 Aloha. Welcome back to Talk Story with John Waihei. We have as our guest, again, the lieutenant governor of the state of Hawaii, who is a medical doctor and a leader, and a leader in helping us understand and combat coronavirus. And I thought that because of his interest and involvement in this issue, we ought to have him back. So this program is coronavirus part two. Where are we? And what's happening now? Welcome, lieutenant governor. We appreciate you taking time from your very busy schedule to be with us today. I understand you actually came out of a meeting right now with about 40 of the leading citizens of Hawaii discussing this issue. If you can, can you brief us on what was going on at the meeting? Yes, Governor, thank you very, very much for giving this opportunity. There's a lot to share. Let's dive right in. We currently have two individuals, two, that have tested positive for COVID-19. That's what we're calling this coronavirus. Coronavirus, disease, that's the D19. What are you calling it again, sir? COVID, COVID-19. COVID and that's there. That's the short form. Yes. And so COVID-19 for 2019 when it started. We have two cases now. One of them is in a very sick state over at the hospital. It's at Kaiser, and we have another individual who's recovering, but we've had just these two cases. Now, having said that, we've had a lot of concern in the recent days because as we know, there's been concern about individuals that were sick on cruise ships, and then they came to our islands and traveled in each different island. We've got a lot of individuals returning because it's spring break from Seattle, Washington and across the country. We've done a good job with our Department of Health following all of the leads that exist out there, and that's been one of the many reasons why we've been able to keep our disease counted just two. And we've also not had any community spread. In other words, an individual like me, if I were sick, spreads it to my wife or someone else that I work with. What do you do when you find somebody with this virus, like these two individuals? What happens? Or if somebody new comes up with some symptom? Great question. So if someone is very sick, they stay in the hospital in isolation. We have rooms that they circulate the air to a special filter and then out of the building so that there's no chance of spreading anything that they breathe or sneeze or cough in that room or into the ventilation. So we have 166 of those beds statewide. We put them in isolation and then we give them help with their breathing. There's no antibiotic that works on a virus, so we give them the best supportive care that we can. A lot of people, 80% of the people that get COVID-19 are having very mild symptoms, just like runny nose cold symptoms a little bit like the flu. Those individuals can be at their home. They can be at home and recover and if they get sicker, we take them into the hospital. But there is a third group and that is if people are travelers to Hawaii and they don't have a home, we don't want them to go stay at hotels and spread it at the hotel. And if people are homeless, they're similarly in that same category. We don't want them walking around Waikiki or other places sick, spreading through sneezing and coughing and touching people with their hands that are infected, the disease. So we will have to have some quarantine capacity to help people out. And for that, the Department of Defense is working with DMAT, those folks, that do emergency preparedness to get us several small quarantine spots just in case. So these quarantine spots are already established and there's a protocol that the state is following. If somebody, like if I feel or somebody feels like they have flu symptoms, I have already taken a flu shot. So I'm not supposed to have that kind of symptoms supposedly. But if I feel I do, what do I do? Where do I go? Who do I check with? Well, that's brilliant. Let's start you right from the top there, Gov. So if you feel sick, if you feel the classic symptoms of COVID-19, which are the following. Fever is almost always the case. 88% of people will have some fever. People will have also shortness of breath or cough. Those are the top three. If you have those symptoms, which are very much like the flu, you need to call your healthcare provider. Go through them again. So I want people to hear this. I really want them to understand it. You bet. The main symptoms are fever, number one, by far the highest. If you have a fever, you probably still have the flu. But let's just go down the list. Fever, cough or shortness of breath. Those are the top three symptoms that COVID-19 patients have. Those are also very similar to what people have with the flu. So what will happen is you feel this way. You've got the fever, you've got a cough, you maybe were in touch with somebody. So you're worried, oh my goodness, did I have a contact that had a risk of COVID-19? You call your doctor's office and they will say the following. We'd like to test you for the flu. We're going to get you a test in a quiet place. We'll test you for the flu. If you have the flu, that's the end of it. You can't have both. Right. You're not going to have both. Once in a blue moon, on top of a blue moon, you get two of these viruses. So we don't worry about that. If you have the flu, you are fine. Now comes the tricky part. You know that doc, that's the first time in my entire life that I've heard a doc to say that. Sorry. And it came out very naturally because right now I have no worries about the flu. If you've got the flu, we will watch over you. I'd be so happy to have the flu instead of what you're talking about. We're going to have a flu party at home with a, you know, covered up. Okay. So you have the flu. You don't worry about COVID-19 anymore. You just get ready to be at home for a little while, drink your fluids, take Tylenol. You'll be okay. If you don't have the flu, but you have these symptoms still, then we're going to test you. Now I have breaking news for you, Governor. Okay. Up until now, we had to go through a very rigorous process, right till now, where the Department of Health then has to use its very limited supply of testing to decide whether or not we can afford to test an individual out in the community at a doctor's office or at a clinic for COVID-19. So there was an elaborate protocol to get a test. Correct. And it's been a protocol at first. You had to come from those countries like China, Korea, Italy, Iran, and also have these symptoms like I just told you, right, fever, cough, and shortness of breath, then they would test you. But if you didn't have that travel history, they would not test you and they would not consider you at risk. That's changed. That changed a week ago today with the CDC because as we know, sadly, a lot of people are having the condition because they've caught it perhaps from being on a cruise ship or running into somebody from a cruise ship or running into someone from a cruise ship or being in Seattle where there was a surge of cases or in New York and so on. So that went out the window. So now it's just down to these symptoms. But even then, they were concerned that there would be a run on the tests. So you had to basically be in deep trouble at the hospital. And then they would make the determination whether to test you. That left a lot of people out a lot of people that had minor symptoms, but they wanted to know why we'll get to this in a moment. You don't want to have the symptoms, even if you're pretty healthy, 50 year old or younger, and you have the symptoms, sure, you're going to do fine. You're not going to die of it. But if I go and visit my tutu, right, I could kill her. And that's not going to be okay. So the point being is that now starting tomorrow, we will be able to go to clinical labs. And with the doctor's recommendation, the doctors know they will be able to mean this is the same place where we could go to get a blood test. Correct. Correct. What they're going to actually ask us to do is as doctors do the swab and call clinical labs. So we will be able to do the swab. It's a swab that goes into your nose. It takes a couple seconds. Take it out. It's no joy, but it's fine, believe me. And then a couple days later, you'll get your result. In another week from now, we'll be able to do it totally here and get it in the same day. But the good news is we will now have the capacity. This is new. This is new. This is breaking. This is something that everybody ought to know. There wasn't available, what, an hour ago? That's right. As far as people is concerned. Starting tomorrow morning, our private labs will begin to have this capacity. And before a couple days pass, all of the following, Kaiser, DLS, that's our lab, and the third lab is clinical labs of Hawaii. Thank you, Gov. So all three will be able to run the test. And that is very, very important because it will help our Department of Health do what they do best. They can do the epidemiology. They can take care of people. They can do the studies on this stuff. Meanwhile, the health care providers and the clinics and the hospitals can do what they do best, which is test, screen, take care of lots of people, and get an idea of how many cases we might actually have running around. Now, this is not, we should caution people, though, at least at this time, while this availability is exciting news and very important for the people of Hawaii, this is not an invitation for everybody that might not even have a symptom, but who feels insecure to dash down there and try to get a test or something. You're right, Gov. That's actually a very good point. We still want it to be clinically based, so we will still want someone's doctor or nurse practitioner or physician assistant to call in the test or give us a prescription for the test in the lab slip. That's very important because if you don't have any symptoms, I can tell you right now you will test negative. That's the way it is because it's a DNA test and so when you test and you are just not having symptomatic stuff like your nose isn't running, you're not having the fever, you're not having the cough, it's going to be negative the head of the CDC told me and that is gospel. So much better to only be tested if you have the symptoms, what your doctor or nurse is going to do is they're going to then test you to make sure you don't have the flu. Again, you could happily go on your way with the flu or if that's negative, then we test you and so that will help us really describe what we're dealing with in the state of Hawaii so we can move on to some of the other important things like knowing who should or shouldn't go to events, which events we should or shouldn't cancel. We will know better whether we've had any transmission in our state. We'll know how to deal with our long-term care facilities. We've had to have the testing set up in order to get to the place where we can act. Oh, that's fantastic. You know, I'm so glad that you are here. Now, let's say you seem to imply that this is just the beginning though. They'll be as a week from now. We may even have that these tests might even be more available than they are currently. You actually read my mind, Gov. I mean that. So I'm in discussions also with some of our emergency management folks where as another week passes, we may decide, okay, it's good to get more broad testing. We might open, for instance, and this is being done in certain cities, we might open a small tent clinic perhaps over on the parking lot at Jabsum where we can set up the clinic. We have this facility already. Taxpayers paid for it and we man it with say six to eight people and then once again, a doctor or nurse can direct someone to come in and maybe they're less symptomatic. Maybe they just came back from Seattle and they want to make very certain that this runny nose they've got is not COVID-19 because they're on spring break and they are going to be with their family and they're going to see their grandfather or grandmother over at the nursing home. We want to be very safe for people and the way to be safe for people is to have certainty. So that's another thing we're thinking about. We would likely do it for all of the neighbor islands. I do know that one of my private practitioner friends is going to set up a special clinic this Saturday once this whole protocol is in place so that they can test a lot of people. So we are ramping this up very, very significantly and in real time because keep in mind, just a week ago we were talking and there were like 85,000 cases, now there's 111,000 cases. We're up to 3,888 global deaths and the numbers keep going up. Now keep in mind this disease, this disease right now has like I said 111,000 cases. Globally we've probably already had 300 million cases of the flu, 300 million versus 111,000 and by the end of the whole flu season we may be at four or 500 million cases of the flu and we might only reach 200,000 cases of COVID-19. However the COVID-19 virus is more lethal and it's particularly bad for individuals over 75. 8% of people over 75 are dying from this and actually 14.4% of all individuals over 80 are dying from COVID-19. Well those are huge percentages. You know we're going to take a short break now Lieutenant Governor and we'll be right back and maybe you can tell us how we ought to behave doing this period as well. Thank you. I'm Lillian Cumick, host of Lillian's Vegan World, the show where we talk about veganism and the plant-based diet located in Honolulu, Hawaii. I'm a vegan chef and cooking instructor and I have lots of information to share with you about how awesome this plant-based diet is so do tune in every second Thursday from 1 p.m. Aloha. Welcome back to our talk story with John Wahee and our guest the Lieutenant Governor of Hawaii Josh Green who is the I guess the center point of our efforts to deal with and get past this whole coronavirus something-19 scare. COVID-19. That's right. COVID-19. Thank you Lieutenant Governor. You know I am like I am actually this is one of the few shows where I can honestly tell our viewers out there that I am as concerned as they are about what you are about to say during the entire time that you are on. So I want to get back into the conversation. Where we have all these tests in Hawaii? Where did they come from? I mean who's doing it and how do we know that they actually know what they're doing? That's a very very good question. So the right now the only people up until today that we've been using the test from is from the CDC the Centers for Disease Control out of Washington well really out of Georgia and that test has long been vetted and they had to work it out we had some problems out of the gate they sent us broken tests but it finally got fixed and now we've been testing people. Initially the tests weren't necessarily effective like they ought to have been. That's right they didn't give us authorizations to do the tests adequately and it was a problem and it really set us back. It hamstrung the Department of Health so we didn't know in every state including ours whether or not we were experiencing cases of COVID-19 so that was a big problem. Finally got resolved over a week ago so we can do a small number of tests on our sickest people that's what we've been doing but we have to test more broadly because like I said earlier in the show we have to have reassurance we have to know whether or not a person can go back to work whether they can work at the hospital. All of these questions are taken care of by getting the test result. If you're negative you're fine you may have a cold or the flu but you don't have to worry about this somewhat life-threatening COVID-19. Now where do the tests come from? Well they come come come from all over the country from the private sector. Oh so we now have private sector people producing the test. And they'll be producing millions and millions of these tests. I'm not going to lie to you I think that these companies are you know they're part of the capitalistic system and they're trying to get their tests out but they have to go through a rigorous process approval by the FDA and then they have to in our labs get kind of teed up and tested so that we see that we get an accurate result. When we get the accurate result over the course of a couple days then we can test widely and we can do tests like if someone is sick God forbid in Mililani or Ka'u instead of telling them sorry you're not sick enough sorry you didn't travel to Iran or Italy or or South Korea we can actually just test them and let them go on with their lives. You know the thing about that is it does it would a test would give the patients some security for themselves but it also gives their neighbors security. I mean it's good to know that anybody that feels like they need it or have some hint of the system will be tested. Yes and it's not just your neighbor down the street you know down on the highway or whatever it's also your neighbor in the workplace the neighbor that's working in the cubicle next to you it's your neighbor that you share your bathroom with it's your neighbor in the dorm room it's your neighbor when you go to Starbucks it's your neighbor in all of Arohanna. I have to confess I now go when I go and use the restroom I don't like opening the door. Yes see it gets psychologically into your skin right and then you see someone else touch in their nose and you think that person shouldn't have touched their nose and then they hugged me. I know exactly how that feels like. That's right so it's about reassurance a large part of what I'm doing and my coordination part for the GOV just so you know is to coordinate the health care component of it. They have a ton of work to do on the epidemiology and the economy and all that which I'm interested in of course but I'm coordinating a meeting that I just had that was with 40 of our health care leaders from across the state which meant the top people from Queens and Castle and HPH and health care system of Hawaii and HMSA and Kaiser and the labs and then all the people around them those are the people that are giving me guidance on what the right process to do is like I can tell you please get your flu shot don't sneeze on people don't cough on people that's all good advice and wash things up clear the virus which last minutes to hours on surfaces do all that but if I don't have the capacity to set broader policy by getting the lab tests into doctor's offices by setting some of the quarantine standards in case somebody's traveled here and needs to be set aside for two weeks if we don't have that health care advice from the top people then we're dead in the water and so I wanted to be a part of that. As a result of your meetings now if I need a test or anyone needs a test will my health insurance cover it I mean is this something that's in the plan? Yes thank you for that question I've gotten I've gotten the full go ahead to tell people that their health insurance will cover it as will Medicaid as will Medicare and the Department of Health is covering all the public health tests so there should be no co-pays for anybody and if someone is uninsured or indigent we will not discriminate against them because they happen to be the unlucky soul that caught the flu or COVID-19 and because our last conversation if you remember we talked about the fact that there was concerned that people that didn't have any means to buy you know service maybe the most vulnerable to get the infection. Well God help us if one of our homeless camps get infected and they then get swept by the mayor and they go to the wind and they end up seeing everybody all across the state they're going to infect everybody so I mean are there people thinking about the consequences of our policy that it's not business as usual with at least as far as those kinds of activities are concerned? I think that's my job yes I am and my team of 40 people on our advisory council and and we actually have in addition to our health care advisory panel we have a whole another subset of people that we meet with starting tomorrow at 7 30 in the morning we're going to have an all health care provider call in we'll have hundreds of health care providers that can call in and get this very information that I'm sharing with you today so that they will know you ask the question how will patients know their providers will say if you have these symptoms call me and we can discuss whether or not you need a test and of course now there's social media to convey that and we will share that on the main news channels as well so I happen to be telling you first but that's just because you're so sexy and you're performing all you sound like my wife yes I wish you would tell me that but anyway but that's why we decided to do that so we have this group tomorrow morning and it'll be every month every sorry every Tuesday morning at 7 30 where if doctors are in Ca'ou where I used to work or if they're in Hana or they're on the night shift and they're not hearing everything they will be able to get distilled information without a filter just exactly what we're all experiencing and they can ask questions a lot of the proposals that I've shared with you today have actually come from our work group and it's the best ideas that this group of smart people have and who are passionate about our well-being and our health care have been giving me and my team for the last several days so I appreciate the gov putting me into this space and I know I push the edge of the envelope a lot to get these things going but the truth is if we are proactive about a thing like COVID-19 we can keep it relatively at bay well lieutenant government let me tell you something when it comes to the health of my family and my neighbors and myself push the envelope thank you do push it as far as you can go with it because you know now on the other hand just because we have this test we ought not to have everybody go out and suddenly call their doctors the first thing in the morning and treat these tests the same way they were treating toilet paper about a week ago you're exactly right there's there's always moderation and it's there's moderation in tests because you don't want to one example is you don't want to test a thousand extra people that have no symptoms and get an unfortunate false positive if you get a false positive we could end up sending that poor soul into two weeks containment and home quarantine without any need we would test them again mind you to make sure it wasn't a false positive but there are reasons to test right and let's go through the symptoms again I want people to get this if you go to if you have these symptoms call in for the test if you don't you know put take your time in line don't panic in other words yes so okay number one fever if you got a fever you start thinking about the issue fever in 88 percent of all people who had COVID-19 they had a fever if you have no fever you're right off the bat pretty much in the clear number two coughing if you have a cough and it's new it's not your chronic cough you're not smokers cough you just have a cough and fever now you're talking you probably have the flu except now because of COVID-19 we're worried a little and then finally shortness of breath you're having a lot of trouble breathing just please call 911 or go to the ER we'll take care of you we will check you for everything that's fine but when you have fever or cough or shortness of breath you are on the list of potential for COVID-19 we will first check you for the flu after checking that you have no flu no flu at all then we'll get a little bit more concerned we'll ask a couple more questions and now because of the private labs we'll test you for COVID-19 we'll tell you to go home for a couple days and sleep rest if you get very sick you go back to the hospital if not we'll call and tell you what your result is that's the process and it really doesn't sound complicated but I'll tell you it was very complicated to get these tests set up here in Hawaii through the private sector on short notice we want to thank you for all the effort that you put into making that happen now I know that you're you are the primary focus as far as the medical medical response for the state of Hawaii but since we we got a few a couple minutes left I know as as lieutenant governor you're also playing in the other issues what what is there any reason to be overly concerned on the about the economic impact or the rest of it I mean are we going to see a day when there's a what what do you call it when we stop seeing flights from say japan or china or anything like great question right now we're getting our guidance from the cdc they have categories level one level two and level three travel advisories the level four is they shut it down that's what happened with china okay no china shut down channel shut down right now we are not beyond any of the level three categories for anybody else if there was a continued surge if there was a continued surge in south korea or japan then we start up to get we have to get a little bit more concerned I don't believe that's going to happen italy shut down today on their own italy will not be having travelers leaving italy until it's settled down and we've stopped transmitting COVID-19 we are looking at all of the concerns we're making sure that no one comes in from china we're making very serious precautionary answers we're getting answers about how to handle the cruise ships we're being very careful about that because we're worried about our people we're talking to the feds about that and then finally we're just using common sense i'm getting all these notices from the airline saying that they're doing special filtration tests and systems on on the airplane to make sure that at least the air that's being circulated is pretty clean air and things like that do those actually help they help a lot in the old days there was no no circulated air and so you would really be putting everybody at risk now it's really just the people in the rows two rows up in front of you and two rows in back we're being especially cautious some people do one row hawaii's doing two we're being careful all i can say to you gov is that you keep spreading the word the word of watch out for fever cough and shortness of breath don't go to sick don't go to work sick don't go to school sick that's the kind of information you want to spread you spread that word you won't spread the virus that's where we got to be well lieutenant governor we want to thank you we want to thank you for your accessibility and for your leadership on this issue i i can tell you that i feel a whole lot better that you came on our show thank you