesday by the DOH showed COVID cases increased by 3,370 from last week, bringing the statewide total to 248,405 cases. That includes a total of 491 new cases reported on the Big Island.

The total case count reported this week is an increase of 1,634 from April 20, when just more than 1,700 new cases were reported statewide, including 150 on the Big Island. That also was a jump from April 13, when the DOH reported a total number of 1,327 new cases statewide, including 160 in Hawai’i County.

Reported case numbers have increased by a little more than 2,000 statewide since April 13.

“So we are very much still in a pandemic phase,” Char said. “That being said, our response to it — it’s not sustainable to do the level of emergency response that we had been doing for the past two years now. So we knew we had to transition at some point, especially as the public is more aware and there are more things in place in the health care system. So, while we are transitioning, we are still very much in a pandemic.”

Ige opened the press conference by saying COVID isn’t going away.

“In fact, case counts are increasing and the experts expect that COVID will be with us for the foreseeable future,” said the governor. “Our response must transition from emergency response to disease management, and that’s where we’re at.”

Ige said that means handling COVID more like other diseases, something health care providers diagnose and treat. It doesn’t mean, however, that the state will stop much of the work that he said has helped Hawai’i have the lowest case counts per capita and some of the lowest death rates in the nation.

That work will continue to include the DOH doing surveillance and whole genomic sequencing to identify new COVID variants, among other measures. The department will also continue to issue guidance aimed at keeping people safe and schools and businesses open.

“Again, COVID will remain with us, and we are transitioning to address current conditions,” Ige said.

The governor said the tools are available to limit severe illness and COVID’s impact on the community, including vaccines and effective treatments. There are no plans to impose new mask or vaccine mandates, but the state will continue to evaluate the situation and take action as required.

“But we all must remain smart and careful as ever as we transition during this pandemic,” Ige said.

He said everyone must play their part in the state’s response to managing COVID.

“We all know what works. We all know what we can do to help fight against COVID-19,” Ige said.

That means staying home when you’re sick and isolate, wearing a mask indoors and in crowded places, getting tested if you’re exposed or become symptomatic and getting vaccinated and boosted, if you’re eligible.

“We do know that all of these actions help to slow the spread of COVID-19 and will help to keep our community healthy and safe,” Ige said.

Char said the DOH has three main goals moving forward, mirroring federal guidance: protecting against COVID, detecting and preparing for new variants and enhancing community resilience.

Vaccinations remain widely available to all residents despite the phasing out of mass vaccination clinics. Char said there is plenty of vaccine available through pharmacies, health care providers and others. She also said it’s important to get a first booster shot and recommended those eligible to get a second booster.

Testing has shifted from temporary community testing sites to testing by health providers and at-home tests. Char said there’s also a lot of testing available, including community testing through the counties and county providers and testing for schools via a U.S. Centers for Disease Control and Prevention program and state DOH-sponsored testing. The state also is participating in several federal programs that give it access to testing.

Over-the-counter at-home test kits also are widely available and can be mailed to residents’ home for free.

Char said there also is a good supply of therapeutic treatments throughout the state for those at high risk of severe illness. They should be readily available by prescription and include monoclonal medications and anti-viral pills.

“Treatments do not replace vaccines, but they really can help for those who are at highest risk should they get infected with COVID,” she said.

Case counts have climbed gradually during the past month nationwide and in Hawai’i, but the state is still doing well overall, Char said. Hospitalizations started to increase during the past week in the state, but hospitals still have the capacity to provide optimum care for COVID patients.

The current daily average reported case count statewide is 362, which is a four-fold increase from a low of 88 cases per day on March 18, according to Kemble. As the DOH watches this trend, she said the state is in a good position to manage and respond to the increase.

“But we still urge the community to act with care,” Kemble said.

The increase in cases is something the state expected as COVID restrictions have been lifted.

“People are returning to a greater state of normalcy, so they’re doing many of the things that they maybe haven’t been doing during most of the pandemic,” Kemble said, adding variants also might be playing a role.

She said thousands of people also are now taking at-home tests, the results of which are not included in the department’s data. All of those variables are contributing to the recent increase in cases, meaning a level of caution must be maintained. However, the numbers the state is seeing now are not so far associated with a dramatic increase in hospitalizations.

There is room for hope that large numbers of cases won’t mean critical illness and death. Kemble said now, after two years of the pandemic and several surges in infections, there is an expectation that a more substantial proportion of the state’s population has immunity from prior infection in addition to those with vaccine-induced immunity.

“So all that taken together, I would still caution, we’ve seen in every prior surge that hospitalizations are a lagging indicator,” she said. “It’s too soon to conclude that we are in the clear with respect to COVID-19. We must still use all the available tools in our toolbox.”

Kemble, in response to a question later in the press conference, added that it’s too soon to make a judgment about whether the latest COVID variants are less severe than previous variants. She said it will take 2-3 weeks to see if the curve for severe and critical illness flattens.

When asked what the benchmark would be to declare the pandemic finished, Kemble said COVID has surprised officials at every turn.

“When we talk about pandemic, to me that means global, uncontrolled transmission of disease, and in that sense, we are still very much in it,” she said. “We’re still seeing ongoing global, uncontrolled transmission of COVID-19 and we’re still seeing emergence of yet new variant strains. So I would say we’re still in that period of uncertainty.”

Kemble said if the state gets through another winter respiratory disease season without seeing another major increase in hospitalizations or dramatic rise in deaths, that could mean a possible transition out of the pandemic.

“I wish I had a magic answer to say exactly when that happens, but the real answer is when we no longer see that emergent state happening, that’s when we’re endemic,” she said. “I think, realistically, we’re looking at a pretty long time frame to really understand the impacts of where we’re at now, of immunity so far and how that’s going to help us through the next season.”

In his closing remarks, Ige emphasized that COVID-19 isn’t going away. He reiterated the importance of getting vaccinated and boosted, staying home and isolating when you’re sick or symptomatic and getting tested if you’ve been exposed.

“We do know that when we do all of these things, we can slow the spread of COVID-19 and get back to the new normal,” Ige said. “We continue to work to reduce the spread of COVID and I think most importantly take the actions that can help us keep our community healthy and safe, restore our economy and really get back to managing this disease in the best way possible.”

To watch the press conference on the governor’s Facebook page, click here. Click here for additional guidance and more information about testing, vaccination and therapeutic treatments, including what you should do if you test positive for COVID.