 Okay, we're back, we're live. I'm Jake Fidel. This is Think Tech and more specifically, this is a Corona Watch and we're talking with Carl Kim today. He's the director of the National Preparedness Disaster Preparedness Training Center, which is in downtown Honolulu, but which has a national, it is a national federal agency. Carl is also a professor of urban planning at the University of Hawaii for many years. Carl, thank you very much for joining the show. Thank you for having me, Jake. So let's talk about how, you know, all of a sudden, as of what, a month or two ago, our world has changed and as a disaster planning organization, certainly your world has changed. Can you talk about that for a moment? Sure. What we have is a national center that works on developing training courses for first responders and emergency managers on different types of hazards and threats. We have a big focus on natural hazards and epidemics, pandemics, et cetera, can be considered a natural hazard as well, too. And so we've been involved with this in working to both increase the level of preparedness, but also to share public information related to this coronavirus. Yeah, it's very clear that public information is one of the, you know, the methodologies involved in any response because we're talking about the public here and any epidemic involves the public right up to their eyeballs and we have to communicate with them. And so I'm happy to hear that you're, well, I would have assumed you're involved in that. So one of your communications features is a movie that you guys made. Can you talk about the movie and we'll show the movie? Yeah, it was a short video, which we, our staff and our partners put together very quickly. And what we wanted to do was to summarize what available information that we had about the coronavirus and the various types of protective actions that public and others can take in order to protect themselves, but also to reduce the likelihood that the public can take in order to protect themselves, but also to reduce the likelihood that the public can take. That the disease will spread in Hawaii. We think that Hawaii also has some unique challenges because of our remote location, the lack of adjacent communities because we're separated from, by being in the middle of the Pacific. And that really makes it important for us to have strong community action. So that was what was behind the video. Okay, why don't we play the video and then we'll come out to the other side and we'll talk about one of the things that have been covered. Okay, let's go. The National Disaster Preparedness Training Center based at the University of Hawaii is authorized by Congress and funded by FEMA to develop training courses for first responders and emergency managers on natural hazards. The center has trained more than 50,000 people across the nation. Our mission is to support the emergency management community with training, research and development and integrating new technologies for risk management. We focus on vulnerable populations in island and remote communities. At the time of this recording, the highly contagious novel coronavirus disease known as COVID-19 has spread across the globe and into the United States. There are over 420,000 confirmed cases worldwide. While most cases present mild symptoms, fever, cough and shortness of breath, the elderly and those with medical conditions are at increased risk of severe respiratory symptoms leading to death. The global fatality rate is approximately 4% of those infected. The higher mortality rate and the speed at which it spreads makes COVID-19 more dangerous than the seasonal flu. In the United States, we currently have over 55,000 reported cases and over 800 deaths with more to be confirmed as testing expands across the country. Anyone is susceptible to contracting the virus and experiencing life-threatening complications. You may be a carrier and not know it. Many people experience mild or no symptoms for days after contracting the virus. If you are infected, everyone you come into contact with can further spread the disease unknowingly. The primary concern is our ability to treat the most severe cases. Under normal conditions, intensive care units and hospitals operate at around 70% capacity. There are only 30,000 ICU beds nationwide available to treat seriously ill new patients. Johns Hopkins Center for Health and Security estimates over 1 million Americans might need ICU level care, which is 33 COVID-19 patients for every ICU bed in the country. This large influx of cases can be managed if they are spread over time, but if infection rates continue on their current path, many patients will not receive the care they need. Already, medical professionals are being asked to cancel or reschedule electric treatments. Hospitals are starting to reuse personal protective equipment. Testing for COVID-19 adds additional burden on the system and supplies. Technicians must use PPE that might otherwise be available for critical care efforts. Only those who show symptoms and under the direction of their primary care provider should seek a COVID-19 test. Remote and isolated communities face greater challenges when responding to pandemics like this. Supplies and equipment take longer to reach our communities and first responders must cover larger areas. There are fewer hospitals and driving to another state is not an option. Island communities survive using narrow just-in-time supply chains. Currently, we are seeing clear indicators of the stress on supply chains as retailers struggle to restock basic necessities and medical facilities face shortages of supplies and equipment needed for response, transport, treatment, and care of sick people. Unfortunately, a pharmaceutical solution will not arrive in time to stop the spread of the disease. Instead, we need to rapidly adopt social distancing and other measures to head off an accelerated public health crisis. Our president issued guidelines calling for 15 days of actions to include staying at home if you're sick, don't go to work, inform your doctor, keep your children at home if they are sick, don't send them to school, inform your doctor. If someone in your household tests positive for the coronavirus, keep everyone at home, do not go to work, do not go to school, inform your doctor. If you're an older person, stay home and away from other people. If you have serious underlying health conditions that can put you at increased risk of infection, stay at home. States and municipalities have issued further guidance and restrictions, such as limiting social gatherings to 10 people or less, closing bars and clubs, reducing restaurant services to drive-through, takeout, pickup, or delivery, closing theaters, entertainment centers, and visitor attractions, avoiding discretionary travel, suspending services and activities in places of worship, not visiting nursing homes, retirement, or long-term care facilities. Stay at home orders. Social distancing means keeping at least 6 feet of distance between ourselves and others. Expressions of affections such as hugs and handshakes should be avoided. We can further reduce infections through increased basic sanitation. Everyone needs to take precautions, such as frequent hand-washing and sanitizing high-contact areas and separating infected people from high-risk groups. Disinfect common touch areas, including doorknobs, light switches, and remotes using a diluted bleach solution, or with products that are at least 70% alcohol or EPA-registered household disinfectants. Disinfect soft surfaces using the hottest manufacturer recommended water setting and instructions. Wear disposable gloves while disinfecting and wash your hands afterwards. An online course that covers life-saving skills was recently developed by Northeastern University. Please share this with your colleagues and employees as part of your mitigation activities. Data are essential to planning, decision-making, and action. We need information as to who has the disease, who may be infected, where they live and work, and who they may have been in contact with so that we can take action such as quarantine, isolation, and social distancing. We can also deploy assets and resources to sanitize these areas and also encourage healthy people to support the needs of others who are sheltering in place. We need to collect this information without stigmatizing people and adhering to laws and ethical standards with regard to privacy and sensitive personal information. Contact tracing is the mapping of infected person movements through time and space, identifying where and when the infection may have spread, and individuals who may have been infected and areas that may have been contaminated. Real-time information would allow communities to rapidly identify hotspots and public high-contact areas needing sanitation and facilities and care homes which require deliberate social distancing measures. Federal, state, and local agencies are currently overwhelmed. Grassroots efforts and community-based efforts are underway to collect, crowdsource, share information, and help those in need. NDPTC is working with partners to build contact tracing tools for Hawaii. Links in the show notes below for the latest developments. Look for community-driven resources on social media platforms such as Facebook, Twitter, YouTube, Instagram, etc., where members are helping each other by sharing localized updates on supplies and services. Answer the call to help your fellow community members. Many measures are currently voluntary. If conditions worsen, we should expect increased government intervention. There may be further shutdowns and forced closures of businesses, transportation, and other services if the disease continues to spread. In addition to actions you can take to protect yourself and family members, we also need collective social action. We need innovative, responsive, effective solutions for managing and sharing information and actions to limit the spread of the pandemic and hasten the response and recovery. Join us in terms of our efforts to increase awareness and to build a whole community response. Contact us with ideas, resources, services, and assets for saving lives and reducing harm from COVID-19. All right, Carl, that's a very interesting movie. The reaction I have is, gee, the numbers have changed. Every day the numbers change. So it's good that you put that caveat in there. No, I look this morning and I think worldwide the number of cases has already jumped to 523,000. And in the US we're over 80,000 and in Hawaii we have 95 confirmed cases with 68 in Honolulu. And so this is a constantly changing and evolving situation and it's really hard to keep up to date on this, but we're doing the best that we can. What's the takeaway you'd like people to remember after watching that movie? What's the core point? I think the core point are there are many actions that we can take individually with our families, with our colleagues, with our friends to really reduce the risks of contagion. I mean it's the basic personal hygiene issues, it's understanding and adhering to the quarantine, isolation, and social distancing guidelines that have come out. And it's really sharing information about who's at risk and what are the things that we can do collectively to prevent the spread of this disease. I think the other message is that Hawaii is unlike other states. We are not connected to other adjacent states and communities, we're located in the middle of the Pacific Ocean. So we don't have the kind of mutual aid or surge capacity to go to another state, another city easily. That's why I think given our large population size, given the potential for this disease to spread, why we have to really first take this very seriously and implement community based actions. The other thing is that because this is a pandemic, because it is a global problem, it's other states, other places that we would normally rely on, they're facing the same challenges. And so we're really limited in terms of the ability to receive outside assistance, outside aid, because the entire system is being stressed and challenged by this global pandemic. You know, one thing, you know, it struck me that just as the numbers change, social mores change. For example, I asked myself seeing your movie, I asked myself, gee, when was the last time I actually shook somebody's hand? And I have to say it was probably maybe two or three weeks ago. And somewhere in there, I made a personal decision for good cause, of course, that I wasn't going to shake anybody's hand anymore. I was going to put my hand on anybody's shoulder anymore, and I wasn't going to get close to anybody anymore. As time goes by, those things are, you know, ingrained in me. And in my daily activities, to the extent I see anybody anymore anyway, because I'm mostly at home. And I think that a lot of people, you know, have taken the juice. They are doing this more and more. They realize, not at first, you know, it's training films like that, you know, that sort of filter into the community and change the way people think about these things. At first, people were rejecting and making light of it, you know, not treating it as seriously and not changing their way of containing themselves and their family and friends. But now, I think it is actually working, and probably because it's scary, you know, that people do not shake hands. They do not touch each other, even at home. Even at home, I have a different view of other human beings now, don't you? Well, again, it's hard to make a lot of these sorts of changes, and it takes some sort of adaptation in terms of our cultural practices, in terms of our social practices, and so forth. And we're also really concerned about the impacts this has on business, on education, on communications. And so I think we've had to make very drastic changes very, very quickly. The closing of schools, the shift online, or web-based web delivery of training and education. And many types of business transactions have to be done now by virtual means. And I think these are really dramatic, sudden changes that were triggered by the disease and also the different response efforts. Yeah, it may be long term. In one of these days, hopefully the curve will be flattened and there will be fewer cases or, you know, minimal cases and fewer deaths or minimal deaths. And we'll be hopefully back to normal, but you know, during the abnormal, you know, we're changing our way of looking at things. And I wonder what it will be like when somebody gives me the all clear whether I'm going to start shaking hands again, because I know that viruses like this don't go away completely. They become endemic, you know, and they still exist only to flower out again some other time and they're always around us. And I mean, if that isn't clear on this one, it really should be. And so I think my whole life I'm going to be a little reserved about shaking hands and, you know, I'm getting close to people. And the other thing is you talk about transactions and business deals. It's very interesting. I was, you know, I was having a meeting and my meetings changed in the last few weeks to sitting at a table from sitting at a table to either online or if it was in person, I would ask the person to walk with me. And we would meet walking, because that way you look ahead, you don't look at the person. And so your droplets or his droplets or her droplets are not, you know, they're not contaminating me or there's no risk of that. But so the meeting is a different experience. And furthermore, and furthermore, usually in a business meeting, I mean, you know, this your whole life, you start by shaking hands. And you've been shaking. It's a punctuation point. It's a statement that, yes, I know you. I trust you. We're going to have a serious, you know, trust type discussion here. And when it's over, you're saying, you know, we've had a good discussion. I mean, now we have to separate, but I will think good thoughts about you going forward. You can't punctuate like that anymore. It's so weird. You start the meeting without shaking hands. You end the meeting without shaking hands. It's like you never really had a meeting at all. And it's like, where is the meeting? Will the meeting please start or stop? And I think this is very fundamental for at least questions society, maybe the whole world now about how we deal with each other, how we transact with each other, not only in business, but in personal social experiences as well. And it may be permanent, at least in our lifetime. What do you think? Yeah, it'll be interesting to see what the recovery is like. And this type of disaster is really different from the other types of hazards and threats that we've worked on, you know, like hurricanes or tsunamis or earthquakes, you know, where there's really a clear sort of beginning, middle and end. It's more of a kind of a creeping, complex disaster with many different layers. And also we're seeing that it, you know, comes in waves. It may start up again. It may come down. It may go up and down. And, you know, it may be permanently with us. And in some ways, it may be an issue kind of like the other creeping long-term threats like climate change and sea level rise and other types of environmental change. And so I don't know that there are equivalents to not handshaking that are going with that, but there are these other transformational aspects of adaptation that I think are important for us to understand. But right now I think the most important thing that we have to do is to protect ourselves and especially protect our first responders and medical personnel who are on the front lines of response. And part of doing our part is, you know, not shaking hands with people and minimizing contact and reducing the spread of the disease so that our capacity does not get overwhelmed. I mean, I think we have only something like 3,069 hospital beds in the state and then only 340 ICU units. And so very quickly our medical capability can get overwhelmed. And what we have to do is to reduce the contagion, reduce the incidence of people getting sick and infected and requiring hospital care because we're very, very concerned about the capacity of our system to respond and handle this. This is a different thing for the National Disaster Preparedness Training Center because you've been talking about those special disasters that happen all of a sudden that are extreme. Some of them are climate change or extreme weather, resultant climate change. This is different for you. And I wonder if you think about this possibility, Carl, because you're so steeped in climate change is that maybe there's a relationship between climate change and the coronavirus. I've seen a couple of articles for that proposition that, you know, the change in temperature, the change in the environment, you know, all kinds of changes in the environment, they may have led to the development of the mutation of this particular virus. Have you thought about that? Oh, sure, sure. And I think that there are those important connections that we need to study and understand and work on. I mean, I think that there are more immediate phenomena that relate to globalization, urbanization, the development of transportation networks, which are directly related to how the disease has spread, where it has come from and where it goes and how it moves. And so that's some of the research that we're engaged with right now. I mean, it's really kind of odd in some ways because for most of the time we've been trying to increase public transit. We've been trying to increase accessibility and mobility to promote shared rides, to promote, you know, ways in which we can move more people more efficiently, more quickly. And it's like putting people together in proximate situations, isn't it? That's right. That's right. And, you know, I've been on your show talking about transit, talking about bus, talking about all types of really important programs that, again, we have to kind of reverse engineer and to think how do we know our knowledge, or how do we apply our knowledge about how these systems work and function, and how can we then use that to prevent the transmission and spread and contagion of the disease. And so that's been really interesting and challenging in terms of the things that we do. But I want to really go back to the other point because I think it's really key because, especially for our community, we need to think about ways in which we can support our first responder emergency management and especially our medical frontline people. And the first thing is we can do things to not get sick. And then the second thing is that we can really reduce the spread of this disease. And what's the most insidious about this is that there may be people that have the disease but don't know it. And so they could be spreading the disease unknowingly. These are nice people. These are nice people. They've taken care of themselves. They haven't shaken anybody's hands. They've been washing their hands all day long. And yet this is insidious disease can make them super spreaders. It's very concerning because where's the fairness in that? There's no fairness in virus. You can quote me. Right. Right. But again, that points to really the importance of these types of social distancing actions and trying to reduce the contact and the potential spread of this. And then also getting the information systems that we need to support effective mitigation strategies. And we've known about these for some time. I sent you for advanced reading for today's discussion, the CDC guidance on pandemic planning. We know a lot of this already, what to do, how to do it, how to bring it up. But we've not only disinvested in the science and the technology in terms of understanding all of these connections. We haven't invested enough in preparedness. We haven't invested enough in terms of dealing with these types of complex emergencies. And so that's why I think it's really important for us to, you know, use this as a learning opportunity to use this as an opportunity that we can kind of marshal the community resources and assets to really identify the actions and steps we can take to minimize but also mitigate. And then ultimately, how do we recover from this? Because it's not like an earthquake. It's not like a tornado that, you know, it's clear that it's going to take more time. And so those are the challenges that we do need to think about. Well, thank you for helping us. That is helping the community through this. I mean the national community because you are national. And I want to say that we will take that movie and play it on our overnight playlist. We'll do what we can to disseminate it and I assume you'll be making other movies. You're not going to play them in movie theaters because we don't do that anymore. But you will send them to us and we'll play them in the notion of getting the word out because it's very important that we do that. Some movies, Jay, we call them instructional videos. I do think another thing that we do need to focus on is our supply chains and supply chain management, not just in terms of emergency goods and services, testing kits and personal protective equipment and other things like that. But I think that there are larger supply chain issues that this particular event, disaster or crisis have emerged. And so I think that that's another kind of big takeaway that we do need to think about. How can we increase our self-sufficiency? How can we shorten our supply chains? How can we have more backup redundancy, more flexible systems for delivering needed and important goods and services to island communities? Yeah, and how we can deal in the emergency when the supply chains are threatened or broken in some way, not only supply chains and goods but also in services. Anyway, Carl Kim, a professor at UH in urban planning and also the director of the National Disaster Preparedness Training Center. Thank you so much for coming on. I hope we can see you again in this context and stay well. Yeah, you too and I hope I can see you at the opera soon in person. Yes, thank you, Carl.