the highly infectious delta variant ignited surges of covid19 cases in hawaii sending hospitals into crisis mode it also intensified the fierce debate over vaccines and with confusion over new mandates questions about booster shots and a new variant detected many just want to know if it will ever end we're talking with health and data experts to see if it's too soon to tell tonight's live broadcast and live stream of insights on pbs hawaii start now [Music] aloha and welcome to insights on pbs hawaii i'm darryl huff in recent weeks hawaii's covent case numbers skyrocketed to levels we've not experienced health officials say the majority of cases that result in hospitalization are patients who are unvaccinated but there are breakthrough cases among fully vaccinated residents as well the reality is vaccines are not bulletproof but health experts say they greatly lower a person's chance of getting severely ill or dying your vaccination status is also becoming increasingly important with more government and employer mandates rolling out and according to the state health department there are more than 141 000 eligible residents who have not gotten the shots for a variety of reasons with the delta variant changing the odds our panel tonight will discuss the collective struggle to fight the virus we look forward to your participation in tonight's show you can email or call in your questions and you'll find a live stream of this program at pbsy.org and the pbs hawaii facebook page now to our guests republican state senator kurt favela is a lifelong resident of ewa beach and is a campbell high school grad he represents district 19 which includes communities in ewa beach ocean point evo by gentry and iroquois point hilton raethel is the president and ceo of the healthcare association of hawaii the organization represents 170 healthcare organizations including hospitals skilled nursing and assisted living facilities and hospices monique chiba is a mathematics professor at the university of hawaii at manoa she's also a volunteer with the hawaii pandemic applied modeling working group which is working to increase scientific understanding of covet 19 within the state and kenny akamu is a crisis nurse at the queen's medical center west on oahu and at kaiser medical center in his position he oversees all of the patients at the hospital he has more than 30 years of nursing experience ranging from neuro cardiac and medical icus kenny you're the on the front lines of this of this battle tell me what it's like in the hospitals right now for you and for your colleagues trying to take care of people it's been really busy i can tell you that for one thing i mean it's unbelievable how many patients are in the hospital just cannot breathe and it's really sad because i mean when you look at this person gasping for air he can be gasping for air for like one whole week before we finally decide on maybe intubating him and putting him on the pencil later and it's it's really frustrating because a lot of times we're looking at each other and we're going that two injections would have prevented all of this from happening and you look at the patient's face and they got this really scared look on their face like they're afraid that they're gonna die and they get the same look they look like damn i should have put those two simple injections and it's crazy i mean two simple injections and a lot of people are making it like where they're cutting off their arm or something i don't know it's it's getting ridiculous you know um hilton raythel for the hospital association we have a graphic up right now that describes the queen's health system's current situation this is statewide with 94 hospitalized with covid 12 fully vaccinated 82 not vaccinated 24 in their icus three fully vaccinated 21 not vaccinated 21 on ventilators two fully vaccinated 19 not vaccinated hill did do these numbers at queens is seeing is that reflected across our health care system we're seeing those numbers very consistently across our system um what we have been experiencing throughout this surge which has been devastating for our community is that somewhere in between uh probably 87 to 80 uh 88 percent of the coveted hospitalizations are unvaccinated so that's um you know it's almost 90 when we started off this surge about 95 of the patients our hospitalized patients were unvaccinated but then as a delta variant spread more into the community it impacted more of the vaccinated individuals but even as recently as yesterday 88 of our hospitalized patients covered hospitalized patients yesterday were unvaccinated so the numbers you're seeing there for queens are very consistent across the entire state and then uh monique chiba you folks actually try and estimate how where covett is going at this stage what are you guys looking ahead to seeing in terms of the future of this this virus and i understand your models take into account the current situation of mandates and uh travel and all those other sorts of things right yes so in early august we forecasted that big surge uh that was with no indication of the future mitigation that would uh that would come but then the mitigation came and now like everybody can see on the data on the numbers we're training down the big question and what we're looking at now is how are we trending down how fast are we training down and how low we're going to go because this is going to determine the future and uh how the mitigation can be lifted these are those are really the uh the question that we have now rather than numbers in stone it's really to try to find the rate at which things are changing and uh if they're going to plateau we've seen on other countries they go down and the plateau and they go up or the plateau too high and this is what we want to avoid senator favela let's talk a little bit about your community of eva eva beach um how has covent affected your your community in general i mean uh it had a fairly low vaccination rate for a while but i think you folks have managed to bring it up some yeah it just i think it was just more for in ewa beach area almost of accessibility we have a lot of family members that catch bus transportation public transportation to go to work and go anywhere um having it at queen's hospital is good for people that has cars uh it wasn't good for people that don't have cars so that's the reason why we try to take the grassroots effect and try to bring it into the communities more into the parks next to the schools i mean the community centers just to have more accessibility and that's what we've been asking our mayor and our governor to help us with in pushing this uh vaccine um against uh rallying to educate and uh put more uh shots in arms you know uh kenny acaba and uh i think perhaps hilton on this one too uh have we gotten better at treating people i mean i i know we're certainly better than we were at the beginning but when someone comes in and they're hospitalized are they more likely to survive now than they were say um a year ago can you know when it first came out uh the statistics i recall was like for a patient who goes onto the ventilator it was like almost like an eighty percent mortality in the beginning of this disease and then they came up with uh deservier and steroids and i think they're treating it better and i think lately the statistic was if you're on a ventilator it's something more like 35 percent mortality so it looks like it's gotten better um i think i'd like to bring up about those statistics though like cellulose patients and ventilators i mean i mean two of them was unvaccinated i mean two of them was i'm vaccinated and yeah that's that's really unusual to see a ventilated patient vaccinated i mean a ventilated patient it was actually vaccinated yeah so yeah hilton are you seeing um that people are not as likely to die was they go to the hospital now absolutely the um as kay just mentioned the treatments have gotten much better this is a brand new disease and so it took quite a while to figure out what was the best course of action and things like pruning for example well it took a little while to figure that out whether or not people should be put on ventilators or if they should be put on ventilators when should they be put on ventilators uh the use of rendezodia for example that kenny mentioned has been pivotal in terms of healthy helping people who are in our hospitals so our survival rate has certainly gotten a lot better but what has also happened is that fortunately the overwhelming majority of individuals who are elderly and who have chronic conditions have been vaccinated and so the very early on in the pandemic before we had vaccinations we had a lot of people who were older and or had chronic conditions who were dying so the death rate was certainly much higher now because many of them are vaccinated what we're seeing in the hospitals is a lot of we're seeing 20 year olds 30 year olds 40 year olds 50 year olds in the hospital and unfortunately some of those are dying because they are unvaccinated you know monique chiba in your projections did you ever do a projection back uh before we had vaccination like could you tell me if we had not had the vaccination process begin when it did what the condition would be of this pandemic at this stage yeah we did that we did try so we did two different things regarding the vaccination so one of it was uh i just withdraw the vaccination and keep the course and it the delta variant would have really skyrocket uh what the cases to a level to a catastrophic level it was the it was the venue of the delta variant would have put us in in a complete crisis completely alarming and uh it would have been completely under control uh uh out of control i'm sorry uh then we did another simulation where we just took off the fact that the vaccination is protecting against symptoms and severe symptoms but it's it's still protecting transmission it's reducing transmission in that case the case the daily cases would not skyrocket as if no vaccination however the hospital would double so having the vaccination being able to really uh alleviate the severe cases is even now uh putting us in a much better position that it would have done um can can i ask you kenny acaba as a nurse um hilton mentioned that you're seeing younger and younger people come in you may be better at treating them but what i'm wondering about is does is the delta variant people who have the delta period did they the course of their illness is it different um i was hearing that you get sicker a lot you get sick faster and you are sick longer is that what you've noticed about it well it's hard to say because i think the main thing i got out of what he said was that i think most of the older folks are vaccinated so now we're looking at different populations that's that's unvaccinated populating the hospital and so they've got stronger bodies to actually fight this disease so there might be hospital life i've seen patients who've been asking for like one month and and and that's why i think that's where the course of the unit is longer because they're fighting it for one month just when in the beginning of the disease the older folks would probably die much faster than being in hospital for one month oh that's a big difference right because if if you've got a younger population they're gonna they're gonna handle the disease much differently than the older population that was originally getting hit before what's your advice to to younger people though a lot of people um are just like they feel invincible my advice now this is simple i mean i guess i'm not a politician so i don't have to be nice i can just say but do i say how i feel i mean just don't get stealing just getting injections thinking about it a little bit too much i mean it's ridiculous together injection when my my 14 year old daughter can get the injection you can get the injection i mean this you cannot just write the code tables of all of the people who are sacrificing themselves and getting the injections and you think okay if everybody gets the injection i don't have to no way occur you might get sick longer senator favela you you deal a lot with vaccine resistors in your in your district what do you say to people who come to you and say something about the vaccine and i i don't i don't want to get it what what do you say to people how do you persuade people who are so so entrenched against the vaccine have you ever managed to persuade any of them to change their mind well someone was my family members and i only do them as experienced uh when when um recent one was my auntie in vegas was in the hospital for three months she went in there for a procedure and she got the viruses she was on a ventilator for three months still on an oxygen machine i had my nephews who recently all of them mostly all of them was vaccinated and they're all in their 20s and early 30s and the one that wasn't vaccinated in the queen's hospital he recovered and recovering slowly but the ones that had the vaccination within three days it was okay no fever no running nose no nothing so that's the thing that i share with the community in every beach all the way to uh waianae when i'm in a vaccine uh truck or the bus i just shared my experience that i had family members who did it and got really sick and family members who did and didn't get real sick and that's the only thing i can tell them because stop reading social media and stop believing other people because they're not doctors and health professionals they're just youtube video fanatics and making people scared and i don't want a youtube doctor doing any surgery on me okay so there are things that we need to make sure that our community knows okay yeah i said i think it's a very good point that a lot of people are repeating personal stories they've heard and and not relying on science what you're saying is i take my personal story and turn it the other way uh monique uh chiba you wanted to toss in something here yeah i wanted to mention that what the model was very clear is that without the vaccination the only way to deal with the delta would have been through very severe lockdown that would last for a long time that was the only mitigation that would have addressed the delta variant if we didn't have vaccination at the time and the the less vaccinated people the more severe we have to do the mitigation in order to address the issue and this comes very clear through the model okay so i'm starting to get quite a few questions here and i want to honor our our audience for their questions um this is always something that comes up uh i hear this often and uh for hilton and kenny miles and hawaii kai asks of the vaccinated patients vaccinated patients who need ventilators what percentage have underlying conditions can the doh publicize this and we don't have anybody from the doh on our panel but um hilton um let me start with you do you know how many of the people who are vaccinated to end up on ventilators that is this small number have an underlying condition that puts them in that position well it's certainly true that if you are elderly or frail or of underlying conditions even if you're fully vaccinated you're just still at a higher risk if you do get infected if you're a so-called breakthrough case so yeah we are seeing that it is true that we are seeing people with underlying conditions and as kenny said their bodies aren't as strong and whether it's whether it's because they're old whether it's because um and when you're talking about all of them talk about 80 year olds 90 year olds you know or whether you have underlying conditions or if you have compromised immune system then your body doesn't have the same defense mechanisms that it does have for someone for all that other people have but there is a marked difference between those who are vaccinated and end up in hospital and those who are not overwhelmingly the people who are vaccinated and end up in hospital and it's only a small number they may be in for three four five days and generally at a much lower level of care and then they recover and they go home whereas the people who are unvaccinated they can be in for two weeks three weeks four weeks or even longer there's a very very distinct difference between the hospital hospitalization of a vaccinated versus an unvaccinated individual you know kenny when you um deal with these patients you're the a crisis nurse so are you mostly dealing with them at the at the most uh dire moments as opposed to when they're first checking into the hospital i'm kind of curious as to what you've seen across the board in this are the vaccinated patients what happens to them generally when they come into the hospital vaccinated patients um well it's hard because i don't see much vaccinated patients it's like maybe i can count the vaccinated patients with one hand maybe a couple it's usually the unvaccinated patients and of course they're usually thicker so and it's true that i'm i usually see the thickness of the sticks usually right before you put putting them on the ventilator um so i've got a monique chiba did we see a labor day increase did we see a bump from labor day in terms of our numbers the question is are we past the labor day weekend potential increase we've already talked a little bit about underlying issues but how we did we get a bump from labor day it seemed like to me people were not out very much on labor day and it's not just that but there was also a decrease in traveling and we had also the safe axis coming right behind and we had the ban on gathering so there was a lot of of uh restriction that would counteract uh the labor day so i don't expect as of now to see a big surge that would that i would attribute to the labor day you know i want to take the second half of this question also um and uh uh hilton if you wouldn't mind how much does underlying issues play in the recovery and potential for survival i think that there's a sense that oh if i'm a healthy person and i've managed to remain fit that i've got a much better chance of survival and that a lot of the people who've died i mean when you see the health department saying it's underlying conditions underlying conditions underlying conditions i'm wondering if that gives a false sense of security to where people are generally fit absolutely it does we have seen individuals in hawaii and across the nation who are very fit no underlying conditions no prior health history of any significance and yet they can still die now it's not a lot of individuals but it's not a it's not a free pass just the fact that you're healthy you take care of yourself you eat well that does not give you a free pass when you're talking about covered cover does not discriminate the delta variant does not discriminate um kurt favela um i'm wondering what is it is that a misconception in the community that somehow if you're healthier and you're you're not obese or you don't have asthma that you're going to be fine is that what you hear well especially in the younger generation um because they exercise they eat right they go to the gym you know they stay away from crowds they wear their masks and they think that you know there's no there's not there's no need for getting a vaccine and um and i try to explain that that's not true um when it hit you you know um in the beginning we had a lot of community members that was very healthy and young and got very very sick and uh using oxygen tanks today you know so it's very serious that they realize they're not invisible and the virus don't have any prejudice against anybody that does monique sheba as a epidemiologist also have you what what trends have you seen in the age ages of the people who test positive now um i just want to clarify i have no background in epidemiology i work with epidemiologists in high pan but uh i'm just a mathematician so uh um i just have access to the public data i don't have access to any uh specific granular data that gives the age of uh of the people but what what can i say because i i work at uh and we have the vaccine mandate and we've done some simulations that would show what would have happened if we if the uh students would go through a 60 percent vaccine uh rate rather than a 95 percent rate and it would have impacted negatively quite significantly the uh the state one thing i would like to ask though have you been satisfied by the data that's being generated in hawaii by uh you know that's available to folks like you in in analyzing independently what's going on i mean is the state generating enough data for you to really do all you want to do in terms of trying to predict what's going on this is a very very difficult question because uh the word got cut by the pandemic without expecting it so i don't think anybody knew what type of data we needed there are a lot of data that are coming out we need we would need a more granular level of course uh in order to do the modeling there is a lot of information that we don't have about like the length of the people in the hospital or the age of the people in the hospital we don't have access to that so the model sort of finds that there are shift in hospitalization ratio but at the same time and that's what we're working now as modeler we're trying to understand what are the data that they need to provide us so that then we can have a proper data protocol i think you hit a very very important question that is in development you know a couple of questions have come in and i think these are probably for you hilton um actually don't this is a kind of a hard thing someone wants john via facebook please explain in a nutshell the new technology with the vaccine i think that a lot of people think that there's something new and kind of scary about this vaccine is there anything new or different or about this vaccine that differentiates from other vaccines that people are more comfortable with i'm not a immunologist but um you know having having read quite a bit about these vaccines the these uh these vaccines uh the technology has been around for quite a while now how they were developed is you know they were developed over a relatively short period of time which is true but there was a huge amount of time and effort and money that was put into the development of these vaccines much more so than there would be normally for vaccines you don't have that same sense of urgency and so the what people need to understand is that all of the necessary stages for the development and testing of these vaccines they the manufacturers had to go through so they they may have done some of those there may be some overlap between some of the stages um because of the urgency again of the situation but there they had to follow all the protocols and all the requirements that any other vaccine manufacturer has to go through so there was no shortcuts taken in the development of these vaccines and they and in terms of how many have been administered and how safe they are we're incredibly fortunate that these vaccines are as effective and as safe as they are um let me kurt favillo let me ask you this real quickly do you get a lot of people who say oh i don't want you to put something experimental in my body all the time i mean they're saying that and you know the sad part about it is that we have a lot of other family members that have certain other underlying diseases that they do exper you know expert you know drugs that has not been on a market long time but it's all about choices if you want to you know um debate um and put your life on the line i i it's hard to say this is your choice your body but then you're in the hospital cannot breed and then now the decision you want to take it is too late you know what i mean so you know you're gonna turn to one zombie it's gonna it's gonna make your dna change are you going to be labeled how you're taking the market obese um there's all of these things that is being said but if i can trust in in the science and try the data within my family to have my my my daughter my wife and my dad my family to take it um and it's proven my daughter had no symptoms no even when i took the vaderna was a little bit different because that's the only one we had at the capitol at the time but the visor for the pfizer is is really great my wife and my daughter took it and my dad and no pain no bruising no nothing so i just really kind of trusted the data of what's being put out there and that's the only thing that i share with the community that's the proven fact within my family so go forward keep our family safe thanks senator and then again back to you um hilton uh this distinction someone asks you know from mel and kakaako why hasn't the media mentioned that the pfizer vaccine is the only one approved by the fda there's a lot of different levels of approval should anyone be concerned about that about one vaccine being better than the other or one being approved and one not well it's really the amount of time that we've had to actually review the findings and so for the vaccines that have received dementia use authorization which in the u.s is johnson and johnson and moderna they have a shorter periods of time they have received immense use authorization but have not received the same amount of time in terms of following up the results after the vaccine that the pfizer did so pfizer had had more data faster than the other two vaccine manufacturers now pfizer does now have full fda authorization for individuals 16 and above the moderna and johnson johnson vaccines are still operating under emergency authorization although they will be applying or have applied for full fda approval just going back to the point about the um that you're talking about about the drugs and being experimental what is fascinating here is that the fisa vaccine has received full fda approval and people are concerned are still concerned about taking that still calling the experimental and yet as the senator said when they end up in the hospital one of the most effective treatments we have is rendezvir which is administered in a hospital setting which is under a uh men's use authorization that is not yet received for fda approval and yet i do not know of a single instance of someone who's in hospital who has turned turned back the rendezovir as a treatment because it is it because it's under immense use authorization once they get that sick they say give me whatever it takes i don't want to die i want to get well so they've rejected a vaccine which is full fda approval and yet they get treated by rindesvier which is which is approved under emergency's authorization i think one of the things that that i noticed i think this was new york times reported um that a dose of treatment by rendezvir or by these monoclonal antibodies costs about two thousand dollars per patient paid for by the federal government which is basically us well as a vaccine cost like 20 bucks so thank you all of you guys jumping and running to severe for for spending my money uh kenny acaba uh what's been your experience at the hospital level with people who are vaccinated um i'm sorry unvaccinated what kind of things do they say when you you tell them there's not much we can do for you except we gotta basically play this out isn't that basically what you have or are you able to treat them and what kind of things do they ask for that you can't give them well some people actually ask for the vaccine after they're really sick they thought that they had the option of getting the vaccine and that is totally false the only time you can get the vaccine is when you're healthy so that your body is healthy enough to produce the antibiotics so someone then is really surprised that oh wow can i get the vaccine now yeah too late so yeah that is one of the misconceptions that needs to be cleared and and also getting back to that experimental part i think isn't there like 182 million people who already got the vaccine in the whole united states alone and and everything all of the data has been collected with 182 million people so there's no you should never ever use experimental as an excuse no way um let me uh throw out this i've got several questions now about the the crisis of care plan now hilton fairly recently as recently as three or four weeks ago we were looking at peaks of the hospitalizations and ventilator uses so much in hospitals that were at a near crisis level that is you almost were in a place where rationing of care might be necessary and this is what this crisis of care plan is about can you describe it and um comment a little bit about the concern about the uh the age as a tiebreaker for something like that could you explain that to the general public why you would need this kind of triaging of care rationing of care is the term is often used why would you need it and how would age fit into the equation so we were very very fortunate that we never got to the point in the state of hawaii where we had to enact the crisis standards of care framework um and that's that's a terrible place for to put doctors and nurses and other health care professionals in where they have to make decisions about who does and does not get care so again we're very very fortunate we did not get there idaho for example they are operating right now the whole state of idaho under crisis standards of care so they're having to make those decisions every single day so that's but the the crisis standards of care framework is a framework for saying if you literally run out of resources whether it's oxygen whether it's ventilators whether it's beds whether it's staff whatever it is how do you allocate resources scan resources now there was a huge amount of work done about a year ago by a very dedicated group of physician leaders in the community and they put that document together working with the department of health and the healthcare association um of the hospital the healthcare association of hawaii now that document is undergoing revision because it's a living document so it was written at a point 12 months ago before we had vaccines for example and with the information we had at the time it is currently undergoing edits right now there will be a new version of the document coming out now going back to age the age is a factor in any medical decision because if you are older then there is a especially you know depending on how you know as you talk about getting much older then your body doesn't have the same ability to fight disease as it does as maybe a younger person does in general now there can be you can have a very healthy 80 year old and a very unhealthy 50 year old for example so so all of those factors are taken into consideration but we do understand that when that document was put together the the age was put in there that those particular sections are being looked at they're being revaluated re-evaluated right now and there will be a new version of that document coming out that that is you know that what we we don't want this age tiebreaker concern to be a detractor from the fact that there should be a process there should be a legitimate process and so again there will be an updated version of that crisis standards of care document that is coming out very soon and again fortunately we are able to bring in enough resources into the state in terms of oxygen in terms of staff to avert what has happened in other parts of the country um kenny akamo let me ask you um have you ever been in a position where you had to make a decision like that that is i've got one vent i've got two patients um and then how did you deal with it we always try to improvise the person who already is on the vent very gonna pull nobody off of the event we'll figure it out somehow we'll add a diagonal with oxygen or we'll transfer them to another hospital we'll find some way to take care of the patient we would never pull treatment away from another patient to treat the other patient can you figure something out can you describe to me what it's like for the patient and even for the caregiver when a person gets to the point where they need and we keep saying vent it's ventilator which is essentially a forced breathing device right so what's it like at that point how do you decide whether someone should be ventilated or not and what's it like when you have to do that i tell you the patient has suffered a whole bunch a whole lot before we even get to live on a later question they've been suffering and they've been shot abroad and they've been desaturated and we've been doing everything we can to pump oxygen into the patient's body so that they can add it so that we can adequately oxygenate them a lot of times you got this really high flow oxygen you're blowing up to 60 liters of oxygen through the nodes trying to oxygenate them and we're constantly trying to encourage them to lie on their stomachs because that helps we learned that because of the anatomy it oxygenates them better we're doing everything we possibly can and when there is absolutely no choice when it comes to the point where i mean it's a good chance that the patient can't die because you cannot get any more oxygen to them and then we would be set on putting them on a ventilator so when you see all of those patients in the ventilator those patients would have probably died if not for the ventilator and also you are also at that point forced to put them under right i mean you can't be really conscious while you're on a ventilator isn't that true right so we'll we'll give them adequate sedation and um we'll keep them on the ventilator sedated and try to keep them as comfortable as possible but at a certain point i mean you know we keep we do everything we possibly can we'll adjust the ventilator the different ie ratios will increase the speed we do everything we can but at certain points you're on 100 everything you're doing cannot work and at those stages you might have to error that's to left the last step we will do paralyze the patient and then we might keep them paralyzed and in a deep medical coma for as long as we can sometimes stay but during a deep medical coma you've got this system it's called a bi-spectrum it's like an eeg for the brain and we kind of hope that the patients well sedated but but of course i mean they become tolerant of the sedation and then sometimes they might wake up and you try to give them more sedation and and well that's it's just basically out of touch let me move on to a couple of questions we've gotten about mitigation and i think monique sheba and senator would would be best to talk about this um should the unvaccinated be banned from air travel uh monique chiba i mean what effect do you think that would have on our spread rates and stuff yeah that's a good question uh there was uh uh this week some uh some news about uh the fact that uh the the testing might not detect as much uh or uh filter as many uh people that are unvaccinated that was for unvaccinated travelers um that uh uh and and then that it can be as low as 20 so it is something uh to keep in mind but but again that was the study was for unvaccinated people and most of the travelers are vaccinated right now i think what about the effect of reinstituting testing in the same in the same light uh dr chiba is it um you know the would that make a difference or again is there too much leaking through and and from the big picture is travel affecting our rates here um it didn't come out we have uh we canceled tourism uh like when you have a model you can virtually do whatever you want right whatever experiment or scenario you want so you can shut down tourism and so you still have residents traveling uh there is a lot that came through the resident and then it gets uh rooted into the community and this is has this has been uh the main source of the spread the travel people going to the mainland and bringing it back uh as individual travelers as i as i recall a quick trick to the mainland and back you're totally not going to get caught by a test for 72 hours before you travel i mean the chances of you getting caught in that test are pretty small right yeah i don't have the exact data about that senator favela tell me about talk about the politics behind these travel bans and stuff what what's your feeling about it do you feel like we're we're we're too open right now or do you feel like we we uh we should open up more where do you stand on that and and what kind of discussions are going on at the capitol about that kind of stuff i think you're you're muted senator i think you're beauty try check i think we've lost your audio let me let me try that question for hilton uh wrethel what what kind of big mitigation do you think is still ahead i know okay senator can you start start again my question to you is what kind of discussions are happening at the capitol about particularly travel well the bottom line is for travel um we wanted to go back as our colleagues talking to coronavirus committee we want to go back to the tier system the tier system would give a better prospect on how traveling would be and if we have to have the vaccine and mandate the vaccine for every single person coming in or going out for travel to keep our family safe i think that'd be a good recommendation but we got to go back to the clear system to give the people off hawaii knowing what is the restrictions and what can happen if we reach a certain tier but right now we don't have that you know this that question just came up just the other day when the city and county decided to sort of drop to your system tears being this many cases we do this this many cases we do this there's many cases we do this or this many hospitals in disorder are more holistic look at all the different factors and make a decision it sounds like you're saying that you're somewhat uncomfortable with with that position you'd rather see firm numbers and why is that because we can at least let the community know where we're at to before you go to a total shutdown and be more careful i mean more village in knowing that we're in a certain area and we don't need the mayor or the governor to do this the department of health has the power under the pandemic to inquire and do do they do their own tier system they don't need the neighbor island mayors or the governor to do this they can do it themselves on the power of the pandemic under that order to go ahead and implement any of that kind of um theory system we don't need the mayor of the governor they can do it because they have the data and they have the power between it push that power they don't want to put a trigger and somebody needs to put a trigger to keep our families safe in hawaii somebody needs to take the leadership and do it that's the only way we're going to have the community no when we had that tier system you think about it back when we had it everything was uh nothing better but it wasn't as worse than it is now open open range nobody knows what's happening today let me let me hilton raped on a travel issue um we have heard recently that there may be more travel uh related that we're not catching because people who come from the mainland don't generally get tested uh here or even when they get home unless they get sick is there still confidence in the medical community that the number of travelers coming is not really having a big effect on our case counts and the spread of the disease here well what what we most feel familiar with is what's happening in our hospitals and we do track how many of these travelers end up in our hospitals and that's what we're most concerned about with this disease is how many end up people actually end up really sick and what we're seeing overwhelmingly and we've seen this for since the vaccinations have been in fact that the travelers are not the ones who are bringing the vaccine into the bringing the virus into the state now that does happen on a small number of occasions but when we look at our hospitalizations the tourists from that are coming from the mainland because it's predominantly u.s tourists that are coming in right now they we only end up with a very very small proportion of those in our hospitals what we are seeing more of and certainly probably 95 93 95 of our hospitalizations are either locals and through local spread or as our own residents who go to the mainland go to the vegas go to other states they're not careful or they just inadvertently get um do get infected and they come back and then they spread it so it is not the tourists it's a very very small number of tourists who end up sick in our hospitals because of code um can i change the subject a little bit um because this is an interesting question we've been talking so much about the people who get very sick and obviously those are the people you deal with for the most part but you're also in this community i'm sure as a nurse you get lots of questions from people you're probably aware of many people who have gotten infected who maybe didn't end up in the hospital but the question is talk about covet in young adults i think that we've we've talked so much about the dire cases what happens when younger people get it and maybe don't end up in the hospital kenny are you familiar enough to talk about that remember i mean a lot of us got really really really sick from the flu but we never did end up in the hospital so just the fact that these people are in the hospital it means it's pretty bad and that's not even mentioning that that thousands of people who get sick who don't even get to the hospital and i mean it's the plain fact that getting the vaccine is going to make you elastic so you get the vaccine you're i mean you're sick for maybe one two days you don't get the vaccine you're sick for maybe six days there's four day difference where you can actually spread the disease it's a big difference just during that four days you cough on one you mean a compromised person an old person make them sick make them die i mean i think it's everybody's responsibility just get the vaccine just get the vaccine you might prevent somebody from dying isn't that a good enough reason to get the back seat yeah i i i understand what you're saying and that we we talk about if we talk about a lot about people who don't get really sick it makes it sound like it's not that serious but in fact you could very easily get somebody else sick for whom it would be very very serious um a couple other questions and a lot of people a lot of people are very very sick and they don't even go to the hospital we don't even talk about that population do you see them come into emergency rooms is that what happens some of them drive in and some of them come to the image a lot of them get brought in from from the city and canada ems and again if they get sick i'm vaccinated they're spreading it to all of the ems workers bringing into the er workers the the hospital workers i mean right there you know i mean that's just unvaccinated people are spreading it to more people just the fact that they you're not only at home they're coming all the way to the hospital and bringing it to everybody else um hilton we got another question uh from uh someone who said who says that they looked it up and actually rob desevere is approved by the fda but is that on an emergency basis similar to what the vaccines are approved for um yeah let me let me just double check on that real quick um i know it was approved under binge use authorization um when we first started using it so that's and um when we did first start using it it was again was um you know it was it was taken by patients who were unvaccinated they're very happy to be treated by rendezvous even though it was operating under mid-use authorization back then yeah i mean as of yesterday when we were doing stories about it i was hearing that it was still emergency approval okay a question uh from someone who just has a basic question uh what exactly is in the vaccine my friend said it has baby placenta in it does it um from what i understand no but does anybody on the panel have that information hilton i mean no again i'm not an immunologist i'm not a scientist so i'm not qualified to but okay so what is it hilton what is the status of some of these um and maybe kenny you want to weigh in in this to this ivormectin thing now today uh we learned of a lawsuit by someone it's a new york lawyer who goes around the country making these same lawsuits who is suing to try and force one of our big hospitals to give a patient ivormectin what's going on with that is that a good idea and how do the hospitals feel about force being forced to try unapproved therapies hilton um sorry i was just looking up that question same question same question i emailed you this afternoon okay um yeah the um we you know we are not supportive of um of you know that drug or other drugs that are that have not been um not being used in clinical trials now there are there are drugs that are using clinical trials under very controlled circumstances and very strict protocols as to how they use but that's not how this particular drug is being used and so no we're not supportive of that drug being used um for the treatment over and deserve there's no clinical evidence at this point in time that it does work and but to the contrary there's actually a lot of evidence that it has very significant and profound side effects you know one of the big things and i'll start with senator favela this question is you know our kids are back in school um are the kids up till 12 cannot be vaccinated even the ones that are older than 12 maybe half of them are vaccinated senator favela are you confident that it's safe for kids to be in school not just for them but for the whole community and i know you guys have been asking doe and health department about this you know um i really feel like the ones that don't have the option to get the vaccine should be more um you know be more aware of not having an option to have um distance learning but the reason why i changed a little bit on why kids should be in school i just using um my school in my district camo as an example we have fights we've been having fights mostly every day some of these kids never ever been on a high school campus or been in school for almost two years so the social attitude and social skills that they usually have by bonding and i'll be the last person to bring this up because i was totally against my daughter going back to school even though she had the vaccine because of the high risk of endangering our teachers faculty and staff but it's more so of a psychological thing for the well-being of the kids interacting with other kids instead of not having that interaction uh is it really being a 50 50 chance of doing even more harm than good in going forward and i really feel for the family and friends that don't want their kids going school because our campbell high school is one of the highest in uh in testing and having positive results but in the long run i think our kids will suffer more psychologically if they don't be able to have a school environment and believe me you can ask my colleagues i want a hardest person to have no kids go back to school but when i seen firsthand what happens when you don't have these social skills and understanding the authority of an officer that has a gun and a badge and you just just keep on going like they're not even there um a society is going in the wrong direction okay senator monique chiba you had something you want to picture there i am curious as to whether you've modeled the impact of school attendance into the case counts well we cannot model them because we don't have data there is no data that is telling us uh like for instance the age of the person of the people in the daily cases we have almost no data on that age group 0 to 11 that isn't vaccinated however there are data supporting the fact that the transmission is very reduced in the elementary school and the kids that are sick and that test positive the transmission likely occurred outside the school environment at that age because the younger so i don't know if it's the viral load that is smaller but that that has been a trend that has been observed so that's what i wanted to pitch in so in other words uh you can be in school in fact it might be safer to be in school than it is to be out in the community yeah i wouldn't go that far about seeing something like that but there is data supporting the fact that uh the school are not a huge at the elementary age another huge vehicle for transmission in between the children um hilton raytheo what have you been seeing when it comes to very young transmission uh very young people going into hospitals we're very fortunate in hawaii to have not seen any significant numbers of pediatric cases or covert cases in children um you know we we do have some and there and certainly in some other states uh it's interesting that the states that have the most children that are hospitalized are the states with the low vaccination rate so there's a very high correlation there which you would expect so if you've got a low vaccination rate in the community then more kids are going to get it and so therefore more kids are going to get up in hospital but yesterday for example before i called the numbers correctly we had two pediatric patients in the state or two pediatric patients in our intensive care unit in the state pediatric intensive care unit i'll pick you with covert and that's that's a very very small number and so as we track those numbers every day okay i guess it's very small i'm sorry we have just run out of time so i've got to say to mahal to all of you and our audience for joining us tonight and we thank our guests republican state senator kurt favela president and ceo of the health care association hilton rethel uh professor of mathematics monique chiba and crisis nurse kenny akamu once again thank you for your service kenny next week on insights hawaii's transgender community will discuss everything from discrimination and prejudice to the push for better health care and legal rights please join us then i'm darryl huff for insights on pbs hawaii aloha [Music] you