Hospital could handle ‘modest-sized outbreak’
Lt. governor visits Maui Memorial, speaks with doctors
Assistant City Editor
WAILUKU — Maui Memorial Medical Center likely could handle a “modest surge” of COVID-19 patients, but a larger outbreak could create challenges, Lt. Gov. Josh Green said Tuesday afternoon following a tour of the hospital.
“A modest-sized outbreak would be if we saw single-digits to teens in a number of cases that had to be hospitalized immediately because people became very sick, so we would have no difficulty at all,” said Green, who’s also a physician. “If we saw 50 to 100 cases of COVID-19 and people had respiratory challenges, had to have ventilators, we would be in trouble. We don’t anticipate that. That’s never happened before.”
Green and other elected officials took a tour of the hospital’s Intensive Care Unit and Emergency Department on Tuesday afternoon and sat down with physicians in a private meeting to learn their needs and concerns should the virus reach Maui.
So far, Hawaii has just two presumptive positive cases, both on Oahu — one involving an adult resident who fell ill after returning from a cruise aboard the Grand Princess, and another involving an
elderly resident who got sick while in Washington state.
Mike Rembis, CEO of hospital operator Maui Health, said that if a COVID-19 patient came to the hospital seeking medical care, there are over a dozen isolation rooms with negative pressure “ready and available.” The rooms allow the hospital to isolate a patient without the contaminated air circulating through the hospital.
“If it’s maxed out, we put them in private rooms, making sure that the ventilation is remote controlled, and take care of the patients there,” Rembis said.
If the hospital had to house any COVID-19 patients, Rembis added that “we will continue to monitor not only our patients but our own staff, making sure they are not getting ill as well, and making sure they don’t have symptoms, and if there’s any concerns, testing our staff in the future as necessary.”
The CEO said the hospital has thousands of masks, gloves and gowns and is prepared to use them over the long term. The facility also has access to more supplies through its affiliation with Kaiser as well as the state hospital association.
When asked if having a dozen negative-pressure rooms would be enough for an outbreak, Rembis said that “at this time, it seems more than adequate.” Rembis didn’t know what size outbreak the hospital could handle and said that “no one does.”
“All we know is we’re prepared as we can be working with the state of Hawaii,” he said. “We feel confident we can handle whatever is presented.”
He added that Kula Hospital, which is also overseen by Maui Health and has a lot of longterm care patients, is screening all visitors and vendors who come to the hospital “to make extra protection for the very elderly and vulnerable patients up at Kula.”
Outside the ER, Maui Memorial continues to screen patients and staff for flu symptoms. Dr. Lee Weiss, medical director and chairman of the Emergency Department, said that triage was moved outside so as not to contaminate patients in the department. If people pass the screen, they’re brought back in to triage; if not, they’re put in a negative-pressure room.
In the ICU, physicians said that nursing staff were trained in “donning and doffing procedures” and that they had protective equipment and two negative-pressure rooms.
“We have a protocol where if we have a suspected case, we can move patients to other rooms and open that space up,” Dr. Michael Shea said.
Shea added that “if we ever have a real big outbreak,” one of the greatest needs would be support for staff.
“Because obviously medical care folks are going to be at risk for getting this disease, looking to other places where we can find extra staff to help support us when we are filled to the gills,” he said.
Not being able to test patients has also posed an obstacle for health care providers.
“There’s a lot of patients that we suspect,” Dr. Chris Martin said. “It’s like threading a needle to get the Department of Health to give the go-ahead to test.”
Green said that problem should be addressed now that Diagnostic Laboratory Services and Clinical Labs of Hawaii have the ability to test, with Kaiser set to come online “very soon.” Physicians won’t have to jump through the same hoops, and the private labs will help provide additional screening capacity.
“There’s been a big challenge when it was only limited to the Department of Health,” Rembis said. “Now that it’s commercially available, a lot of those barriers will disappear, and I think physicians will be able to request the testing much easier, and it’ll be available to a much larger group of patients who really need it.
“Not everyone should be tested. They need to talk to their physician and make sure their physician believes they need to be tested.”
Green said after the tour that he believed there were adequate beds in the ICU and the Emergency Department to handle an outbreak, and that the hospital has a fast-track diversion program to do basic testing for people with minimal disease.
However, Green said that a modest to large outbreak with lots of patients in the ICU would create a challenge for Maui Memorial, as it would for any facility in the state. He said that if the hospital were at capacity, they would have to set up emergency hospital facilities. One option might be a mobile hospital with ventilators and extra staff. The state also has “iso pods” that could quickly transport very sick patients by plane to Oahu where there are more beds.
The lieutenant governor added that if a local resident got sick and lived alone, they would be isolated at home, and social services like meals and visiting nurses would be available to them. If someone gets sick and lives with family, the family members would be asked to wear protective gear while taking care of the sick person.
“We also will ask people to isolate in their own homes, but that’s difficult because sometimes their homes are not large or they’re small condos, and that can be a challenge,” Green acknowledged.
If travelers come to Hawaii and test positive, the state is asking them not to stay at hotels and would provide quarantine space. The U.S. Department of Defense and Hawaii emergency management officials are looking for places of five to 10 capacity beds, Green explained.
“We have a lot of options in the rural settings actually,” Green said. “The question is, do you do it at a facility that’s already underutilized? Or do you do it at a place where it’s kind of considered an institution but not a health care facility?”
Options may include clearing a ward of a hospital or using a military barracks; some states have even rented out hotels, which could be more of a possibility if visitor numbers and occupancy decline. Green said that the DOD would “isolate a few different options for us in each county, and we’ll use those.”