Long before Hawaii’s first cases of COVID-19 were discovered in long-term care settings, the state’s nursing facilities had been working hard to keep the coronavirus away from vulnerable kupuna.

They strengthened their infection control measures and were successful in keeping the coronavirus away from their residents even as the virus wreaked havoc in long-term care facilities across the nation.

It’s important to understand what they did.

The Healthcare Association of Hawaii (HAH) and the long-term care providers worked in unison with the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, the American Health Care Association/National Center for Assisted Living, the Hawaii Department of Health, and faculty in the Department of Geriatric Medicine at the John A. Burns School of Medicine at the University of Hawaii.

All 48 nursing home members of HAH, the trade association for the skilled-nursing facilities, shut down visitation, except in very limited circumstances such as for compassionate care related to end-of-life situations. They got creative and used electronic means of communication or drive-through visits to enable families to continue their interactions with their loved ones in the facilities.

They stopped nonessential visitors, such as vendors, from entering the premises, and conducted business away from the care units of the facility. Additional hand sanitizer stations were installed, and adherence to rigorous hand-washing techniques was monitored and reinforced with staff and residents. Courses on COVID-19 were offered free to staff through a collaboration between HAH, the medical school, and the regional quality improvement organization, Mountain-Pacific Quality Health.

Use of additional personal protective equipment (PPE) was also instituted across the state. Facility administrators were able to obtain additional PPE from Hawaii Healthcare Emergency Management (HHEM) when needed. Hawaii is fortunate, as not every state has a resource like HHEM to assist its health-care organizations.

In Hawaii, skilled-nursing facility staffers are also screened every shift for fever and other possible symptoms of COVID-19 infection. It was during a routine screening when reporting to work that a staff member at Maunalani Nursing and Rehabilitation Center mentioned having a headache. That was enough for the facility screener to send the employee to seek medical attention, which triggered a COVID-19 test, which turned out to be positive. This allowed the virus to be detected and stopped early. The employee remains self-quarantined at home with no respiratory issues. No one else at this facility has tested positive for the virus, resident or staff.

During the pandemic, state health officials have continued to inspect long-term care facilities, paying particular attention to infection-control measures. This means that important regulatory oversight of the industry continues, too.

All of these efforts have played a role in first preventing, and then slowing the spread of the infection in Hawaii’s long-term care facilities. Even with the recent COVID-19 cases discovered, Hawaii has the lowest rate of positive tests in long-term care in the nation, according to Medicare data.

With more infection circulating in the community, there are more opportunities for the disease to take hold, despite even the best infection-control measures in skilled-nursing facilities. Public health experts from Harvard, Brown and the University of Chicago have concluded that due to the highly infectious nature of COVID-19, the infection rate is highly correlated to the amount of infection in the surrounding community.

In other words, the more active cases we have in Hawaii, the more likelihood of infection in senior living communities. COVID-19 can enter a facility even when everything is done right.

This is why we ask everyone to stay vigilant and contain the spread of infection. Continue to maintain social distance, wash your hands and wear a mask. This not only helps the community at large, it protects our kupuna by slowing the spread of COVID-19.

Please protect your kupuna, and everyone’s kupuna.