Hawaii’s Lt. Guv on the ‘Fail’ That Helped COVID Roar Back

Hawaii seemed to have beaten COVID-19, with cases approaching zero in May.

And nobody could have been happier than 50-year-old Josh Green, who is both the state’s lieutenant governor and an emergency room physician who continues to work two weekends a month in a hospital.

Green has treated COVID-19 patients and witnessed firsthand this disease where 11 of every 100 cases is hospitalized, and two of those end up on ventilators, and one of those dies.

“Those are numbers in the whole world, pretty much,” he told The Daily Beast.

But thanks to a near-total lockdown and adherence to the established precautions and a 14-day travel quarantine, all backed by enforcement resulting in hundreds of arrests, COVID-19 cases in Hawaii fell to just 30 a month.

“Thirty days, 30 cases, one a day,” Green later said.

And nobody was happier about than Green. He is from New York and arrived in Hawaii in 2000 with the National Health Service Corps, serving for four years as the only family doctor for 8,000 people in an underserved section of the Big Island. He became concerned enough about the lack of trauma care and drug rehabilitation and medical services in general that he decided to run for the state House of Representatives. He won and went on to the state Senate and became lieutenant governor in 2018. He served as the governor’s primary COVID-19 liaison at a time when it seemed Hawaii could show the whole country how to beat the virus. 

“We thought we had it pretty much licked,” he told The Daily Beast his week.

Too many Hawaiians seemed to imagine the pandemic as a thing of the past. Extended families gathered. Crowds formed on the beaches. Bars and restaurants filled. And social distancing went the way of masks. 

“People imagined they could just go back to normal,” Green said. “Then came the Fourth of July weekend.”

Green figures the nation’s birthday also marked the start of the surge in Hawaii. He began detecting what he had come as a clinician to recognize as telltale signs of COVID-19, not just in emergency room patients but in people he encountered in his role as lieutenant governor. He even saw it in people during Zoom meetings. 

“A lot of times, their eyes may be sunken and rings under their eyes,” he said. “They all look wiped out. You see people and you can tell they’re sick.”

He understood there also had to be asymptomatic people.

“You just never know,” he said.

He did note one sign in otherwise asymptomatic ones who knew they had been around people with COVID-19.

“The worried look on their face,” he said.

The number of cases grew to as many as 200 a day or even more, and Hawaii has gone from role model to the state with the highest rate of infections.

Where the Hawaii state Department of Health had been lauded for overseeing an effective shutdown, it fell far short on the contact tracing essential to curbing an outbreak. The department had largely ignored warnings from a number of officials back in May that it needed to have some 500 contact tracers on hand in the event of an outbreak. 

“That was a fail,” Green said this week.

At an Aug. 6 hearing before the state Senate Special Committee on COVID-19, the health department’s chief epidemiologist, Dr. Sarah Park, testified that there were only 105 contact tracers on the job, and that might have been an exaggeration. She appeared to anger several legislators when she sought to downplay the importance of contact tracing and blamed the public for the spike in infections.

“What we could not have predicted, quite frankly, is how badly our community would behave,” she said.

The following day, the exasperated senators marched across the street from the capitol building to the health department’s main offices. The unannounced visit was filmed by a TV news crew. 

The senators, all of whom were wearing masks, demanded to see the contact tracers. The first tracer they spoke to was a young woman who reported she had 131 cases.

“One hundred thirty-one cases, how are you able to track all of them?’“ state Sen. Donna Mercado Kim asked.

“I’m not,” the tracer replied.

“And what about your supervisor, do they know you have this many cases?” Kim asked.

“I’m pretty sure we all do,” the tracer said.

“But we asked them and they said they don’t know,” Kim said.

“I asked this morning and we’re basically prioritizing those over 65 [years old] because they are the high-risk cases, so then there needs to be a way for us to sort that out who are actually the ones over,” the tracer said. 

“And what about the ones who aren’t over 65?” Kim asked.

“I got a call from someone yesterday saying it was Day 10 and no one ever contacted them, and I was like, ‘Oh well, he made it through I guess,’” the tracer said.

In an effort to contain the spread, Hawaii’s various counties had instituted mask mandates and limited the size of gatherings. Restaurants are still open, but bars are closed. Beaches are restricted to swimming, the sand just something to cross on the way to the water. The Honolulu police have remained particularly aggressive in enforcing the emergency orders, which continue to include travel quarantines. A dedicated COVID-19 unit has made more than 400 arrests and has instituted a tips line where people can report violations.

Of course some people still go maskless, particularly the young.

“When I see someone else without a mask, I know there’s going to be the grandmother on a ventilator four weeks from now,” Green said. “You absolutely have to wear a mask.”

On Wednesday, Hawaii reported 202 new cases. Green remembers a time three months ago when it was a case a day. He figures that Hawaii nonetheless remains an example of how the virus can be controlled.

He wonders if the whole country should shut down Hawaiian-style for four to six weeks. And, having learned from Hawaii’s success, we can learn from its mistakes by having all the necessary testing and contract tracing in place when we reopen.

“You absolutely can stop it,” the physician-lieutenant governor said.

Whatever the economic impact, Green figures it would not be as damaging as perpetually seeking to quell outbreaks and fill more cemeteries.

“A slow burn is worse,” he said.