A tale of two cities
This past July, Dr. Sarah Park, Hawaii’s top epidemiologist, smugly described contact tracing as “old hat.”
Park had worked with the national Centers for Disease Control’s epidemic response to West Nile infections in the United States in 2002 and SARS cases in Taiwan in 2003. “We’ve been doing it forever, any time there’s a disease outbreak. It’s interesting to me that everyone wants to talk about it now,” she said condescendingly when asked by state senators if Hawaii would have enough contact tracers to reopen its economy.
Contact tracing is medical detective work to identify and isolate people who have had close contact with someone infected with the coronavirus. If close contacts can be tracked down quickly, they can be isolated and keep the disease from spreading in the community. Contact tracing is essential to Hawaii’s Covid-19 response plan, along with screening, testing, and isolating those infected.
Although Park enthusiastically sold the importance of contact tracers when lobbying for $50 million in CARES Act funds for Hawaii Public Health, in practice she was an inconsistent champion for the role of contact tracers in the battle against Covid-19.
Community leaders accused Dr. Park of hubristically being unwilling to accept offers to enhance Covid-19 testing by the City & County of Honolulu and offers by the Hawaii National Guard to provide military contact tracers.
Political leaders were struck by Dr. Park’s lack of urgency to train and properly equip contact tracers leading up to June’s phased economic reopening. Hawaii’s top public health doctor arrogantly insisted for months that she knew the plan better than anyone, she had everything under control, and everyone just needed to stay home.
But then, several weeks after the July 4th weekend, came an alarming spike of 300 new Covid-19 cases daily from virtually no new cases a day in late May. Hawaii experienced a terrifying ten-fold surge in coronavirus infections and hospitalizations. More than 100 people died in the space of two months. Dr. Park and the Health Department could not track the thousands of people exposed to the virus and the state plunged back into lockdown, triggering millions of dollars in economic losses and leaving thousands of residents jobless.
In the words of the pugilist, Mike Tyson, everyone has a plan until they get punched in the mouth. Everybody has a plan until they get hit in the face. It’s not the adversity that defines you, it is how you react to adversity that matters.
In the face of an existential threat to her community, Dr. Park threw her people under the bus. "From my perspective, we're not ready as a community. It's not about whether Department of Health is ready or these programs are ready. Our community is not ready. To me, until our community shows we can maintain safe practices, I don't think we're ready," she said in exasperation.
As the public health doctor condemned Hawaiians for their foolish behavior, an alarmed U.S. Surgeon General Jerome Adams arrived in the islands to announce federal support for an additional 70,000 Covid-19 tests to augment Hawaii’s dismal community testing. Despite very high positive rates, Hawaii had slowed its community testing because Dr. Park didn’t think it was necessary.
Unlike Dr. Park, most island physicians had come to realize that extensive testing—of people with mild symptoms and even some without symptoms—was essential to control the virus. Dr. Park complained that doing more testing would require a lot of resources. She didn’t seem interested in making the effort.
Park ultimately blamed the public for being out of control. She cited beach and house parties and other gatherings that people should have known not to engage in as causes for the surge in cases that quickly overwhelmed the system. “What we could not have predicted, quite frankly, is how badly our community would behave,” she said.
The doctor’s flippant comments were particularly hurtful to Hawaii’s tightknit Pacific Islander community, many of whom waited for days for public health to call them when they tested positive for Covid-19. Pacific Islanders make up just 4 percent of Hawaii’s population, but they had 30 percent of the islands’ Covid-19 cases, far more than any other ethnic group.
The community generally is made up of people descended from Chuuk, Tonga, Samoa, Fiji, Tahiti, Papua New Guinea, and Guam among other Pacific islands. It’s been particularly susceptible to Covid-19 in Hawaii, where higher percentages work as frontline workers or live in multi-generational family homes. While they watched on TV as politicians and celebrities were personally tested by Dr. Park and her team, some Pacific Islanders worried that public health had simply forgotten about them.
Then in August, a whistle blower came forward describing a dysfunctional contact tracing program with an overwhelmed staff and unsustainable workloads. Everyone was working nights and weekends with no days off. In response, the Government Employees Union filed a grievance.
"Our members have been working incredibly hard to keep up with contact tracing but it has become an impossible task," the union said in a statement. "Had (public health) brought on additional staff more quickly, this steady surge in cases may have been mitigated. This grievance represents the tip of the iceberg of a much larger public health problem."
State senators were shocked to find that Dr. Park had lied about Hawaii’s contact tracing capacity. After the state auditor complained that Public Health had stonewalled their attempts to evaluate the contact tracing program, several senators paid a surprise visit to the department and described a catastrophe. What they discovered was that Dr. Park’s program was well short of the 400-plus workers that public health experts say are needed to rapidly identify those exposed to the virus.
“We spent all of our time worrying about one or two idiots running around the state from the mainland when we should have been building up our public health infrastructure to be ready for the virus being among us,” lamented U.S. Sen. Brian Schatz from Hawaii. “Tourism is not the main cause of the spread. We are the main cause of the spread. And shame on us for believing that we could do whatever we wanted here locally as long as we didn’t let anybody fly in. That’s not how this virus works.”
Dr. Park wanted to save lives even if it meant shutting down the people of her adopted islands; locking them in quarantine; and berating them for being not ready for the virus. While the foul-mouthed, stubborn, obnoxious people of New York figured out how to beat the virus with aggressive contact tracing, Dr. Park figured out every reason why widespread testing and robust contact tracing in Hawaii would be too hard and not worth her time.
As an expensive public servant, Dr. Park succumbed to paralysis by analysis. She forgot that her first duty as Hawaii’s public health doctor was not to save lives. Her first duty was to “do no harm.”
Dr. Vince Akimoto practices Family Medicine at the American Medical Clinic. Send feedback to firstname.lastname@example.org.
s being among us,” lamented U.S. Sen. Brian Schatz from Hawaii.