The University of Hawaiʻi Economic Research Organization Public Health Report, “Shaping Health in Hawaiʻi: The Influences of Poverty, Housing and Food Insecurity,” surveyed 1,575 adult residents across the state. The study examined the links between mental health, food security and socio-economic determinants, such as housing conditions and poverty status.

The report shows that those experiencing housing insecurity, food insecurity and poverty were more likely to have been negatively impacted by the pandemic and reported worse physical and mental health.

“The survey underscores the intricate links among health, socio-economic status and lifestyle conditions in shaping individual well-being,” said lead researcher Ruben Juarez, University of Hawaiʻi Economic Research Organization-Hawaiʻi Medical Service Association endowed professor in Health Economics. “The pervasive impacts of the COVID-19 pandemic, particularly Long-COVID, highlight the continuous need for multifaceted interventions that address economic stability, housing security and equitable healthcare.”

Long-COVID affected 35% of respondents, up from 30% in 2022. Juarez said that there is a clear association between long-COVID and unemployment, with 49% of unemployed vs. 28% of employed individuals reporting long-COVID in May 2023.

Other key findings include:

• General health outcomes: More than 70% of participants considered their health to be good to excellent, but Native Hawaiians and Filipinos tended to report lower health ratings in comparison to Whites and Non-Filipino Asians. Individuals with high income or food security tended to have more positive health perceptions, while those dealing with the long-term effects of COVID-19, or who had delayed healthcare, especially mental health services, reported lower health scores.
• Mental health and well-being: One-third of participants reported symptoms of depression, with significant risk factors being unemployment and recent COVID-19 positivity. Housing instability, housing cost burden and poverty were also correlated with higher rates of depression symptoms. About 80% of respondents reported no food security issues, but—compared to findings in 2022—there was a small increase in those reporting very low food security. Unemployment, recent COVID-19 positivity, younger age, certain ethnicities such as Native Hawaiians and Filipinos, poverty and housing instability all correlated with increased food insecurity.

This report is based on results from the third wave of the University of Hawaiʻi Economic Research Organization Rapid Health Survey conducted in June 2023 by its public health team, in partnership with the Pacific Alliance Against COVID-19. In future reports, the team aims to increase the sample size of survey respondents and deepen its exploration of these findings, including exploring causality and cost, to offer a more thorough understanding of these complex social determinants of health.

Read the full report on UHERO’s website.

While the pandemic may be over, the risk of COVID-19 is still real and as a result the Hawai’i Department of Health recently updated its guidance documents to ensure local keiki are protected from the virus at school.

According to a recent report, the new guidance documents spell out safe practices and recommendations for local students that include home isolation and exposure, return to work guidance, identifying and talking to close contacts, and home care and prevention. 

According to the updated comprehensive K-12 school guidance, there are new protocols for students and staff who may show sickness.

For starters, if a student or staff has become sick at school, they should immediately be separated and go home or to a healthcare provider based on symptom severity.

Here’s a look at a few other guidelines:

• Individuals who are sick should wear a face mask, if possible.
• Identify an isolation area to separate anyone who has COVID-19 symptoms.
• Ensure students are isolated in a non-threatening manner, within the line of sight of an
  adult, and only as long as necessary.
• Ensure staff managing sick students or employees are appropriately protected from
  potential exposure to COVID-19.
• Staff caring for a sick student or staff should be provided appropriate personal
  protective equipment, including an N95 respirator or equivalent (or double
  masking with a surgical and tight-fitting cloth mask if a respirator is not available) and
  follow standard and transmission-based precautions.
• Gloves, gowns and face shields are not routinely required, but consider using during
  interactions with a student or employee who is actively coughing or with special medical
  needs.
• Refer to CDC guidance on “When and How to Clean and Disinfect a Facility” for guidance on appropriate cleaning and disinfection procedures after a case is identified.
• When performing notification, schools should rapidly identify the impacted group setting and notify any potentially exposed group members of contact with a person with COVID-19 infection, while keeping the person’s identity and personal health information confidential.
• If your school is experiencing a suspected outbreak, notify the Hawai’i State Department of Health within 24 hours via the online COVID-19 Outbreak or Case Reporting Tool. The principal, supervisor or program contract manager is responsible for reporting the suspected outbreak to the DOH.

The federal Public Health Emergency (PHE) for COVID-19, declared under Section 319 of the Public Health Service Act, will expire at the end of the day on May 11, 2023, state officials announced today.

This comes after the Centers for Disease Control and Prevention (CDC) announcement last week that COVID-19 is now an established and ongoing health issue, and no longer constitutes a public health emergency of international concern.  

As the PHE ends, high levels of vaccination, widespread population immunity, and available treatments have significantly reduced the risk of severe COVID-19 disease, hospitalization, and death, according to a state news release.

“We mourn the loss of loved ones from the pandemic.  However, our experience demonstrated what we can accomplish when we come together as a community, having the lowest mortality rate in the nation,” said Hawaiʻi State Health Director Dr. Kenneth Fink. “Although the federal PHE is ending, we’ve learned that we must remain vigilant and continue to invest in public health preparedness.”

In terms of what the end of the PHE means for the public, the CDC and the US Department of Health and Human Services provided the following information:

• Vaccines will remain available. Access to COVID-19 vaccines will generally not be affected for now. The U.S. government is currently distributing free COVID-19 vaccines for all adults and children.  To help keep communities safe from COVID-19, HHS remains committed to maximizing continued access to COVID-19 vaccines.
• COVID-19 at-home tests may not be covered by insurance. Insurance providers will no longer be required to waive costs or provide free at-home COVID-19 tests. COVID-19 tests ordered by healthcare providers when clinically indicated are generally expected to be covered by insurance but may have cost-sharing.
• For people with Medicaid coverage, COVID-19 testing and treatment will remain covered at no cost through September 2024.
• No cost testing may be available to people without insurance or in areas of high social vulnerability through CDC’s Increasing Community Access to Testing (ICATT) program. Participating community and pharmacy partners can be located through CDC’s No Cost COVID-19 Testing Locator.
• CDC will discontinue reporting of COVID-19 Community Levels and some other COVID-19 metrics like percent positivity. These changes are because of changing laboratory requirements with the end of the PHE, and also because case data has become less reliable as self-testing gains in popularity.

In addition to the information provided by the CDC and HHS, the Hawai’i Department of Health is notifying the public of the following:

• Sometime later this year, COVID-19 vaccines are anticipated to become commercially available, and DOH will provide more information on this transition to providers and the public as it becomes available. DOH remains committed to working with providers and federal agencies to ensure equitable vaccine supply for Hawai‘i residents.
• DOH will continue to partner with long-term care facilities, other healthcare and congregate settings, schools, and community organizations to investigate illness clusters and outbreaks of concern, provide technical assistance, and educate partners and the public on how to mitigate the impacts of COVID-19.
• DOH will continue to maintain dashboards that provide situational awareness of COVID-19 trends and impacts in Hawai‘i.
• While masks are no longer required in public settings in the state of Hawai‘i, use of a properly fitting high quality mask remains an important tool for preventing COVID-19 and many other respiratory illnesses. Those with high risk of severe disease, such as kupuna and those with chronic medical conditions, as well as those who interact closely with these groups, should consider wearing a mask in situations where social distancing is not possible. 
• The DOH reports that vaccines are still “the best tool” for preventing infection or severe illness from COVID-19. The COVID-19 vaccine is recommended for anyone over 6 months of age. Anyone who has not yet received a bivalent vaccine dose should get one. And anyone who is at increased risk for severe infection and has received a bivalent dose should consider receiving a second dose.  Bivalent vaccines provide better coverage for the variants of COVID-19 currently in the community. Detailed vaccine recommendations can be found here. Find your nearest COVID-19 vaccine provider at Vaccines.gov.
• Vaccinations and masking are particularly important for people who are immunocompromised or for those who have frequent contact with individuals who fall into this category, according to the DOH.

The World Health Organization today said that COVID-19 is now an established and ongoing health issue, and no longer constitutes a public health emergency of international concern.  

This comes more than three years after the organization declared it a crisis back in March of 2020. Today’s announcement marks a transition to a downgraded response.

The announcement came with a list of recommendations moving forward relating to vaccination efforts, ongoing transitions to lift international travel related health restrictions, and sustaining national capacity gains and readiness for future outbreaks.

The WHO Director-General, Dr Tedros Adhanom Ghebreyesus, noted that the number of weekly reported deaths and hospitalizations continue to decrease, but at the same time expressed concern that surveillance reporting had declined significantly.

He announced the publication of the 2023-2025 COVID-19 Strategic Preparedness and Response Plan which is designed to guide countries in transitioning to long-term disease management of COVID-19.

According to the WHO, “global risk assessment remains high,” but “there is evidence of reducing risks to human health driven mainly by high population-level immunity from infection, vaccination, or both.” The organization also said there is improved case management.

“While SARS-CoV-2 continues to evolve, the currently circulating variants do not appear to be associated with increased severity,” the organization reports.

Mauliola Pharmacy in Wailuku is offering a new COVID-19 antibody testing program that’s free for residents.

Funded by federal COVID-19 funds, the new antibody testing program lets community members analyze their response to past COVID-19 infections or vaccinations by testing antibody levels.

“It’s an opportunity for someone to understand their immunity response and make a personal decision about vaccinations and boosters,” according to Dr. Cory Lehano, owner of Mauliola Pharmacy in a county issued news release.

In 2022, the County of Maui selected Mauliola Pharmacy through a Request For Proposal process aimed at providing COVID-19 community-based testing program. The new antibody testing program is an extension of the services offered, and it is being funded by American Rescue Plan Act for COVID-19 money. The federal funds are managed by the County of Maui.

Mauliola Pharmacy is offering the COVID-19 antibody testing from 2 to 4 p.m. Monday to Friday by appointment only. No insurance is required. To schedule company or organization testing at no cost, call 808-867-0622.

Also, COVID-19 testing, vaccines and treatments are available from 9 a.m. to 4 p.m. daily at Mauliola Pharmacy. Walk-ins are accepted.

Mauliola Pharmacy is located in the J. Walter Cameron Center, 95 Mahalani St., Room 28-5, Wailuku. For information, visit mauliolapharmacy.com.

More Hawaiʻi residents are contracting COVID-19, fewer are getting COVID-19 booster shots and the number of those impacted by long-COVID illnesses remain high, according to a new comprehensive report released on Jan. 5 by researchers in the University of Hawaiʻi Economic Research Organization.

The report is based on survey responses from 1,627 Hawaiʻi residents over the age of 18 in fall 2022.

In partnership with the Pacific Alliance Against COVID-19, this was the second survey developed to inform the design and execution of public health programs in Hawaiʻi for COVID-19 and other disasters while addressing systemic health disparities. Researchers have a statewide cohort of more than 2,000 adult residents in the state that are being surveyed regularly over time.

The first report was released on June 20, 2022 and was based on survey responses conducted in May 2022.

Highlights of the Jan. 5 report:

COVID-19 outcomes and vaccination

• COVID-19 positivity has increased since the last report. In November, 45.5% of respondents had tested positive for COVID-19 at least once, compared to only 24.8% in May. Higher rates continue to be seen among younger adults, Native Hawaiian, Pacific Islander, and Filipino populations, as well as among unvaccinated and unboosted individuals.
• High vaccination rate and low booster shots among adults. 94.5% of respondents are vaccinated but only 27% of the sample received the bivalent booster shot.
• Long-COVID outcomes remain high. The overall rate of long-COVID remained stable at close to 30%, but more individuals reported severe or very severe symptoms in the fall compared to the spring. The expected length of long-COVID symptoms increased by almost one month since the last report to 4.42 months.
• Flu shot uptake is correlated with COVID-19 vaccination. 62% of respo ndents have already gotten their flu shots, with an additional 8.4% planning to get one. 77.3% of COVID-vaccinated individuals have or plan to get a flu shot, compared to only 21.8% of those COVID-unvaccinated.

Perceptions and views of COVID-19

• Perceptions of neighborhood/community safety against COVID-19 have risen. More people felt safe or very safe in the fall (68.7%) compared to the spring (61%).
• Some people feel COVID-19 fatigue. Signs of COVID fatigue are present in our populations. The highest levels were found among those unvaccinated and those vaccinated without booster shots.

COVID-19 Impacts

• The impact of the COVID-19 pandemic continues to increase since May 2022. 28.6% of the individuals reported having their savings depleted, 13.6% were unable to pay bills and 9% did not have enough food in their household. 4.4% of the individuals lost their jobs, and 7.2% of the individuals were furloughed or reduced their working hours since May 2022.
• Long-COVID is negatively affecting employment. Despite the rate of long-COVID being about 30%, unemployed individuals have a 47% rate of long-COVID, a 5-point increase since May.
• Depression symptoms remain high but stable. Rates of depression symptoms remained stable since May, at about 1 in 3 adults reporting depression symptoms, with higher levels of depression reported by those affected by the pandemic.
• Race disparities were observed in mental health outcomes. Korean and Japanese respondents had the best mental health outcomes, while Native Hawaiian, Latino and Native American respondents had the lowest mental health outcomes.
• Food insecurity remained high but stable. The percentage of respondents reporting low food security reduced slightly to 8.2% from 8.4% in May.

“Overall, as we enter a new phase of the pandemic, Hawaiʻi’s populations are becoming more confident that the worst of the pandemic is behind us, driving COVID-19 booster uptake down,” according to Ruben Juarez, HMSA Endowed Professor in Health Economics at UHERO. “Significant impacts exacerbated by the pandemic, including long-COVID, mental health issues and the impact of long-COVID on unemployment, may pose significant challenges that warrant monitoring.”

Maui Health has ended its COVID-19 community vaccination clinic in the hospital lobby due to decreased demand.

The final clinic date at the Maui Memorial Medical Center lobby was Friday, Dec. 16, 2022.

“Most pharmacies, clinics and doctors’ offices around the county are now providing COVID-19 vaccines for their patients,” said a hospital spokesperson.

The facility administered nearly 87,000 doses of the COVID-19 vaccine over two years.

Additionally, Maui Health has discontinued outpatient monoclonal antibody treatment (mAb) and pre-exposure prophylaxis for COVID-19 due to the wide availability of alternative treatments.

“Maui Health started offering outpatient monoclonal antibody treatment (mAb) in September 2021 and since then has treated thousands of patients with various COVID treatments,” according to an email update.

• Vaccine sites available at other locations around Maui County are posted here.
• Vaccine sites around the state are posted here.
• Testing sites throughout the County of Maui are posted here.

As of 9 a.m. on Dec. 28, 2022, the latest data available, there were six individuals hospitalized in Maui County with COVID-19. Of the six hospitalized individuals, three are vaccinated (including two boosted), two are unvaccinated, and the status of one is unknownn. None of these patients are in the ICU, and none are on a ventilator.

The number of hospitalized remains below both the 41 reported during the height of the delta surge in August 2021, and the previous omicron high of 56 reported on Jan. 28, 2022.

The state shifted to a weekly data summary on March 16, 2022. Highlights since then include the following: 

• The greatest number of new infections was recorded during the week of May 19-25 when there were 8,924 new cases in the state. 
• The greatest number of deaths reported in a single week was July 21-27, 2022, when 23deaths occurred. 
• For the week of Sept. 22-28, 2022, there were 12,755* new infections *(includes 10,995 historic reinfections and 800 historic cases as a result of deduplication and cleaning of historic data).

The latest weekly count includes 140 cases on Maui, 148 on Hawaiʻi Island, 79 on Kauaʻi, four on Molokaʻi, three on Lānaʻi, and 24 out of state.  There are 697 new COVID-19 cases on Oʻahu.

Testing sites throughout the County of Maui are posted here.

Due to decreased demand, as of Dec. 17, 2022, Maui Health no longer offers COVID-19 vaccines to the community via its clinic in the MMMC lobby. Most pharmacies, clinics and doctors’ offices around the county are now providing COVID-19 vaccines for their patients. The MMMC lobby administering nearly 87,000 doses of the COVID-19 vaccine over two years. The last day for community vaccinations in the MMMC lobby was Friday, Dec. 16, 2022.

Additionally, Maui Health has discontinued outpatient monoclonal antibody treatment (mAb) and pre-exposure prophylaxis for COVID-19 due to the wide availability of alternative treatments. Maui Health started offering outpatient monoclonal antibody treatment (mAb) in September 2021 and since then has treated thousands of patients with various COVID treatments.

Vaccine sites available during the month are posted here.

The Hawai‘i Department of Health has placed orders to supply participating healthcare providers with updated COVID-19 bivalent vaccines for children as young as six months of age.

The US Food and Drug Administration issued emergency use authorization for keiki-sized vaccines Thursday, Dec. 8. The Centers for Disease Control and Prevention expanded the use of bivalent COVID-19 vaccines to include children ages six months through five years today.

Children ages six months through five years who completed the two dose primary series of Moderna vaccines are eligible for a Moderna bivalent booster two months after their final primary series dose.

Children ages six months through four years who received two of the three doses of Pfizer’s primary series will receive a Pfizer bivalent vaccine as their third primary dose. Children who completed all three doses of Pfizer’s primary series are not yet eligible for a bivalent booster.

“The authorization of these updated bivalent vaccines comes at a good time,” said State Health Director Dr. Elizabeth Char, FACEP. “Now young children can get the same protection adults have as families gather for the holidays.”

Initial orders of these updated keiki vaccines are expected to arrive early next week. Healthcare providers can administer the bivalent vaccines as soon as they arrive, according to the DOH.

Parents can find information about providers and the services they offer at vaccines.gov or by visiting the vaccine finder map at https://hawaiicovid19.com/vaccine/.

As of 9 a.m. on Dec. 7, 2022, the latest data available, there were seven individuals hospitalized in Maui County with COVID-19. Of the seven hospitalized individuals, all are vaccinated and boosted. None of these patients is in the ICU, and none are on a ventilator.

The number of hospitalized remains below both the 41 reported during the height of the delta surge in August 2021, and the previous omicron high of 56 reported on Jan. 28, 2022.

The state shifted to a weekly data summary on March 16, 2022. Highlights since then include the following: 

• The greatest number of new infections was recorded during the week of May 19-25 when there were 8,924 new cases in the state. 
• The greatest number of deaths reported in a single week was July 21-27, 2022, when 23 deaths occurred. 
• For the week of Sept. 22-28, 2022, there were 12,755* new infections *(includes 10,995 historic reinfections and 800 historic cases as a result of deduplication and cleaning of historic data).

The latest weekly count includes 147 cases on Maui, 105 on Hawaiʻi Island, 46 on Kauaʻi, eight on Molokaʻi, two on Lānaʻi, and 20 out of state.  There are 1,043 new COVID-19 cases on Oʻahu.

Testing sites throughout the County of Maui are posted here.

The vaccine clinic at Maui Memorial Medical Center is available on Fridays from 9 a.m. to 12 p.m. and from 1 to 4 p.m. to accommodate the booster shot appointments. Additional vaccine sites available during the month are posted here.

*Note: The COVID data from the state Department of Health does not include results from at-home testing. The actual positives are likely higher than what is reported.