Hawaii hospitals are resuming elective surgeries, reopening clinics and removing coronavirus triage centers in the case of The Queen’s Medical Center — a “momentous” sign of hope that COVID-19 is no longer circulating widely in the community.
Queen’s took down its disaster tent Monday, which had been used to triage coronavirus patients outside the ambulance bay on Punchbowl Street. The outdoor triage tent was erected seven weeks ago on March 12 to evaluate, test and separate COVID-19-infected patients from the rest of the hospital population.
Hospitals had scrambled to empty out facilities to make room for a surge in cases and, potentially, mass casualties.
Photo Gallery: Queen’s Medical Center takes down coronavirus triage tent
“It’s a sign of victory. It’s a sign that I think our planning and our perseverance has come through being one of the lowest states in the country that has infections and deaths per capita,” said Dr. Daniel Cheng, medical director of the emergency department at Queen’s, which is currently screening fewer than four patients in 24 hours in the triage center. “Given the lack of any positive tests in the last two weeks in our testing population, we do feel like the pandemic, at least on Oahu, has subsided.”
Queen’s has seen a steady drop in inpatient and outpatient COVID-19 testing and infections. The hospital tested 1,100 people during the week of March 15, compared with about 400 the week of April 19. The number of people testing positive fell to 2.1% the week of April 19 from a peak of 4.9% the week of March 29. COVID-19 screenings have been moved to an adjacent building, with eight screening stations, outside the ER.
As Hawaii reopens the economy and invites tourists back to the islands, Queen’s said it is prepared to reassemble the outdoor triage center if there is a second wave of infections.
“We’re using 12 patients in a 24-hour period as a threshold to open the tents again if necessary,” Cheng said. “If there are any positive tests, we want to go ahead and open up the tents again,” which measured 20 feet wide by 40 feet long. The coronavirus triage tent at Queen’s-West Oahu will remain operational.
Hawaii hospitals had postponed elective procedures and closed clinics because of limited supplies of personal protective equipment and to make room for a surge that did not happen. They are now carefully resuming elective surgeries and reopening outpatient clinics.
Queen’s President Jason Chang said North Hawaii Community Hospital opened clinics and resumed outpatient services last week, followed by Queen’s-West Oahu in a “controlled way” on Monday. The Punchbowl campus is scheduled to resume certain surgeries May 13. The hospital will screen all patients, limit visitors and test surgical patients and their caregivers for COVID-19, he said.
Queen’s reduced elective surgeries by 58% since the start of the outbreak, resulting in a significant drop in revenue.
“The financial impact to date is around $40 to $45 million, and we expect it to continue for some time because we’re not going to just open back to normal on the 14th,” Chang said. “We’re going to take it very cautiously over time.”
Kona Community Hospital announced Sunday that it had resumed certain outpatient services and elective procedures, including imaging, respiratory therapy, rehabilitation and surgeries.
Hawaii Pacific Health — parent company of Kapiolani Medical Center for Women & Children, Pali Momi Medical Center, Straub Medical Center and Wilcox Health on Kauai — said it has been ramping up services “responsibly and safely” with a soft reopening Thursday of its ambulatory surgical center, Surgicare Hawaii.
“A lot of the procedures that patients have been patiently waiting for, we can do those safely and keep them away from our medical centers, with processes to social- and physically distance them,” said Leslie Chun, CEO of Hawaii Pacific Health Medical Group. “We can’t just flip right back to where we were pre-COVID-19. We’re gradually opening that up to make sure we can do it responsibly and protect the patients as well as staff and physicians.”
HPH will closely monitor the rate of new coronavirus cases, testing capabilities and access, public health support (surveillance, tracing, quarantine and isolation) and supplies, including personal protective equipment and medications, ICU beds and ventilators and staffing pools, Chun said. It will also consider the state of the rest of society.
“It’s not right for us to be fully functional and back to normal when the rest of the state isn’t,” he said.
The organization reopened some operating and procedure rooms for non- urgent elective surgeries Monday in a “measured, safe fashion,” Chun said.
“In the coming weeks if we can open up more — safely and responsibly — we will. We’re also ready to take steps backwards if the case rate, supplies or public health support … key indicators, determine we need to take a step back.”
HPH is also slowly adding a “small percentage” of in-person visits at outpatient clinics, which have mostly been providing care via video or phone through telemedicine, which has been a “silver lining for the nation,” he said.
Hawaii’s coronavirus infections rose by a single case on the Big Island to 621 on Monday. A total of 548 patients have recovered since the start of the outbreak — more than 88% of those who have been infected. The coronavirus death toll stands at 17 with more than 33,000 tests conducted by state and clinical laboratories in Hawaii.
With the reopening of the kamaaina economy — barring new clusters or a spike in new cases — health care providers said they are in good shape to begin getting back to normal operations. Testing is currently sufficient for the local population, Chun said, but may not be once the average 30,000 tourists daily start returning to the islands.
“We definitely need to be taking the steps to restore and ramp back up across our society, but we also need to be preparing the community for the ability to step back as needed,” he said. “All the experts are saying there will almost certainly be other people getting sick, and our cures or vaccines aren’t coming anytime soon. We need to be thoughtful and remember why we shut things down: to save lives and make sure our health care system is not overwhelmed.”