Editorial: Neighbor islands need protection

The same aspect of island life that produces many challenges — remote isolation, high living costs — is ironically offering some measure of protection for Hawaii in the pandemic era.

The Pacific Ocean is not an absolute barrier but it’s tough to traverse other than by air. Compared to other states that are attempting to insulate themselves but are unable to bar cars from driving across state lines, Hawaii’s mission of regulating arrivals by air is, while challenging, more effective. Imposing a 14-day quarantine on visitors and residents who arrive in the islands was the starting point.

Now, Gov. David Ige took what is the next rational step in shielding Hawaii, to the extent possible, from the deadly coronavirus that threatens to collapse health-care systems in many parts of the globe. The interisland quarantine order issued on Monday takes effect today through April 30, requiring that anyone traveling between islands of the state shelter in place for 14 days.

Those qualified as “essential workers” — a designation being fine-tuned — will have to travel with masked protections and file an interisland declaration form before going through the TSA gate check.

Early moves to control the seeding and spread of the viral infections may have bought Hawaii some time, especially for its rural neighbor island areas. Social distancing in a sparsely populated area is part of the landscape.

But there are certainly gaps in that protection, and without careful adherence to the rules, the entire state, not just Oahu’s urban center, can be at risk. In particular, Hawaii’s rural hospital network, already fragile before this crisis, will be under perilous strain.

It’s very like the concerns of other parts of rural America, small “islands” of community surrounded by a thinly populated land mass. They fare well early in a pandemic, experts say, but as occasions for exposure to urban populations increase, the risk of infection also rises.

In short, rural areas could take a harder hit later in the progression. And the same can happen in Hawaii — which on Tuesday marked its first COVID-19 death —with an accelerating infection rate.

Lt. Gov. Josh Green, the state’s coronavirus prevention liaison, crunched some of the numbers during a Monday media conference. Green said the good news is that the state is in a position at present to keep the curve of the graph of disease cases within the capacity of the health care network to manage.

Hawaii COVID-19 patients are using 58 of 534 ventilators available and only 37% of the 338 intensive-care unit beds are occupied by those infected, he said.

But that margin of safety can shrink, quickly — and these are still the early days of spread. The case count has risen daily from 95 on March 26 to 120, 151, 175, 204 and 224. The curve can become even steeper, with 8% more cases possible in only two days, Green said. Four days later, the case count can be 15% higher, with a caseload increase by 43% by the sixth day.

That’s alarming enough viewed through a statewide lens, but leaves little room for error on an individual island. Kauai, for example, has only nine ICU (intensive-care) beds available. It wouldn’t take much for adequate treatment to become difficult to access and for the whole system to become overwhelmed.

Additionally, Ige’s latest executive order suspends some restrictions governing the use of telemedicine, and that’s a good thing. Hawaii’s health-care system will be under particular duress from now on, so using alternative modes of care will become everyone’s responsibility. And responsibility begins with observing the state’s new strict quarantine rules, for everyone’s safety.