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Editorial | Island Voices

Column: ‘Five Ts’ are key to public health and future prosperity

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                                Nurse practitioner Sean Plank received a swab from medical assistant Kaylee Ishii at a COVID-19 testing event held Tuesday at the Kalihi Union Church.


    Nurse practitioner Sean Plank received a swab from medical assistant Kaylee Ishii at a COVID-19 testing event held Tuesday at the Kalihi Union Church.

  • Karl Kim

    Karl Kim

The human and economic losses of the coronavirus in Hawaii have been staggering. While the state has been effective in containing the spread of the disease, we need clear, effective guidance to reopen businesses and recover from this disaster. Five T’s including testing, tracing, tracking, technology and training are essential to public health and prosperity in the wake of this pandemic.

>> Testing needs to be ramped up. We must test those who are sick and at highest risk of exposure — our first responders and medical personnel on the front lines of the COVID-19 battle. We need widespread random testing as well as targeted testing of carriers, spreaders and those vulnerable to the disease. We ought to be testing for the virus in not just human subjects but in the environment as well so that residents can take precautions and sanitize homes, businesses and facilities. We need aggressive testing of travelers who may be bringing the disease back into our state.

>> Contact tracing is the identification of people who have tested positive and anyone they may have come in close physical contact with — family, friends, co-workers and those encountered at school, church, shopping and other activities. This is difficult, painstaking work which requires adequate resources and systems for information management coupled with swift actions including testing, quarantine and isolation. While it must be led by public health professionals, contact tracing requires the support of everyone. The challenge, of course, is how to trace those traveling from high-risk areas into Hawaii and interacting with residents and workers in our community.

>> Tracking those who may have been exposed, or may have symptoms or may be carriers is difficult because of privacy concerns and the stigmatization of disease. People may not admit that they are sick or could be a spreader. High-risk vulnerable populations may also be difficult to reach. Yet businesses and institutions need to protect the health and safety of employees, customers and those they serve.

There are new reporting requirements with screening, testing and tracing leading to actions affecting operations, staffing and service delivery. Tracking will be particularly challenging once visitors from across the world return to our state. Tracking requires flexible systems which can identify likely carriers and those people they have had contact with.

>> Technology plays a critical role in the development and delivery of testing, tracing and tracking. There are different systems for testing with varying degrees of accuracy, portability and timeliness. With contact tracing and tracking, there are multiple ways of sharing information including mobile apps, web-based surveys, Bluetooth-enabled, token sharing tools to exchange information yet protect confidentiality. It may also require taking precautionary actions in the absence of data. We must pursue innovative technologies to customize our response to the unique challenges we face.

>> Training and education are key to implementation of novel approaches to fighting this disease. This is not business as usual. We need to train the whole community in response, mitigation and recovery. We need more training on tracking and tracing — but also on the management of risk and uncertainty, and how to operate our businesses and organizations during a time of infectious disease.

Another important T to pandemic response is trust. We must increase public trust and confidence so that we can act collectively in these precarious times. This involves sharing data and increasing collaboration across our community, while protecting sensitive personal information. It also involves greater commitments to equity, fairness and social justice. Together we can emerge from this pandemic as a stronger, more resilient, healthy community.

Karl Kim is a professor of urban and regional planning at the University of Hawaii, and director of the Pacific Urban Resilience Lab and the National Disaster Preparedness Training Center.

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