Kalihi Valley O&E

I helped as an MRC volunteer with the Public Health Nurses Outreach & Education event at Kalihi Valley Homes today. I was on Team 5 along with Aileen, Leema, & Bueno. Collectively we knocked on 64 doors; personally I did 16 and found 6 people at home. All 6 of those households were vaccinated to the maximum extent; most had kids under 12 years old. I found out from talking to one of the people that it is Federally funded housing so they are required to be vaccinated if they want to retain their housing. I had nice long talk story with 2 of the residents. 

L to R: Bueno, Aileen, & Leema.

I walked almost 1&1/2 miles today for the outreach & education event; here is my route. The Samsung Health app showed an elevation gain of 266 feet even though mathematically there was just 119 feet difference; though I did go up and down several flights of stairs to interview people in the upper units. I am glad I spent 30 years working in the field and walking a lot; even though I am out of shape I was still able to do much better than the 2 other women on the team who were about 20 years younger. Only the 24 year-old National Guard guy was able to keep up with me!

 

While at the outreach & education event, I talked to Tracy; I 1st met her on Sunday at the HFD testing event at Aloha Stadium. She is a pharmacist & had brought a bunch of QuickVue COVID kits for the PHNs to distribute to households in the area. She said the state is not following the exact protocol listed in the website; they just want to get kits out to households. She said testing once a week is fine or even testing if you think you have been exposed.

I made another lau ʻuala proothie this morning. I only put one scoop of the chocolate protein powder in this morning; I am running out and did not reorder it early enough.

Reid from Terminix came by today to do the Pest Control treatment. This is one of the 3 contracts that Mom had started; some are longer than others. I started one for rats which had started to invade the attic when the mango & jabon trees had grown large enough that their branches were close to the roof. Here's what Reid did today.

Just before dinner I got another email from Marjorie; it was about helping with the HFD testing at Alpha Stadium this coming Sunday. I volunteered to help with this one again; I hope lunch is better than last week!

For dinner I tried the Tofu Bites; I had them along with some Broccoli Kale Salt Sauté and Mushroom & Artichoke Salad. They're okay.

After dinner I got on a Zoom training for the Kapolei Hawaiian Homesteads outreach & education that we will be doing on Friday afternoon. It was a very helpful & enlightening class. I also got to see Tellie! We were both in the Community Contact Tracing Training Cohort 2.  

 

Part of the training covered the history of the smallpox epidemic in Hawaiʻi & how the monarchy dealt with it to help save the people.

Talk Story is the local way of transferring information. Using the Talk Story framework allows for creating connection between the speakers. Creating connection makes it easier to hear what the other person has to say even if you disagree.

 

Gloria then led us through a Talk Story scenario.

Gloria also covered some myths around the disease, the vaccine, & treatments for COVID-19. She provided talking points to share during a Talk Story if those items came up.

She also provided resources for us to look in to to get more background information. Some of these are also useful for people we meet who may want to explore more.

One topic she covered that I am pretty sure we will get questions on is the recent FDA announcement about booster shots. I like that they are clarifying the difference between "additional doses" versus "booster doses".

After Gloria finished the DOH part of the training, Scott from the Kapolei Community Development Corporation gave us a brief training on the Kapolei Hawaiian Homesteads. I found it to be very interesting since these came up after I had left so I knew nothing of their history. Part of the training was on results of a health survey they had done in 2020 before COVID-19 became an issue.

In the morning I could only find Keala & Luna. Later Keala was the only one of the cats that was visible.

Keala.

Luna.

Keala took over my chair in the afternoon.

I found an interesting live web cam site; it's from South Africa. The initial information I got was for a camera aimed at a flock of flamingos! At night it provides an infrared video feed so you can watch what happens when predators come around to the watering hole. For me, the time difference is opposite; when it is 3 p.m. here it is 3 a.m. there.

At 8:35 a.m. HST, 8:35 p.m. Kimberley, South Africa.

The Aix weather app forecast rain in Honolulu through the early after, then clear skies with rain starting up again after dark. It was just mainly cloudy skies for most of the day until midafternoon when it got very sunny & hot in the valley. For Kapaʻau, Aix forecast rain all day, while the local paper predicted scattered showers with a 50% chance of rain. The Honomū weather station recorded 0.09 in by 7:18 a.m.; by almost 5 p.m. that had increased to 0.1 inches. I think Big Island Now was more accurate than Aix today. For Marysville, Aix forecast partly cloudy skies all day & in to the evening; it seemed to be accurate.

Kaimukī looking westerly at 7:16 a.m.

Honomū looking northerly at 7:16 a.m.

Marysville looking northerly at 7:19 a.m. HST.

Kaimuki looking northerly at 12:12 p.m.

Kaimukī looking westerly at 4:59 p.m.

Honomū looking northerly at 4:59 p.m.

Marysville looking northerly at 5 p.m. HST.

The surf on north, south, & west facing shores was good today. On the east facing shores it was small & choppy.

Laniakea (N) at 7:21 a.m.

This is the Hilo Bay camera for surf on east facing shores. I need to find another one.

Waikīkī (S) at 7:23 a.m.

Waikoloa (W) at 7:24 a.m.

Laniakea (N) at 5:14 p.m.

Hilo Bay (E) at 5:15 p.m.

Waikīkī (S) at 5:16 p.m.

Very late last night there was a magnitude 6.7 earthquake near the coast of Nicaragua; it did not create a tsunami. But it did help me find out there is another view that I can share with you that I think is more interesting. The new view shows an enlarged location of the earthquake; it provides all the rest of the information that the old view did.

The usual view.

The new, improved view!

I love Dr. Libby Char's interviews! She is so much more informative than the previous director of the Health Department. I encourage you to take the 30 minutes to listen to her interview today; but in case you don't have the time here is my synopsis of the interview. Although case counts are going down, hospitalizations, number of patients in the ICUs & deaths are staying relatively steady. Currently ICUs are able to work well but only because there are 650 additional medical personnel from FEMA working & tents are being used outside ICUs and ERs to house patients. Dr. Char says the epidemiological curve needs to consistently be at 100/day or less to be manageable with only local staff & real hospital rooms. She emphasized that we can't drop our guard just because hospitalizations are decreasing since there is a lag between hospitalizations & the death count.

On vaccination rates, Dr Char said in mid-July the vaccination rate went up with the uptick in daily cases; in the month prior to July about 30,000 doses per week were being administered. Last week that number was about 41,000 which is encouraging. She said some 3rd shots are included in the total count, but those numbers are separated out when determining what percent of the population is fully vaccinated. Dr. Char said there are still about 350,000 unvaccinated people in the state. She said in July children accounted for 22% of cases; this number has held steady even with the surge in cases caused by the Delta variant unlike the continental US where there has been a higher hospitalization rate with really sick kids. She recommends adults be vaccinated in order to protect children who are too young to be vaccinated. Regarding booster shots, Dr. Char said currently those are recommended for immune compromised individuals, others still have protection but levels can drift downward over time; antibody levels in those 65 and older also tends to wane faster so kūpuna are also getting shots since they also received them earlier so their levels are dropping earlier. Dr. Char stressed the differences in that FDA makes regulatory decisions on whether the product has met the legal criteria for safety & efficacy but it is the CDC that makes the clinical decisions regarding the actual administration of the shots.

Dr. Char also clarified information about the Crisis Standards of Care. She said the original document was created well over a year ago near the start of the pandemic & has been posted on the HIEMA website since it was approved. Like many of the recommendations about COVID, this is a living document that is constantly being reviewed as new information becomes available. She said it was reviewed in November 2020 then again in August 2021; the document is now posted on the Department of Health website where it is now coming to peoples attention. Dr. Char said it is a well written disaster plan that everyone hopes will never have to be used; which is another reason to increase vaccination rates & do other measures to reduce the spread in the community. She pointed out that age is not an independent factor in the Crisis Standards of Care and that age has already been used in other pandemic-related decisions such as having kūpuna vaccinated sooner than the general population because age is a known risk factor. Basically, age cannot be removed as a factor in determining what might happen to a person when they get sick.

Dr. Char also discussed natural infection; she said there is not enough information on how long immunity obtained via being ill persists & at what level. She said what is clear is that the vaccine creates much higher titer than natural infection, that naturally infected people are more likely to be reinfected than those who have been vaccinated, & that naturally infected people more easily transmit the virus to others. She said early studies of fully vaccinated people show they can be infected & will test positive, but they don't shed live virus for as long as unvaccinated people; the antibodies within the body of a vaccinated person kills the virus faster thus shortens the amount of time that person can transmit the virus to others.

She said he best way to keep spread down, avoid indoor, avoid large wear mask, vax; trying to discourage counties from allowing large gatherings, she said 5 in/10 out; cluster reports show large gatherings

Dr. Char also shared that before the Labor Day weekend various family members asked her what they should do to avoid contracting COVID-19. Because the Delta variant is so contagious, she recommended to her family to return to pre-vaccination habits such as keeping to the family bubble & not seeing others, wear your mask, & practice good hand hygiene.

In regards to monoclonal antibodies, Dr. Char said last week there were 478 doses available in the state & that the State is allocated 610 doses per week & that is enough to handle the cases we are experiencing. Because of the social media hype, requests increased to 1000+ but included requests from many entities that were unable to administer monoclonal antibodies. She said monoclonal antibodies have the same Emergency Use Authorization (EUA) that the vaccines had & do not have full FDA approval; they are much less studied than any of the vaccines. Because of the EUA status, monoclonal antibodies are limited for use in infected individuals who are at high risk for a bad outcome & needs to be given early in the course of the infection before it becomes severe. She said vaccines are musch better studied & evaluate. Dr. Char also said fully vaccinated people would not need monoclonal antibodies; it is primarily being used in the unvaccinated.

In regards to testing of all incoming travelers regardless of their pre-travel test results, Dr. Char said the bottleneck is capacity since 20 to 30 thousand people would need to be tested each day.
She said what is currently happening is returning residents are going in to quarantine rather than doing a pre-travel so no one knows how much is coming in through that route. From the Public Health standpoint, she said testing everyone when the come in would be awesome, but how do you track them down & test them after they have left the airport. Her bottom line is that it is not a good time to travel.

There were 330 new cases of COVID-19 reported today, which is higher than yesterday but not as high as it was last week. 

Hauʻoli lā Hānau e Parks Sensei!