 Aloha and welcome to Talk Story with John Wahee. Unfortunately, at least for me, it's another sobering Monday afternoon as we all work our way through this coronavirus pandemic. I have with me again this afternoon Hawaii's Lieutenant Governor, Dr. Josh Green, who, as we all know, in addition to being the Lieutenant Governor of the state, is a medical doctor. And so he and this is going to be the fourth conversation he and I have had on the current pandemic crisis. And every time we have been able to have him on, we have learned a little bit more about what's going on in Hawaii and the world. So I want to welcome him back again. Lieutenant Governor, it's a pleasure to have you. And, you know, it's unfortunate that the last four times we have been on my broadcast, we have been, you know, sort of pigeonholed into talking about the pandemic. Someday I'm going to have, I promise you, my friend, one of these days, I'm going to have you on the show when we can talk about the great things that both of us and many, many people want to do for Hawaii. But in the meantime, we need to take care of this crisis. So welcome Lieutenant Governor, appreciate your being here. What has happened in the past two weeks? I mean, it's so quickly things occur. It's been quite an extraordinary situation. We have continued to see cases of coronavirus or COVID-19 hit the islands. In the last two weeks, as you know, we've shut down the airports, essentially, and travel into the state of Hawaii. And that has had a very positive effect on flattening the curve. Also, we have people socially distancing themselves and are quarantined at home. And that has meant that unlike most other states in the country and many other countries, we have not seen a spike. So if you look behind me, you can see kind of how the curve has looked for COVID-19 for Hawaii. Yeah, let's look at that a little bit, you know, just if you don't mind. There you go. How about that? And so as the so things are flattening out as a result of the airport, I guess what you'd call it, shut down or seem to be anyway, we have yes, we have 387 cases total in our state and just 16 new cases over the last 24 hours. In the previous three or four days, we've ranged from about 24 cases to 36 cases per day. People are doing a good job socially distancing. They we could always do a little better. I don't want anyone to take their foot off the gas. And as we really, really, really have to concentrate on staying at home, isolating at home. And we have to wear masks when we go out, if we're going to be in a line or in with anybody. But when you look at that curve, look at the green right behind me, that shows that we've kind of flattened out. And I was very concerned that if we didn't, if we didn't socially isolate and did not provide for kind of a shutdown of our state, we would have had that top curve, which would would have gone up first eighth and 15 and 43% very aggressively or some such numbers like that. So people are listening, they're staying home most of the time. And if this continues, this promising trend will result in very, very few fatalities. As you know, we've had five fatalities as of now. And who would have thought that you and I, the first conversation we had, I guess eight weeks ago, we're crossing our fingers, they're hoping that, you know, we wouldn't even have one. And here we are with five. And I know that's not as bad as other places in the country, maybe, but you know, one fatality is one too many. And so, you know, I hope that everybody takes advantage, well, this staying at home situation, I gotta tell you, I thought it would be almost impossible, you know, because can you imagine I used to drive my family around in our car, you know, and we would be isolated in the car and there would be somebody arguing with somebody in a half a second. And here we are. I actually kind of enjoying each other. Well, your wife is really cool. So, you know, you're lucky. And my wife is quite neat too. So we're lucky to have great spouses. But you know, that is an important point. You have been at home for several days now. And we are seeing things like increases in domestic violence, God forbid. That's what I was going to get to. Has there been any social fallout as a result of some of this necessary action? There has, absolutely. So much so that my team actually prepared a phone number for me to share, which is the National Domestic Violence Hotline, which is a 24-7 hotline. So if somebody wants to call for help, to help with their relationship, they should call 1-800-799-SAFE, 1-800-799-SAFE. Because all across the country, there's been more tension and people have had some behavioral health challenges, some depression, and then there's the domestic violence question. So it's interesting that we see the numbers on the board behind me. There's 56 people in the hospital right now for COVID-19, and they're going to get better most 56 total in the hospital right now for the disease, not in the intensive care unit necessarily, but all these other things are happening right around the problem, like domestic violence or depression or all sorts of other issues. So people should really take to heart this time, try to make it quiet, not spread the disease, but be mindful of their other needs. I tell you, 56 people with the virus in the hospital, now I want to understand that. Are they isolated in a section of the hospital? How is that handled? And what impact does that have on somebody who, you know, having a heart attack and needs to be rushed to the hospital? Right. So anybody of those 56 individuals that are in the hospital, all of them are isolated. All of them are in what are called reverse osmosis rooms or rooms where they can't spread the disease to anybody else, the special ventilation in those rooms, the hospitals are safe. We have, I believe it's 161 of those such beds that are especially made up for infectious disease across the state, but then we have other things that I could share so that you understand, of the 387 cases that we've had, the total number of people that went there in the hospital right now are 56, and the number of people in the intensive care unit is more limited too. Let me, if I may. Yes, please, please. In fact, you know, yeah, yes. So here we go. In our, in our state, so people understand what we're looking at is in the state of Hawaii, we have 2,757 hospital beds, of which right now a total of 1,331 of those beds are full, mostly with other stuff, like people had a stroke or their cancer or they broke their leg. 56 of those 1,331 people, just 56 of them are in there for COVID. So we still have 52% of our hospital beds. Now, now let's talk about ICU beds, the intensive care unit. In the state, we have 338 intensive care unit beds statewide. 106 of those beds are full right now, so only 31.3% are occupied. This is very important, because if we do see a lot of extra cases of COVID through like they had in New York, we'll have the capacity to take care of them. And then finally, the ventilators. Ventilators are the ultimate service that one might need if you have an outbreak of COVID-19. In the state of Hawaii, we have 535 ventilators on any given day, and only 81 or 15% of them are being used. And that's only a handful of people with COVID-19, maybe five or six people on ventilators. The other people on ventilators are people who have lung disease or had a stroke or had a heart attack. So this is how we help you breathe and then you get through it. So these are the statistics that are kind of most important, although there's lots of ways to look at the virus through numbers. Well, I tell you, it all starts from the fact, though, that at least at the moment, things seems to have stabilized. And as a result of stabilization, it seems that we might be able to deal with it a lot better than if all of a sudden we spike like New York did or some of these other places, you know, they're still going up and up. Well, that's exactly right. So take a look. This is a visual that is made for me if I can show that this is what the different peaks could look like. And those ones on the bottom are where we are that a flattened curve, that's by by doing social distancing, we're able to flatten the curve means fewer cases. So it goes slowly up and slowly down. The reason this is important is because you can only take care of so many people in the hospital at a time. If you get those very steep peaks up and down real fast, when that happens, you don't have enough ventilators or hospital beds at any one time, and people end up dying. So that's the approach. The approach is to flatten this thing out, gradually get to the point where we have a vaccination, and then we all live. And that's what I'm doing every day. Yeah. And thank you. I mean, just to just so the folks out there know, you're talking to us from your office at the state capital, where you sort of, you know, that's the, the Josh Green central, I guess, and where you keep your, you know, keep your thumb on what's happening with all of this with this crisis that we're, you know, part of the social isolation strategy was the use of face masks. And it's amazing how well that message is getting out there. God, I gotta tell you, you know, I went to a week ago, if you went to the supermarket, most of the people were walking around without face masks. And just yesterday, I had to go and get some milk. And so I went to the market and I don't, I think there was just one person in the entire store that didn't have a face mask. Incredible. It's, this has been an incredible exercise in social awareness and social engineering. It's not going to be a part of the culture. And it's actually how places like Singapore and Taiwan were able to beat it or beat it more quickly because they learned the lessons of SARS where they were hit pretty hard. That was another coronavirus back, back in I think 2012. They were aware that the moment you have an outbreak like this, if you put masks on and you do contact testing, you can really suppress the number of people spreading the disease. And it's pretty incredible because, you know, those cultures are, they live very close to one another. There's a lot of cities with great populations that are very high. They, they survived because of their, because of their social engineered policies. And we're getting there real fast. People in Hawaii are smart. They're going to beat it because they're smart. Well, one of the good things was, one of the good things that is currently happening was that for a while, there weren't any masks to get, to get. And I know some, some, you know, some Hawaii entrepreneurs started to produce their own masks. So, you know, there we are. Yeah. And I love these things, you know. And so I was really glad that somebody decided to step up and start sewing, you know, masks that people can wear. And it's in a weird way. It's sort of fun for me to walk around and see the different types of masks that are now appearing, you know, appearing and kind of a way of even in these worst of times, our culture fosters its way through the surface. You know, you see all this brightly colored mask. It looks so much like we're all in Hawaii for a change instead of the usual, you know, white mask. But isn't when we come back though, I mean, we're going to take a break in a few seconds. And but when we come back, I wanted to talk to you a little bit about that and about the fact that there are different kinds of masks. And you know, we ought to be using the correct ones in the correct places. So we're going to take a short break and we'll be right back with Dr. Josh Green, Lieutenant Governor of the state of Hawaii. Aloha, my name is Duration. I'm the host of Finding Our Future here on Think Tech Hawaii. I'm here every other Tuesday from 1 to 1.30 p.m. Here on this show, I cover issues around sustainability, you know, global issues that matter for young people for future generations, and other social justice issues. So please join us. It's live streamed on Think Tech Hawaii and also uploaded on YouTube. Welcome back to Talk Story with John and our guests, the Lieutenant Governor of the state of Hawaii, Dr. Josh Green. And when we left our conversation, Lieutenant Governor and I were just beginning to discuss the use of masks doing this crisis. And so Lieutenant Governor, you are about to explain to us or tell us what the different types of masks are and what people in general should be using and I guess what should be set aside for people who are actually on the dealing with individuals that might have the coronavirus. Yes, well, thank you, Gov. So here's a couple examples, right? Here is a mask. It's called an N95 mask, which people have heard a lot about. And when you have this kind of mask here, like this, this provides a lot of filtration. You can see up close, there's some filters built into there. And an N95 mask, what it means is it actually takes 95% of the particles out of the air, virus or bacteria as well, and protects you. That's meant for healthcare providers, because otherwise they will catch a lot of disease and spread it to their patients going out. So N95 masks are mostly for healthcare professionals, but every mask can do something good. Here's another one, thin mask. This mask, I believe, came to us, I think, from China actually, and it doesn't have a rating. It provides really just a couple thin layers of protection, but it's better than nothing. And when you put this mask on, you can keep your own germs in, you can prevent yourself from touching your mouth or your nose. And it will provide some extra protection. And then, of course, there are cloth masks out there. And cloth masks, again, if there are at least two plies, two layers of fabric, and if it's a very tight fabric, then it provides some protection. And that's probably good enough when you're out walking at your grocery store, and you have just some need one way or another to get some protection. But we want to use the industrial strength masks that guarantee weeding out 95% or more of the particles out there for nurses and doctors and other first responders. So the first point one of the message is use a mask. Whenever you're outside, whenever you're doing, whenever you might be exposed, use a mask because even the cloth mask will help keep you or keep the germs off of your, I guess, your breathing, you know, out of your body. It's the mucous membranes that are most susceptible to catching virus. So the nose, the mouth, and the eyes. That's where virus can get in the easiest. Someone asked me earlier today, what about open wounds if you got a cut? It's also there, but mostly it's through the nose and the mouth. And so when you breathe in, that's how viral particulate matter gets in, and then it gets into the lungs. And that's when the virus spreads and causes disease. So that's why having a mask is the most important thing. And more important, I guess I should say, then that would be staying at home in total home isolation. That's a very, very good approach to get through till April 30th. If we continue to flatten the curve like we have, then I think we can entertain the possibility of the fact that we're not going to have a big spike in fatalities and we can begin to think about the future and opening the state up again. Well, let me ask you a question because you mentioned eyes. Is there any kind of protection that we should be using? I mean, do you need, should I wear my glasses everywhere? Or how does that work? It's interesting you say that. So, yeah, glasses will cover just the front of the eye, right? But when we use eye gear, we either have a mask that's produced and very interestingly, Ilani and Le Jardin and others have been producing masks and face shields, which has been terrific. That's for healthcare providers. And then of course, we also have medical eyewear. We just ordered 100,000 sets of medical eyewear for the state. So we're getting all of that together. And that's particularly used when people are in the emergency department or taking care of patients. That's when you need it most. But sure, if you've got some wraparound sunglasses, it's going to be better than nothing because you're really worried about coughing. But if it doesn't cover out, if there's gaps, you're going to probably get some some spread behind the glasses. Well, okay, what about just testing? Where are we with testing? There was, I mean, in my naivete, it seemed to me that one of the things we ought to do if we could or should be able to do in any event is test everybody, find out who's actually got it because they are. What I've learned over the past eight weeks is that the people who spread it, who spread this virus may not even have any of the symptoms of the virus. That's right. So a lot of people are asymptomatic carriers. So they've got the virus and they don't ever get any symptoms at all, about 80%, which is, I'm sorry, 50%. 50% have no symptoms whatsoever. 80% don't get very sick, but you just don't know in some cases. And I've been fighting this no secret for a lot of extra testing. I think that it's important to test anyone who's symptomatic for sure. And then any contact of those who are symptomatic to test them, even though we're going to keep them at home and have home quarantine, there's no question, it's still important because we have twice the national average of multi-generational houses. So a lot of our kupuna are in our houses with us and they're at higher risk for becoming very sick with the virus. So that gives us more data on when to separate ourselves from those we love and to be in just one single room in our house or our apartment. That's the kind of thing we need to know. They have done a good job now in the private sector getting our tests up. We're now, I believe, fourth in the country on a per capita basis. So we've really ramped our testing up in the last two or three weeks. But it was a challenge and actually a pretty big argument about that. I just feel very strongly like what you said, which is, test everybody that you can provided you have the resources as long as it doesn't take away from people who are super sick in the hospital. Well, first of all, are the tests available out there if we were willing to, let's say, purchase it? That's a great question. Right now, right now our labs are only capable of running 1,500 tests per day in the state. We have to otherwise send the labs out. If the question is, should we test all 1.3 million people, we do not have that capacity right now. That kind of testing would more likely be when the antibody tests become available. And those are just a quick finger stick, like when you have diabetes, they check your blood sugar. That test is already available, it could become very widely available in the coming months. So I'm expecting us to do that. That type of test is available though right now. Yes, you can get that test right now here in the state of Hawaii, an antibody test. The way the antibodies work is if you get exposed to COVID-19, after seven days, what's called immunoglobulin M, IgM goes up after seven days, then it comes down. And then about 10 days later, your IgG, it's a different antibody goes up if you've been infected and sick. And that's going to be a test that will help us know whether people have had the disease and are immune when they come to Hawaii for vacation. And if we do that right, we're going to be able to protect ourselves and our economy. And so I've already put together the first part of a plan to have three months of testing for any tourists that come in, plus 200,000 of our people, so that we can assess for people who work in health care or food delivery, whether they're seeing a lot of people, whether or not they are now immune. That will be very helpful and it will keep us safe. Well, so let's go down the line. Now, first of all, there are the current testing, I guess the general testing. Now, that test, you need to go to one of the clinics and how long does it take to get the results and so forth? And distinguish the various tests again. So we know what we're talking about. Well, the main test, which takes a look at the DNA from the virus, it is a nose swab where it goes deep into the nose, swab in there, right into the nose, all the way back. And that test, we will get the result within 24 hours, most of the time now in the state of Hawaii. That's when we do it at the various labs. Yes. In addition to that, we just received word that we are going like every other state to get 15 of the rapid testing machines. They're about this big, they look like a toaster oven and they're from a company called Abbott. And that company has a test that we can test between five to 10 minutes. So that test is very rapid, although we are only going to have 120 of those per week, but we can do a rapid test in 10 minutes. But let me ask you again, Josh, these tests already exist and they are they being used in other countries or other states right now? Yes. Because I had heard that America is actually behind everybody in the world, that the other places have these tests, they've been using it. I saw pictures of little children going through the line and immediately finding out what their situation was, were in places like Japan and Singapore. That's not happening in America now? More and more it will, but we are behind Asia. Our FDA and our CDC response was a bit slow and unfortunately, they were prickly about it. I reached out very early in February and asked the Korean government if we could bring some of their tests in and then our federal government and the Korean leadership was more than happy to let us look at some of their technology, but the federal government was not willing to let us use unverified testing, the FDA. So you couldn't use it even if you could get it? You couldn't use it in Hawaii? Is that the situation? Yeah, you would have to smuggle it in and use it in your labs and then it wouldn't be official, but the reason we do things more or less by the book is because you want to make sure that when you do a lab test, it's both sensitive, meaning it catches it if you have it and specific that it's catching the right test. Like you're actually checking for COVID-19 and not getting some other coronavirus. So we tend to do things right in healthcare in America, not completely, but we tend to. And so being a little bit cautious is what we've been talking about doing things right in healthcare in America. Our president, the president just said, I shouldn't use the word hour so loosely, but the president just said that we should all try it, I guess the malaria tests and that's a cure. Well, hydroxychloroquine is being discussed, but it's not a proven cure. And though it has helped some people, they believe, remember, these viruses tend to get better on their own. There's a problem with that in that that's a very aggressive drug that's usually used to suppress immune response in people with like things like lupus. And so throwing a drug like that without any controlled study leaves you open to a lot of concern. For instance, we're now hearing that this virus, in addition to causing lung problems, has killed a lot of people by damaging their heart muscle called a cardiomyopathy. And if that happens, because say we give someone a drug in the high doses that we didn't test, we're going to regret it. So I have always tended to err on the side of not doing too much medical treatment as far as medicines, if we don't know for sure that they're safe. So people should be a little careful. Next thing you're going to hear is people think marijuana cures COVID-19. Well, let me ask you the question. Does it, does it, does it, does it? For everybody who is a boomer in America, does it or not? Does it not? Well, let's just say this. We don't want to smoke anything when our lungs are damaged, right? So I'm going to caution people against that. And I like medical marijuana as much as the next guy. But I'm worried that we jump to treatment conclusions quickly before getting the research done and we should be careful. I think that's good advice, Doc. And once again, you know, we, I really, really can't express our enough, our appreciation for what you do. And for, at least for me, how glad I am to see you in that office. Thank you. I'll be on call this weekend taking care of patients and then I'll be back with you. I'm sure next week or the week after. Aloha.