Hawaii needs to establish day-to-day transparency in regard to how long-term care facilities and community care homes are faring in the COVID-19 battle, and in how the state is responding to surges and clusters at such sites.
That imperative has come into focus, alarmingly, with 10 coronavirus deaths in under two weeks at the Yukio Okutsu State Veterans Home in Hilo. Further, more than 80% of residents there and upwards of 20 workers have tested positive for the virus.
So far, facilities contending with cases are identified only when rising numbers prompt mass testing, such as at the Yukio Okutsu home. In an effort to aid affected families and others, AARP Hawaii is rightly pushing the state Department of Health (DOH) for release of more information, including daily updates on cases that identify facilities (but not individuals).
“Not doing so suggests the state is reacting and not being proactive in monitoring what’s happening in nursing homes, community care homes and assisted living facilities,” said Keali‘i Lopez, the nonprofit’s state director.
She’s right. A steady flow of data is key to building public trust, and greater community awareness can help prevent more outbreaks.
As of Wednesday, Lopez said, the AARP knew of at least 16 long-term care COVID deaths — 10 at the Hilo veterans home, five in community care homes and one in an unnamed facility. “Because the state has not released new information on long-term care facility cases since Aug. 18 … we are blind about how widespread the disease is among our most vulnerable residents.”
After months of leaving the public largely in the dark, Hawaii’s COVID-19 Joint Information Center released an opaque sketch of coronavirus spread, from March 1 to Aug. 18, by way of an aggregate statistics chart. It tallied 94 cases among patients, health care personnel and others at a total of 28 unidentified Hawaii facilities.
The table also showed that during that period, nearly 29% of infected individuals were hospitalized and more than 6% had died — both much higher percentages than for cases in the general population.
But even in instances involving frailty and underlying conditions, those deaths were not inevitable. One of the first outbreaks in the country, which resulted in nearly two dozen deaths at a nursing home near Seattle, made it clear that group-living facilities must prepare to effectively guard against COVID-19’s spread. Now we know that long-term public health vigilance is needed.
Across the country, care-home sites that have managed to contain the virus have done so with basic must-do measures such as using personal protective equipment (PPE), routine testing of employees and residents, and bringing on extra workers. Their successes make clear that careful planning and effective leadership can save lives.
Hawaii’s DOH dedicated months to creating a surveillance plan, in tandem with nearly 50 long-term care facilities, that focuses on infection control and mitigation strategies — but it must respond with urgency when protocols fall short.
That certainly is what’s happened at the Hilo care home, where on Wednesday slightly more than 60 of 74 residents, veterans and their spouses, had tested positive, along with 22 employees. That is a severe hotspot that demands immediate attention.
At surge sites, the local AARP chapter suggests adopting a “strike team” strategy that’s being used on the mainland. Through this model, teams — consisting of medical workers, emergency responders, clergy and others — “parachute in” as they would in natural disasters like hurricanes and wildfires to combat virus outbreaks in long-term care facilities.
While this tactic might be complicated by Hawaii’s geographic isolation, U.S. Sen. Brian Schatz, too, has sensibly called for outside help, via the Veterans Affairs, in remedying the Yukio Okutsu home outbreak. Military veterans there — along with patients and workers in care facilities throughout the islands — deserve to be a state priority, which includes a candid accounting of COVID-19 oversight.