 Aloha and welcome to Talk Story with John Whitehead. As usual, we have an interesting guest for you this afternoon. And we are going to be discussing some very important subjects. With us, we have Lieutenant Governor Josh Green, MD. Now, just with that introduction, you ought to know that what we're going to talk to the Lieutenant Governor about is something that's more in his background. And that's that as a medical doctor, he has been delegated, given the responsibility of dealing with the coronavirus in the state of Hawaii. Now, if that doesn't get your interest, nothing will. Lieutenant Governor, Doc, are you here? I am, Governor. Thank you for welcoming me. I so appreciate it. Yeah, I really wanted to do this. And I don't know quite how to begin, because first of all, I'm going to assume that the people in Hawaii know who you are as our Lieutenant Governor. And outside, beyond knowing that you're a medical doctor, you're also a Naval Islander and a number of things. But I want to get right into our subject. You know, it seems to me that you're the most qualified public official to talk about this subject. And that is the coronavirus and what it might mean for the state of Hawaii. So maybe first of all, you can tell us what it is. You bet. Thank you, Gov. Really, a lot of good people in Department of Health. I do have a little bit of a unique niche having been a doctor here in Hawaii for 20 plus years. As Lieutenant Governor, they have me working hard on this issue. And what is a coronavirus? A coronavirus is a virus not unlike the flu. It's a virus that comes from animals. In this case, it gets you infected and you get upper respiratory symptoms. That means cough, fever, runny nose. Now, this particular virus emanated from China, a place called Wuhan, which is in the Hubei province. So deep in China, this virus broke out a couple months ago and started spreading. And coronaviruses can be quite lethal. We had them in the past. We had SARS and MERS. People may remember that. Again, one person can spread it to another by coughing or sneezing on them. And unfortunately, these viruses can make you very sick. Let's talk about the flu for a half a second. The flu hits everybody. It hits about 8 to 10 percent of all people across the world, which means here in Hawaii, 8 to 10 percent of our 1.4 million people will get the flu. Now, let me ask you something, Doc, before we go very much further. Now, for those people who got a flu shot, are they like safer when this is happening? I wish I could say that they were. The flu is totally different as far as the immunity you get from the flu shot. So people who got the flu shot will not get the flu. And good for you for mentioning that, because we want people to get their flu shots. If they get their flu shots, they will most likely not get the flu. Symptoms are almost the same. If you've got the flu, like I saw people last weekend on call, they got the flu, they got fever and headache and body aches. They feel terrible. Their nose is running a sore throat. Same thing would be said of the coronavirus symptoms. Now, we have zero cases of coronavirus in our state, zero so far. Oh, well, let's keep our fingers crossed. Exactly. So we want to keep our fingers crossed, and we want to keep from getting any cases coming over from China. So what we did, federal government made this decision, but we've supported it. The Department of Health, the Governor's Office, my office, they shut it down for travel from China. Only Americans that are returning, returning from mainland China can come to Hawaii. No other travelers, no Chinese travelers, no Chinese citizens can right now come from China to Hawaii or to the rest of the United States. Now, when you say China, you're speaking specifically about the Republic of China. I ask you that question because there are a lot of overseas Chinese countries like Taiwan and Singapore and the rest. So they are still free to travel to Hawaii. Yes. So just mainland China, mainland China cannot travel here, individuals that are citizens of that country without, and here's the trick, any way, shape, or form coming into the country, they're not allowed in until this thing gets settled. Now, our citizens of which there are 200,000 US citizens that live in China are allowed to return. We take people home, but if they return from China, they have to do two weeks, two weeks in mandatory home quarantine where they're observed and we speak to them from our Departments of Health all across the country. That way, if God forbid that they were carrying the virus, they will get sick at home, be at home, ride it out, that's it. They get very sick, we take them to the hospital, but everyone has to do that mandatory home quarantine if they came from China. Well, let me ask you a question, because you sort of alluded to it. And that is that these, when these symptoms occur, now the one thing about the flu, the flu at one time was considered, you know, a pretty bad disease. And but late, but for the most part nowadays, you know, people do pretty well if they can get inoculated in the rest. Now, this particular virus has flu like symptoms, but apparently it is a plus to it. Yes. Some people get really off the bad end with it. So what happens? I mean, why is that? So there's lots of reasons. First of all, the flu can make you very sick, but you're right. Most times you get better. About one out of every 1500 people that get the flu does die. So it still can be lethal that here's the problem. 25 out of, so it's 25 out of 1000 people that get the coronavirus will die. It's just about 1.5 of those same number of people with the flu die. So it's way, way more lethal. The coronavirus is at least 25 times as lethal as the flu. So I remember when SARS was around, it was, it was, it was even more lethal. If I remember, you're exactly right. SARS was 130 times more lethal than the flu. So SARS was really, really terrible. And this one they're calling it COVID-19, which stands for coronavirus disease 19. This disease is not as lethal as SARS, but it's still 25 times as lethal as the flu. Well, what I got from you, Doc, and you don't mind me calling you Doc when we're talking about the coronavirus instead of L, Lieutenant Governor, but you know, if you got your flu shot, all right, and you now have some flu symptoms, you better go check in. Yes, we want you to check in with your provider because for one thing, people are scared, right? So it's good to check. Now the flu shot is not 100% so you could very likely still have a cold or got the flu anyway. But if anyone has traveled back from Asia and they have the symptoms and we test them and they don't have the flu, then we have to start wondering, man, God forbid maybe they have contracted COVID-19 or the coronavirus. That's why we have to test for that, send the test to the CDC and be safe because we don't want a break, an outbreak of coronavirus here in Hawaii or anywhere else in the country. Now I saw in the newspaper, there were these pictures of people coming out of quarantine. I think they were from Japan. And you know, how does all of that work? I mean, where is the quarantine located? I mean, how do people get processed? Sure. So what happened was when we decided that China was the epicenter of the disease and even more specific Wuhan, that city, it was determined that anyone who came in the last 14 days from the epicenter of the disease would go for 14 days to mandatory quarantine and we set up Pearl Harbor. There's a barracks there or really it's basically a dormitory that's got 60 rooms, no one else is there, 120 beds where if we had to put anybody and we did put that one gentleman who was from China but lives here, we put him into quarantine for two weeks because he had come from the risky area. Now anybody else coming back from China but not that risky area does their home quarantine. So they go home, they stay there, no one has become symptomatic. In fact, right now we have 62 people under home observation quarantine and we check in on them two, three times a day, our Department of Health, they've not gotten sick, but because they were at slightly higher risk, we watch them because we don't want them wandering around the mall or Starbucks or anywhere else. Right, you know one of the signs that we are in an emergency time with regard to the coronavirus is the fact that I just recently went to Long's drug store here located on Polly Highway, Polly Longs. There's a sign right in the front of the area where you pharmaceutical area saying sorry, no face mask available, we don't know when the shipments come. Apparently people are buying those things, buying them all out in town. Do they actually work? I mean is that an important part of all of this? Perfect question. So the masks are good to keep what you've got in. So if you have a flu or a cold or, God forbid, coronavirus, if you had that disease, you wear the mask so you can't cough on people, so you can't touch your face a lot, you protect other people by wearing the mask. The N95 mask, which means it takes 95% of the particles out of the air when it gets coughing on or sneezing on people, that's pretty good. But really, we only recommend the masks technically for people who are either sick or in the healthcare profession because a nurse, we have to cover up his or her mouth because we don't want that person getting sick and then seeing another 50 patients and infecting them. So regular people do not need to wear the masks, but I do recognize it does provide some comfort. Now masks are sold out all over the country and the world, so we're really supposed to be utilizing them in hospital settings just so we don't spread it that way. Well, let me ask you another question, Doc, and that is, you know, as a public official, putting back your lieutenant governor's hand, what are the consequences of all these actions so far with respect to our number one industry in the state of Hawaii, which is tourist? Well, the first impact is that by shutting down any transportation from China, any direct transit, that represents 1.5% of all of our tourists right now. So China is 1.5%. So small sliver. Now there's a couple other large problems. One is that right now Japan and South Korea have just been listed as level two travel advisory nations. That means that if someone here, any Americans are older, meaning it's not old, but you know, 70 or older and might have a compromised immune system, we're telling people not to travel to Japan or South Korea because they're level two and no one's to go to China right now. That has other implications though, because then it's going to be less likely over time that people will feel comfortable going back and forth between the nations if it gets worse there. That's one thing. Two, Japan itself, which is very, very important to us because we love our Japanese neighbors. We also love our Chinese neighbors, but the Japanese do spend a lot of tourist dollars here. Their economy is going to see a major downturn because they get 40% of their tourism from China and that is now closed off. So there will be a great diminishment in their budget in the next year or two years. That means those individuals will have less money to travel to Hawaii or to the mainly United States or anything. So these are major events and if it gets worse right now, as of this moment, my understanding is there are 844 total cases of coronavirus in Japan and 833 cases in South Korea. If it gets worse in those nations, we do have to wonder when the State Department will make some determination that there has to be no travel. If that happens, it is going to be a billion dollar impact on Hawaii. Wow. You know, and I've heard that probably one of the unknown countries of the world, it might be one of the places with the worst outbreak, might actually be North Korea where we don't have any real statistics from. Are you aware of any of that? It's a black box to us or to me at least. We know that China delayed their response for several weeks and North Korea hasn't given us much data at all. It doesn't even appear on my list and every morning I get a list from the CDC and our defense folks of exactly how many cases are in each different nation and I have not seen any meaningful data from North Korea. So we have to really hope that they're doing their part in keeping quarantines under effect. Well, I tell you what, we're going to take a short break right now and we'll be right back and we'd like to talk to you a little bit about the most vulnerable people in our society, those of our citizens who are homeless. Sounds good. Aloha, I'm Keisha King, host of Crossroads in Learning on Think Tech Hawaii. On Crossroads in Learning, our guests and I discuss all aspects of education here in Hawaii and throughout the country. You can join us for stimulating conversations to enrich and liven and educate. We are streamed live on Think Tech bi-weekly at 4 p.m. on Mondays. Thanks so much for watching our show. We look forward to seeing you then. Aloha. Welcome back to Talk Story with John Wahee and our guest Lieutenant Governor Josh Green, Dr. Josh Green. And Lieutenant Governor, right just before the break, you mentioned, or doing the break actually, you mentioned something that I found very interesting and that is that the agency is responsible for deciding whether or not there would be a quarantine from any of the current countries that are up for review with regard to the coronavirus are the U.S. Department of Health and the, I guess, Center for Communicable Diseases, but also the Pentagon. Yes. And that might not be a decision based solely on medical evidence. In other words, there is a political security aspect to all of this. That's exactly right. So they both rank them on level one, two and three, three being the most risky for populations. So the CDC under Health and Human Services determines whether or not it's a health risk going up the ladder. So right now Japan and South Korea are two, China is a three, the top risk. But at the same time, the Pentagon is making political decisions in part with the help of the CDC because they have an interagency task force under the president, but they have to also look at and choose to look at international and global security. So if they feel there's a security risk in addition to a health risk, they can bring the hammer down and do what they did with China, which is to say no one will travel from mainland China if they're not a U.S. citizen to our country. So really big decisions and I'm talking to the CDC and I have contacts at the White House to kind of encourage them under any circumstance, talk to our federal delegation and our governor before you make that decision because look, we want to make sure everyone's healthy, safe, no matter what. But you can imagine if you take a billion dollars out of Hawaii's economy, we won't have as much health care or education or public safety and police. Big, big implications that you as governor obviously dealt with very effectively for many years. So we have to be mindful both of the health and the financial and economic consideration. Well, I tell you what, you, the most vulnerable group probably in our community right now are those that don't have homes that are on the streets and homeless because they don't have all the protections against contacting a disease that you and I actually take for granted in our daily lives. Now, I'm going to use your lieutenant governor's hat again first before we get back to your medical doctor status. And that is that as lieutenant governor, you are intimately associated with the efforts that the state of Hawaii is carrying on to do something about the homeless problem in Honolulu and across the state. Tell us a little bit about what you're doing before we get to the vulnerability of that particular population to this coronavirus. Thank you. What's happened? Yes, thank you, governor. So we have 8,000 individuals right now every night who are on the streets of which a quarter of them are children, which is the heartbreak and unacceptable. And over the course of a year, 15,000 unique individuals in Hawaii seek services for their homeless conditions. So some people fall in and out of homelessness, but it's 15,000 unique individuals. These individuals, if an outbreak were to occur, like for instance, it happened in San Diego, there was an outbreak of hepatitis. It will run right through that community and spill over to other people that are out and about going to work, going to school. So it's a very dangerous circumstance for us to not get everyone housed. We have to end homelessness. What my role is, is to support all of the programs. There's a whole lot of them to get people into shelters and into permanent housing. But it goes very slowly. So we are employing a lot of other methods, but too slowly. And we're doing as hard as we can, at least I am. We will have Kauhali, small villages formed. We will have to build additional middle-class housing to get more people to housing. And we have to really just get everybody out of camps and into stable spaces, which are a little private. Because you can imagine, like you said, imagine if you have the flu. It's terrible enough to have the flu and be laying at home and having to take Tylenol and drink fluids and you're aching and you feel terrible. Imagine if you're sleeping in a tent or on the street and you're trying to deal with that. And imagine how difficult it is if you're in a cluster of 60 people at, say, Waimanalo Beach Park or downtown at the park outside of Jabsum. You're going to spread it to everybody around you when you go to get water, when you are huddling together at night, when you're moving en masse because someone moves the whole camp without any notice. You can't wash your hands. You can't get a flu shot. These things could spread like crazy. So this is one of the many reasons that we have to solve homelessness in our state. Not just because it's terrible, which it is, and not because it's inhumane, which it certainly is, to not take care of people, but because it would actually have consequences if we had... For the rest of us. Yes, exactly. Now, you mentioned something that I didn't realize. I suspect it, but that they were children out on the streets as well. But you mentioned a certain... You said that out of the 8,000 people, 25%, that would be like 2,000 of them are children. That's exactly right. School-age children and younger? Little ones usually. The average age is low. They're like little kids. And you know, the homeless population is economically not doing well. They have not made many decisions on family planning. They have a bunch of little kids and they can end up homeless. And it's just totally unacceptable. Do these kids go to school at all? They do. They go to school. The DOE does an amazing job trying to make sure that they have meals at school and get health care at school from the school nurses and get their shots and everything. But everything is difficult. You know, you've got beautiful kids grown now and you know how hard it was to raise them. Oh, yeah. Imagine if you were raising them outside of a tent or a lean-to shelter. And so these kids, many of whom are disadvantaged, there's a hugely disproportionate number of Hawaiian kids, Samoan kids and Marshallese kids and they're out on the street. And so if we get an outbreak, it's going to run like crazy through our children. And those homeless children are going to be sick. What are we doing to, what is the state doing to seek shelter or homes or communities for, especially for the families, the people with children on the street? Well, it's- And or each, what are the various population groups, if you don't mind. And I know that this is sort of great. You know, it may be a little generalization, but what are the various groups in the homeless population? And real quickly, what are we doing to try and help that particular group of people? Well, we're going, what we're doing is we're going five steps forward and four steps back every year. We go forward a little bit nicely and then we have new homeless individuals or more people slip into it. The breakdown is this. Right now, 18 to 20 percent of our state is Hawaiian. I know this, you are the champion. You're our best, best representative of excellence from the community. 20 percent Hawaiians in the state, yet homeless population is made up of 40 percent Hawaiian. So huge, exactly twice what the representation should be. And then each of the other ethnicities are also very, very highly represented, especially those from the free associated states, you know, Micronesia from Samoa. These are the people that are most challenged. And then I already explained that it's a quarter children, but 20 percent of all the homeless are single adults that have had chronically homeless conditions that they can't break out of. These are individuals that tend to be severely drug addicted or have mental illness and they continuously are homeless. They overwhelm the healthcare system because they have nowhere else to go. They go to the ER and the average cost per person who's homeless is $82,000 per year. Monies that we could be spending on housing or on immunizations or on prevention of coronavirus or anything. So it's just the system has to fix itself and write itself. And that's what I'm working on. But when you see big camps of homeless people, all we really need to do is continue to build housing and build some small villages, which we're calling Cow Hallway, to do those two things and follow the premise of Housing First, which I know you're very familiar with. That's the solution. It just takes political will. So we're doing it. I would do it 50 times faster if I didn't have anybody in my way is all I can tell you. What about clinics and making, you know, one of the status sites is driving up past Queens Hospital and see people in their patient clothes sleeping on the street. And you know that they've just been released from the hospital and there's no place to receive them or or I suspect maybe that they're already thinking that they might get back in. Yeah, you're totally right. Well, we do have some good news on that front. First, let me tell you a story real fast. Guy named Gary Grinker told his story to me and she wanted me to share it. In 2017, he went to the hospital Queens 241 times himself. He's the guy that was always in the gown, always outside. And so Gary spent $1.2 million of health care just because that was his cycle. Now we're starting the H4 clinic, which is Hygiene Center, 24 seven health clinic, medical respite, third floor and permanent housing on the fourth floor. What a great idea. And that opens up now or imminently in the next couple of months in Evalet. And that means that those guys who are getting discharged to the street can at least go to the third floor and sleep there and we get them better and they cost come way down. So we do those kind of things, then they can get health care, then they don't get infection that spreads like the coronavirus. If God forbid it comes to Hawaii. Well, I tell you, you know, it's, it's, I think we are very lucky. Josh, you know, very frankly, and as an old friend, I'm saying this to you, that we have you working on both of these issues in the state of Hawaii. First of all, I don't know a better advocate than you for people who are down and out and on the streets. And secondly, I don't know of any other public official elected official, I should say, because as you point out, we have a lot of good people working at the Department of Health and in the private hospitals, but I don't know any elected official with a better background than yourself to deal with these with the medical issues of the coronavirus. Thank you. Congratulations. And we appreciate your, your commitment. But have you anything else that you'd like to tell us anything that people ought to be aware of or anything in for both issues? Well, keep being generous. We've seen the incredible generosity of the people of Hawaii. For instance, when we went to Samoa and we immunized 34,000 people, the Hawaiian people, 480 people volunteered to go within one day's notice. And we can apply that same kind of generosity to challenges like prevention of the coronavirus, which we have no cases now, or homeless solutions. So if people follow that kind of lead, the kind of lead the way that you governed, we're going to be just fine. Well, thank you, Lieutenant Governor. We really appreciate your commitment to the people of Hawaii and for your joining us today. Thank you for an excellent presentation. Thank you, Governor.