Special to The Hawai‘i Herald
Editor’s Note: Because the pandemic situation varies day by day, it is relevant to note that this interview was conducted on Aug. 13, 2020.
HMSA’s Dr. Mark Mugiishi Says, “We Will Have to Learn to Conduct Life Differently”
Dr. Mark Mugiishi, president and CEO of the Hawaii Medical Services Association, graduated in 1983 from Northwestern University Medical School. He then co-founded both the Endoscopy Institute of Hawaii and the Eye Surgery Center of Hawaii. In addition, Dr. Mugiishi is a general surgeon affiliated with the Queen’s Medical Center and Kuakini Medical Center who also serves as faculty of the John A. Burns School of Medicine.
Q: What is COVID-19?
A: COVID-19 is an infection caused by the SARS COVID-2 virus. Other coronaviruses, like SARS and MERS, can cause the common cold as well as serious illnesses, but SARS coronavirus-2 is called a novel coronavirus, because this is a new version of the virus that started in animals in Wuhan, China, jumped from those animals to humans, then spread from human to human.
Q: What makes this virus different?
A: This is the first time humans have experienced it, so we don’t have a lot of knowledge about how our immunity can fight it. As a result, you see it being very easy to transmit; the virus leads to intensive-care unit hospitalizations and fatalities. So the lack of a human immune response has led to the virus expanding everywhere. Hopefully, as more people gain immunity, it will diminish, but many believe we will need a vaccine to achieve the protection necessary to control the infection.
Q: What is the current situation in Hawai‘i?
A: Our current situation is like the tale of two cities. We started off being a model of how communities should confront this. When the first cases emerged, we were quick to lock down the state and require people to work from home. We closed our businesses and required social distancing to limit people from passing on the disease. We also closed our borders by stopping inter-island and out-of-state travel.
But once you gain control of the disease, you have to initiate several public-health safeguards that will prevent the virus from resurging: extensive screening, testing and contact tracing. Most people know about screening and testing, but contact tracing is just as important.
Q: Why is contact tracing crucial?
A: Contact tracing requires authorities to identify who the infected person may have had close contact with, and to isolate those people, so that they can’t transmit the disease to others.
If you take the analogy of a wildfire, contact tracing encircles the problem early and puts out the small, smoldering hot spots — before it turns into an inferno that burns down the whole forest.
Instead of broadly implementing any of this, we relaxed. The public returned to large beach gatherings, house parties and bars, where people refused to wear masks. As a result, the disease re-emerged with a vengeance.
Q: Can Hawai‘i’s hospitals cope with this crisis?
A: There is one lucky aspect of this disease in its current form. It doesn’t appear to be as severe in terms of hospitalizations and of how many people end up in the ICU.
So while we have far more cases of infection than before, our hospitalizations and ICU admissions are similar to the early stages of the pandemic. Right now we have the hospital capacity to take care of the people who are getting sick — as long as the numbers don’t rise above a certain level. Of course, if they do increase, then the math will change.
Q: What are the prospects of a vaccine?
A: I’m optimistic that we are going to have a vaccine.
If you are waiting for a perfect vaccine, however, you may have to be patient. There are three criteria that must be met:
First, the vaccine must be safe. We are giving the vaccine to healthy people, so the last thing we want is to make them sick.
Second, it has to work. It has to confer some degree of immunity to the coronavirus.
Third, there must be a sustained response. People have to be protected for a certain period of time, so they don’t have to be inoculated every month.
So eventually something will arrive that is safe. It will probably work, but we won’t know for how long; we may see vaccines that have to be given repeatedly.
But it’s important that people understand that the vaccines don’t have to be perfect. If we can get a vaccine that is 50 or 60 percent effective, that alone would help flatten the curve.
Q: What is the long-term impact on the state?
A: The most obvious consequence is the toll it has taken on our economy. People have lost their jobs; many businesses have closed. I’ve heard people say that public health is our first priority, and I don’t disagree.
But the economy is directly tied to public health. If people don’t have enough money to eat and afford decent housing, that is the greatest determinant of a poor health outcome. That will affect an entire generation.
If you take all of these young people, and they go through four years of a depressed economy, this will impact their health for their entire life.
We have to get a handle on this quickly; we all need to do our job by practicing social distancing, wearing masks, avoiding large gatherings and maintaining good hygiene. All of these new habits are critical because they will allow us to control the infection rate and regain the Hawai‘i that we know and love.
Q: What does the future hold for all of us?
A: We won’t be like we are now, but I don’t know if we will ever get back to how we were before. It’s going to be somewhere in between.
We will have to learn how to conduct life differently: a lot of what we do will have to go online. For example, in healthcare, we have learned to deliver a lot of services digitally and virtually. Of course, some things will still have to be done in person, but it’ll be a long time before 100,000 people can pile into a stadium and watch a football game.
We will have a new normal. It won’t be like it is now, and it won’t be like it was before. It will be a new normal.
Alan Suemori teaches Asian American history at ‘Iolani School. He is a former Hawai‘i Herald staff writer.