Column: We need targeted interventions to flatten the COVID curve

We are being bombarded daily by statistics on the number of new COVID-19 cases and fatalities in Hawaii. However, we are not given the necessary collateral information to make sense of these statistics, and in particular, to figure out how we can reduce the spread in our community.

For example, the Star-Advertiser on Monday reported data showing that 30% of cases are within the Pacific Islander communities, far exceeding their proportion in the general population (4%). Yet we lack the detailed information that is needed to truly grasp why this disparity exists, other than anecdotes of people from these communities congregating in a church or attending a funeral. What church? On which dates? Were they wearing masks? Were they distancing from one another? Not every single detail needs to be made public, but we have no idea whether the policy makers have these facts, and if so, how they are planning to use them.

Another example comes from the data broken out by age. At last count we see that the plurality of COVID cases are in the 18-29 age group, comprising 23% of cases, followed by the 30-39 age group, comprising 21% of cases. Thus, 44% of all cases are in young persons between ages 18 and 39, a percentage that exceeds their proportion in the general population (30%, according to 2018 Census data). Why are younger people more prone to get infected, beyond the general reports of their attending large gatherings at beach parks? What beach parks? On which dates? How many were in attendance? Importantly, why are the authorities withholding this information?

At the other end of the age spectrum, fully 81% of COVID-related deaths are in those aged 60 and above, even though they account for less than 20% of infected individuals. It is well-established that older persons, especially those with underlying conditions, are the most at risk, but once again, we do not know if these fatalities are occurring primarily in nursing homes (which ones?), or in multi-generational households (in what neighborhoods?), or are the result of community spread.

Merely hearing state and city officials repeat the refrain of good hand hygiene, masking and distancing is insufficient to flatten the curve. What Hawaii needs more than blanket lockdowns and unreasonable restrictions are focused interventions directed at specific demographic groups, using methods that have proven effective with each group.

For instance, there is much talk of doing culturally appropriate health education in the Pacific Islander communities. This is a good idea, but who is walking this talk? Similarly, some have advocated social media campaigns targeted toward younger people — emphasiz- ing the importance of protecting their kupuna — to reduce the rate of infection within both groups. What is the status of such efforts?

In an Aug. 20 column (Island Voices, Star-Advertiser), professor Karl Kim lamented the lack of actionable data regarding the pandemic in Hawaii. Since then, we have had triple-digit cases on a near-daily basis, total cases have surpassed 10,000, and the official death toll stands at 99 at this writing.

The surge testing that has just been concluded will be useful only if it yields actionable data followed up by the type of targeted interventions described above. We have no shortage of multidisciplinary expertise in Hawaii. What has been missing is the political will and interagency cooperation to safeguard our public health.

David J. Lam, Ph.D., is a clinical and consulting psychologist in Honolulu; he recently published articles on the mental health aspects of the COVID pandemic on medium.com.