 Welcome back to Think Tech. Welcome back to Community Matters. I'm Jay Fidel. And we're gonna talk about plague doctors, a new book by Jonathan Borkin, who is actually one of the plague doctors. There's a cover of the book. You can get it. It doesn't cost very much, really worthwhile on Amazon and elsewhere. So Jonathan, thank you so much for coming around. Really appreciate you to flesh out what happened in the plague here in Hawaii. Hawaii has had more than its fair share of plague. I mean, gee, we lost a good, solid percent of the population back in the middle of the 19th century. And you think that would stick with us and we would have a plan. We have a big Department of Health, though. Our Department of Health is 3,000 people plus. It's huge. And one of the reasons is that we lost so many people in the 19th century. But then we are faced with, first the SARS in the early old years and then now more recently COVID-19. And COVID-19 changed the world. And I guess if we thought about it at the time, we would have known it was changing the world. A million people died in this country and government was thoroughly tested. And you were there. I'm so happy you were there because we needed to have your expertise, you and your colleagues. So it's wonderful that you did what you did and thought what you thought and collaborated the way you did. It's also wonderful that we have you in the state to deal with this kind of thing. Welcome to the show. Thank you. Yeah, okay. Thank you. It was very humbling and a story I like to tell. I trained at University of Hawaii, at least for my medicine training. And when you walk through the ground floor at Queen's Punch Bowl, one of the things you see there is the portrait of Queen Emma. And she's looking down. It took me a while to research that portrait, but it turns out the Queen's Health Systems was built in the wake of a smallpox epidemic. There was an attempt, a very conscious attempt by the kingdom of Hawaii to produce infrastructure that would protect the Hawaiian people from pandemic disease, from epidemic and pandemic disease. And boy, when that began to sink in March of 2020, that was a humbling moment for me. And I realized, we need to really step up to this moment. It's not acceptable to allow what happened in 1850 and 1860 to reoccur in 2023, not with the technology and the education and the resources being there now. So much of the book is a story of my attempt in the attempt of healthcare workers around the state of Hawaii to protect its state and to prevent history from repeating itself in that way. Hmm. Well, why in the world did you go into epidemiology? Did you have a mentor? I mean, for example, Dwayne Gubler would have been a good mentor. Did you have a mentor back when that directed you there, or was this something that you could see as a phenomenon that will have huge effect on humanity going forward? I think it was just something that drew me. When I was a medical student, I liked doing international work. So infectious disease clinically is a profession that allows you to travel quite a bit. And it overlaps with epidemiology. It's not exactly epidemiology, because we're much more just hands on with the patients. But there's obviously a lot of back and forth and cross fertilization between us and epidemiology. In terms of mentors, absolutely. I mean, there were people here in the University of Hawaii who mentored me, people like Bruce Saul and Elaine Bello. And then, you know, in infectious disease fellowship, I had, you know, Opal and Flanagan, Tim Flanagan. He was one of my mentors. So I've been very lucky and blessed to be around, you know, some of the most gifted and moral people in the perfection of medicine. And that's my intellectual background. Yeah. But it's dangerous, isn't it? I mean, when you contemplate virology and epidemiology and infectious diseases, you always think about and worry about getting it yourself, especially if you're traveling to developing countries to do research. Yeah, this reminds me of Samuel Shem's House of God, which was a classic from residency age. He has these iron walls of the House of God in medicine. And I think it was the fourth law, is that the patient is the one with the disease. Right? So I always remind myself, it's the patient that has the disease. I don't have the disease. My job is to fight the disease. And there's all kinds of tools that protect us as a healthcare worker. Some of those tools failed in the early phase of the pandemic. And that was genuinely scary. And some of those stories are in my book. But for the most part, I've never felt unsafe at work because, you know, we have the knowledge to prevent these things from being healthcare workers. Um, let me also straighten out one thing in my own mind is that being an epidemiologist or a virologist, it's really, it's about vectors. It's about prevention. It's about watching a given epidemic or pandemic travel from one part of the world to another. It is not necessarily about putting an oxygen mask on someone's face. It is not necessarily about trying to use drugs that we never heard of before. Only Donald Trump heard about them, yeah. And trying to do novel things in the hospital. It's rather about trying to find how this thing is wending its way around. Am I right? Yeah, I think, you know, virologists really focus more on the basic science of how viruses evolved, their biology, their epigenesis. You know, epidemiology is the science of how these infections spread through human populations. And there's a fair amount of field work in epidemiology. That's a point of connection between myself and to Wolf Miller. We're both very fond of that kind of thing. And it's a source of friendship for us. You know, as a clinical infectious disease guide, my routine prior to the pandemic was taking care of patients with infections. And most of those infections were not occurring in epidemics. You know, they were occurring based on the individual risk factor of the patients. So, you know, I trained in general internal medicine, and then I learned a little bit more about how to take care of infections. I never imagined that I myself would be would be involved in, you know, fighting an epidemic per se, only that if an epidemic came, I would be one of the people taking care of the patients. And that's what ended up happening. Yeah, I like that part of your book where you explore the aha moment, where, you know, everything focuses and all of a sudden you realize it's really happening. It's not a joke. And a short story, if I could, you know, ThinkTech covers technological conferences. And every year there has been a technological conference in Hilton Hawaiian Village over telecommunications. It's called the Pacific Telecommunications Conference Council. And I have gone every year. One year, that is 2020. I get a letter from the president of the council. And she says, you just sort of let all you people know that there was a attendee at the conference who had, who had COVID. And so what, what, this is January 10th, John. January 10th. That was my aha moment because I knew early, there was going to be a bad time. And so we all had our aha moments. Some of us were very late. Some of us never had one. As you say, it's an intersection of so many things. Can you explore the kinds of things that, you know, that's happened in the world and humanity that bring the virus together to make it so lethal? Yeah. I mean, emergence happens constantly. You know, we call this emergence. And we're talking about either new infections entering the human population, typically from nature or from animal reservoirs. You can use the term more broadly if there's an old infection that starts behaving differently or fills a new niche. It's a similar idea. But, you know, what tends to happen is it's a product of evolution of the creature, but also human behavior and the interaction of the two. So when we have a booming human population and we have more and more insurers and intrusions into nature and degradation of the natural environment, and we have more and more globalization and people moving across borders and goods moving across borders, and we have more and more medicalization. So we have more vulnerable people. You know, all of these factors can kind of come together to create emergence or reemergence of pathogens. And another interesting point about that is that it appears to be happening more commonly. That's a little tricky to get at because we're also a lot better at detecting it than we were maybe 100 years ago. But it does appear to be that there's an acceleration of emergence events. And, you know, this is why infectious disease has gone from being a field that was sort of neglected and thought to be on the way out at the end of the 20th century to now one of the most important fields in medicine. Yeah. So I guess I'm interested in exactly what happened in Hawaii and I suppose on the mainland because we weren't really prepared for the, you know, terrible possibilities of this virus. How prepared or unprepared were we? And what did we see as the necessary steps at least at the inception? I mean, for example, contact tracing, I always find interesting. That has to be a big study about the Hawaii response. Yeah. I mean, I don't think there was any agreement at the very beginning about how severe the threat would be or what the best countermeasures were. One thing that helped me get my head screwed on straight at the very beginning was I played with some online epidemiology models. And one of the things that I realized when I was plugging in different assumptions, the model, is that, you know, these epidemics are mathematical phenomena. You know, they grow in time and there's something called a doubling time. So there's exponential growth of cases, right? And if you don't interrupt transmission, you have an exponential growth in cases. So, you know, you can make different assumptions about how lethal a given infection is going to be. And if you double the lethality and you double the number of deaths, but if you double the transmissibility, you go way more than double the number of deaths because what you've done is you've fed into the monster of exponential growth that the infection has. So one insight I had pretty early on was that we absolutely needed to interrupt transmission, that we weren't going to be able to survive the first punch in the first round if we didn't interrupt transmission. We knew that over time we would get better at handling the infection. So I knew that whatever the fatality rate of the infection was, it was likely to go down with time. But that if we didn't interrupt transmission at the very beginning, we were going to get socked really hard and knocked out in the first round. And that would be the mass mortality event that we were trying to avoid. And that's kind of what we saw happening in places like Bergamo, Italy, and New York in March and April of 2020. And my work spirit at that time was that we were going to have something like that happen in Hawaii. And I'd say about 100% of the focus of my effort early was just on avoiding that. Yeah. And then can I throw in one factor for you to discuss? And that is the mutation, the variance. I mean, that was terrifying. After you've seen it do terrible things in the space of 60, 90 days globally spreading around the world in such a short period of time, then you find that it mutates. And it mutates because there is so much spread. Can you talk about that? Yeah. I mean, we see that with other viruses. Those of us working in infectious disease are used to having these meetings in infection prevention and control committees where we talk about which flu springs are circulating. We know flu mutates every year. And we have to update flu vaccines. So I wasn't surprised to see that happening with COVID. We don't really have any control over its mutation. So I tended to focus my own mind on things that I can control or that we can control. But I wasn't surprised to see it begin to mutate. And the question with the mutation is always, OK, is this going to escape our existing countermeasures, whether they be the countermeasures that come from natural human immune responses or the vaccine countermeasure or the antiviral countermeasures? So whenever I hear of a new strain of COVID-19, those are the things that I'm interested in. And if there's not a big shift in any of those variables, then I don't worry too much about it because that's just viruses doing what viruses do. So how would you rate Hawaii's response? And I know it's hard to rate Hawaii's response in a vacuum because it was happening globally, and especially some of the misogast, that's a Spanish word, the misogast on the mainland. So I'm just wondering if you could go back and look at the response we had, what would you think was a good part and what was a substandard part? It's funny to be asked to grade it. I guess I'd give us a B plus if I was a taskmaster or a school teacher. You know, I think we avoided that first knockout. And that's huge. One of the things we can try to estimate is something called the infection fatality rate. And that's if you add up all the cases and you make that the denominator over a given period of time, and then you take the deaths, that's the numerator. It's just simple division. What percentage of people, what percentage of total cases are dying? What you saw at the beginning of the pandemic was in some places the infection fatality rate, we think was 1.5%, was as high as 1.4% in New York by some estimates and in other places closer to 1%. And this was devastated early on. Right now we think the infection fatality rate is likely below 0.1%. So if you're going to get COVID, it's better to get COVID in year three when we have a number of countermeasures in place that can logarithmically lower your chance of dying than it was in that first few months. So to the extent that Hawaii avoided that first-ground knockout punch, I think we did well. And I think that is perhaps the most important single detail that people need to wrap their heads around. It was pre-vaccine, it was pre-antiviral. It was critically important that we can kill transmission in those early months. And enough people understood that, not everybody understood it, but enough people understood it that we were able to adopt some effective transmission control maneuvers, in particular, the 14-day entry quarantine, the very first lockdown, and then eventually the tier system that came into place in Honolulu. All of those things were pre-vaccine. The reason why it wouldn't give us an A is because we didn't really develop the kind of public health infrastructure that I would have really liked this to do. Or we did, but it took a while. And that's the kind of Singapore style, Korea-style public health interventions that they started rolling out at the very beginning. So if you look, for example, at the Korean public health response, from the very beginning, they had testing. From the very beginning, they had contact tracing. They had centralized quarantine, or centralized quarantine. They had wraparound support services. All of those things were integrated. And it took us about eight or nine months to stand that up in Hawaii, which was too long. And then we dismantled most of it as soon as we had a vaccine available. I would like us to have that as kind of muscle memory that we can immediately implement the next time there's a major pandemic. So I think that would be the difference between a B and an A. Okay, well, thank you for that. What would you give Singapore, taking a look at the behind the mask, which they seem to be able to get their hands on it in six months? Yeah, this is fine. The great different responses. I would give Singapore any advice. And I'm being ridiculous, of course. But I think what Singapore did very well was they had a kind of integrated response from the very beginning. The long lines that we were just discussing. One area where Singapore struggled was they had a very large population of migrant workers in housing. And they did take care of those workers when they got infected, but the illness absolutely ripped through the migrant worker housing. And it's sort of the economic underbelly of Singapore. It's this large population, density crowded population of migrant workers. I'm not sure what their wage situation is. But that ended up sort of being their Achilles' heel. And it also ended up being the Achilles' heel for a lot of other jurisdictions. And in the United States, it tended to be other crowded places, public housing, prisons, places like that. Here in Hawaii, you had a big outbreak in public housing. So what happened was the virus just took advantage of whatever gaps there were in our social fabric. And that's where it inserted itself. Well, New Zealand and Australia, you covered this in the book, did better because they came down hard right away and shut out any visitors. Unfortunately, Hawaii's economy is connected with visitors, and we didn't see it the same way. Had we shut things down the way Australia and New Zealand did, we would have done better clearly. But how much better? Yeah, I mean, if you look at our mortality compared to the American mainland, we had the lowest mortality rate in the country. So if you compare us to Florida, for example, I'd like to bring up Florida because the governor seems so proud of his COVID response. But if you look at our fatality rate compared to Florida's fatality rate, we're about a third of where Florida is. But if you compare us to places like New Zealand, we're considerably higher. So I think we could have had a lower mortality, had we controlled transmission even more aggressively early on. But as you point out, we're more dependent than New Zealanders on tourism. And this gets at some of that infrastructure that I'm talking about. Had some of that infrastructure been stronger at the very beginning, we could have had more international travel. For example, if we had the ability to produce a locally produced test and we could have tested people upon arrival, we might not have needed to shut down the airline for 10 months like we did. So, you know, in the future, and this is my hope for Hawaii is that we develop some of this, you know, nascent IOTET that we can accomplish much of what we accomplished in 2020, but with less disruption, with less disruption in particular to public schools and possibly with less disruption to travel. Yeah, well, yeah, I do want to reserve some time with us today to talk about the takeaway lessons. But first, I just want to suggest that Hawaii does have a special social, special sauce. And as you write the book, you talk about other virologists, other epidemiologists that are at Japsam and elsewhere in the state who made significant contribution and you guys collaborated. And you worked out, you know, collaborative solutions, decisions, protocols that actually had a pretty good effect. And I'm thinking of Elaine Bellow, for example. I'm thinking of Scott, Kim, members of the last name in Queen's Hostel. Oh, Miss... Scott Gallagher. I mean, there were some real heroes in the story in Hawaii. Probably because you guys talked to each other and, you know, it's a professional thing, but it's more than that. It's a network of expertise. Thank God we have that. Can you talk about that? Absolutely, yeah. I mean, that would be a good time for me to point out that I'm not a representative for Queens and I don't speak for them in any official way. But my career has been wrapped up with Queens Hospital since I was a resident because that's the place that I've worked. And I feel really lucky by the colleagues that I've had there. So, you know, like any other group of people in the beginning of the pandemic, you know, we came to the realization that we were dealing with this problem at different speeds. We did not completely agree with each other at the very beginning. But one thing that's really lovely about Hawaii is that we were able to have these discussions in a way that was constructive and that allowed us to come together and that allowed us to form a closer approximation to the truth and to do what we needed to do to protect the patients. So, you know, my collaborations really began within the hospital and then it became clear as I was messing around with these epidemiologic models online that we could do everything right in the hospital. But if we didn't control transmission outside the hospital, the hospital was going to get crushed. It was going to get overwhelmed no matter how well we did internally. And that's when I began speaking with people, including people like the Wolf Miller, you know, Kim Brown, some early fraud, people at University of Hawaii in New Hero, and then eventually people within, you know, Kirk Caldwell's orbit who were involved in the county response. So, we ended up having a two-tier strategy and the book very much reflects this. There were the things that were happening in the hospital and those were the daily stories of doctors fighting the disease up close and personal. And I think that's what most readers connect with in my book. But there was a parallel story unfolding which was how can we stand up public health infrastructure that allows us to knock down transmission prior to widespread vaccination and that gets at the policy level and the public health level. And those were a different set of collaborations for me. Yeah, the public health level was criticized. The public health level way into the pandemic was once it became clear in the press that there was very little effective contact tracing which is kind of remarkable because at the time as I remember there were various software packages that would geographically connect patients. So all you had to do was get the data and you could draw a map of where it was and where it came from and so forth. But we didn't do that. Am I right? Can you help me with that? Yeah, that's right. I think the public health infrastructure in Hawaii that existed during the pandemic focused a lot on managing known diseases. I interact on a regular basis with the tuberculosis control branch in order to take care of my patients. Sometimes the leprosy branch sometimes venereal diseases other infections. They're very good at their jobs. What I think we were left well prepared for was an emergency response. An emergency response is a completely different response. What it requires you to do is make a quick read on the situation. Try to identify what are the crucial variables and in this case, transmission was probably the crucial variable early on. And then stand up infrastructure quickly tackle all. And I think we were just too slow as a state in that area. One, when Libby Char was running the Department of Health, Libby has an emergency medicine background and I think that's kind of the right mindset for a pandemic. So that's one possible lesson from all of this. But yeah, no, I think there were opportunities. One of the early opportunities was to get testing done quickly. That wasn't purely a local problem. That was a national problem. If you probably recall, the CDC had tested kids and the FDA was holding everybody up on lab developed kits. The Koreans were rolling out mass testing and we were waiting for permission from the FDA to get private labs to offer testing. As far as I know, that still hasn't been fixed. If there's a pandemic tomorrow we're going to be sitting on our hands waiting for permission from the FDA to test people. So that whole playbook needs to be reconsidered and it's a federal issue, it's a state issue and then obviously it impacts medicine for individual people. How do you think the federal government how would you rate the how would you rate the federal government? There's so many hiccups. We should have cleaning fluid, we should have all these drugs we never heard of, horse drugs and all this and then this very strange mixed message about taking vaccines or not taking vaccines or wearing masks or not wearing masks. So really this two part question was how do you rate them in terms of dealing with a national, international issue and the other thing is did their I hesitate but I'm going to use the word again. Did their Mishigas have any effect on Hawaii? Absolutely. Just to take that last part we look at the testing fiasco. A lot of the tensist moments for me in the early part of the pandemic we're trying to stand up testing. Not being able to test it's like you're going into a boxing mat with a blindfold on your face you don't even know where it is. You don't know how many cases you have in the community because you're not testing anyone and then you're reassuring everyone that the risk is low because you're not seeing cases and that's circular logic. So to reassure everyone at the beginning of the pandemic you do a lot of tests you can come at that negative and then you can say okay with confidence we're pretty sure it's here yet. We had no ability to do that. So that absolutely impacted us and it's one of the reasons why in my in my book and in every time I've had the chance to talk about it since I've advocated for us to develop biotech infrastructure locally that allows us to develop our own tests and obviously we need to regulatory reform around that too so that we're allowed to use it. You know the Koreans did not have that problem. They had multiple flaps and entrepreneurs partnering with their government that gave them situational awareness right from the very beginning. That's the gold standard. That's what we should be trying to do. There were other issues you know with the CDC response early on. Repatriation of people on cruise ships where cases were the major issue. Mixed messaging around masks was a major issue. I think to be fair the problem is not that they sometimes change their advice. The problem is that they were not very transparent about why they were changing their advice. So it's okay to say we don't know. We think this is the right thing to do. Here's the information that we're trying to obtain and when we know more this recommendation might change. But when you kind of change the recommendation without acknowledging that you got it wrong or why you got it wrong or what your reasoning is that's what creates this problem. So I don't think it's a consistency of the messaging it's not the issue so much. It's the lack of transparency. Your book is really a great contribution not only to the medical field because I think it's a book that every doctor wrote a read honestly. But to the public in general because this affects us all and it will happen again and maybe worse these various factors you describe are escalated. So my question is what are the takeaways that we should focus on? Yes we should maybe correct our regulatory environment we should learn. A million people died we owe it to them to learn and that's what your book is about. It's about learning how to deal with it the next time. But what are the big takeaway points done? Yeah I mean well on the positive side I think we have a culture here that is collaborative and that's cooperative in which you know there's this notion that we should protect vulnerable members of our community. That we should not be selfish in situations in which there's public crisis. This gets back to the host culture the Hawaiian culture the notions of aloha we absolutely should lean into that. And to me one of the important takeaways from the book is that you know one of the reasons we did well relative to many other parts of the country is because we have this unique local culture of cooperation I want to I want us to celebrate that. You know we also leaned into our geography you know we essentially used the Pacific Ocean as a giant movement. And I think that at least in the early months of the pandemic that was clearly the right call. It was a controversial call not everybody liked it. It definitely did some economic damage and there's no doubt in my mind that it saved hundreds if not thousands of lives. So you know we're almost certainly going to have to do that in the future if we want to have a successful response. In terms of areas of improvement it's the stuff we were just talking about. Can we get testing out quicker? Can we have an aggressive emergency response that does things like contact tracing, isolation and quarantine. And we take advantage of hotel rooms that aren't being occupied right from the gate and use them in quarantine facilities. I mean either what the places that did the best in the world did. And then those advantages. And we have less disruption to the core parts of our economy that matter most to us and to the core parts of the culture that matter most to us. And what I'm particularly thinking about is public education. Because you know the school shutdown was entirely too long in my opinion. And unnecessary. So you know if we could if we could you know learn some of these lessons and apply them in the future I think we could have less disruption to education in other areas. Well that takes me to the question of the vaccines and I was astounded that there were such large numbers of people who were politicized who hung on some sort of religious notion and refused to wear a vaccine to take vaccines and argued with those who wanted to take vaccines. I mean it became a ridiculous debate. Ridiculous. Your thoughts. Well for me this was settled during the Delta wave because as you'll recall the Delta wave hit in the middle of 2021. Most of the population of islands had already been vaccinated. I think our vaccine rate here on the Big Island was about 60%. So that meant about 40% of my island here was not vaccinated and I got to see up close and personal an unethical science experiment play out where half the island had been vaccinated where it is a highly transmissible variant roll through and the result was disaster. Our hospital filled up with unvaccinated patients who had bilateral pneumonia at the peak of the Delta wave 50% of our beds were occupied by COVID patients almost all of whom had pneumonia and almost all of whom were unvaccinated. So it was a tragedy and you know I don't know what to say. Snake oil is as old as America. You can find it in Mark Twain there's always going to be people pushing to make oil and shame on you if you fall for it. I think that's clearly a major problem going forward is this misinformation and what do we do about it? Yeah I totally agree. It's like when you have a really bad experience like catastrophe, a global catastrophe like this you want to learn from it and you want to say never again those lessons are serious lessons and they affect millions of lives so let's not allow people to die when we can save them gee whiz. But you know, the state of humanity is to forget. When we say never again we're saying never for a little while then we forget. So I want to ask you it seems clear to me that we live in a soup of virus part of our planet, part of our earth and it bites humanity once in a while starting a long time ago and it will continue to do that but the factors that make it more dangerous are increasing and will continue to increase there's a relationship of course between climate change and COVID ThinkTech made a movie about that actually looking into exactly what the origin might have been in China or elsewhere and I guess what I'm asking is this is going to happen again then we agree on that are we going to be better prepared and is your book a roadmap on how to be better prepared but is it also a roadmap on how an autocrat an evil person could use virus technology for really bad purposes too yeah I mean I think a lot of my book is focused on our communication and the way we relate to each other and the gaps that that created that allow the virus to exploit our vulnerabilities you know part of my book is kind of bedtime story for residents of Hawaii about you know how did we fight this off and I think there's a fundamentally optimistic message in the book actually but there's also a frank discussion I couldn't resist it I'm you know originally a northeast guy I'm pretty blunt there's a frank discussion in there about things that I think we could have done better and where I think our social vulnerabilities lie it's not inevitable that we're going to do better next time a different set of personalities a different leader a more cynical person in a powerful position with a tremendous amount of damage and that's why it's important that I think we have these conversations and that you know people understand that they have a role to play in making sure that the outcome is a happy one yeah absolutely well I can get your book on Amazon I did and I suppose Kirk Caldwell wrote a book similar how would you compare the two stylistically they're quite different you know Kirk you know had obviously a very different view I'm taking a ground level view as a doctor and then there are parts of the book where I intersect and overlap with Mayor Caldwell that are interesting but he had access to all of the most powerful people in the state and interviewed many of them and his book is a series of conversations and it's as such a really excellent addition to this conversation I was pleasantly surprised to find that the basic underlying themes and the message of the two books I think are complementary I think we see so what are we actually so we should buy yours first and his second right that's right you know I don't say this to everybody Jonathan but I do say it to you I know you didn't make a million billion in the course of the COVID experience we learned a lot and maybe there's a great value in terms of being on the earth and learning a lot and having a life with some depth and value to learn a lot but the other thing is that you have provided Hawaii you have contributed to Hawaii and it's a success to the extent it was successful and to its future success so I want to say one thing thank you for your service, Jonathan we appreciate all that you've done and we appreciate your contribution to our quality of life it was my pleasure to help and I appreciate the time when your chair passed Jonathan Dworkin Dr. Jonathan Dworkin talking about his new book and it's about COVID it's about COVID in Hawaii so take a look at it thank you Jonathan, aloha aloha Thank you so much for watching Think Tech Hawaii If you like what you do, please click the like and subscribe button on YouTube You can also follow us on Facebook, Instagram and LinkedIn Check out our website thinktechawaii.com Mahalo