Hawaii’s hospitals could hit capacity in a week, health care leader warns

If the three-digit surge in novel coronavirus cases over the past week continues for the next seven to 10 days, Hawaii’s existing hospital capacity will be at risk of being overwhelmed, as happened in New York, Ray Vara, CEO and president of Hawaii Pacific Health, said Tuesday, when 144 new cases were announced by the state Department of Health.

He had delivered the same message Monday, when 207 new cases were recorded, before the State House of Representatives Select Committee on COVID-19 Economic and Financial Preparedness.

“We were tracking pretty well with our projection models of virus spread and the ability of our existing health system capacity to handle it until the last week or so, then (we) saw (the) slope of the curve change dramatically (upward),” Vara said, adding that the 7-day average of daily case positives is now about 119.

Since March, the models had predicted a manageable growth in new cases as society reopened, he said, but this was based on assumptions that the state would conduct necessary and effective testing, contact tracing, quarantines and public outreach, and individuals would socially distance, wear masks, wash their hands and stay home when sick — assumptions that have fallen flat.

“We’re hearing reports the state is having some difficulty keeping up with contact tracing,” Vara said, “and we continue to see large gatherings without social distancing or masks on beaches and in parks, and for events such as weddings and funerals” that have resulted in case clusters.

He called for the state and individuals to immediately act to stem the “exponential growth” of infections before the ability of Hawaii’s health care system to care for COVID-19 and other patients is outpaced.

“We’re at about 50% of ICU occupancy within the system,” Vara said of Hawaii Pacific Health’s four hospitals on Oahu and Kauai, including Kapiolani, Straub, Pali Momi and Wilcox.

He added, “we have the ability to isolate COVID-19 patients, and opportunities to expand our ICU capacity to care for them,” but since the triple-digit surge, the HPH system has “seen hospitalization growth for sure, and some ICU growth” in patient numbers.

ICU capacity

Lt. Gov. Josh Green said Tuesday two hospitals in the state are currently approaching ICU capacity, and the state has 138 confirmed or suspected COVID-19 patients currently hospitalized, up from 80 last week, and in an email to the Honolulu Star-Advertiser he expanded upon Vara’s warning that capacity could be exceeded if people don’t behave responsibly.

“As of Tuesday, we have 1,210 active cases in Hawaii with no signs of slowing down,” Green said. “As the physical effects of the virus take several days to manifest in patients, we can expect our hospitalizations to spike after we see the initial surge in daily case rates, which now a week later, we’re starting to see this in our hospitals.”

Due to that lag, “and the fact that patients on average spend 10.5 days in the hospital,” he added, “unless we take action now to slow the surge of new cases, we could see our intensive care unit and ventilator capacities overwhelmed in the coming weeks.”

Adding beds

Statewide, Green noted, we have 244 ICU beds and 459 ventilators. “With help from our hospital leaders we could expand our hospital bed number by 30%, but there can be staffing and critical care access challenges if we reach that level of hospitalizations.”

While the Federal Emergency Management Agency and the military could also build out emergency hospitals “if absolutely necessary,” and the state has “a contingency plan to add 1,000 beds under extreme circumstances,” such desperate measures could be avoided if the community works together to slow the virus’ spread, Green said.

Vara called upon the state to provide daily “constant, clear, accurate communication” to the community, “so that people understand how many positives cases there are, how many total tests did we do and how were they acquired, providing any demographic information, whether by geography, race, age, that we can while respecting privacy.”

Also needed from the state are “clear instructions as to what we expect the community to be doing, making it clear what the enforcement and consequences will be otherwise.”

Given the 4-5 day viral incubation period before tests can read positive or symptoms appear, if everyone behaves responsibly starting now, he added, the number of cases would start coming down before hospital capacity is exceeded.

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Star-Advertiser staff writer Gordon Pang contributed to this report.