From Diana Shaw’s perspective, it’s not surprising that Covid-19 has come to the small Hawaiian island where her health center is located. The surprise is that, when the virus finally reared its head, it spread like wildfire.
The island of Lanai, home to approximately 3,000 people, is a boat or plane trip away from the nearest large city. A barge brings supplies to the island weekly – although Shaw said the trip is sometimes canceled if the waters are choppy.
That, combined with limitation on travel within the state, kept the virus away until October 20, when Lāna’i Community Health Center received word that three Covid-19 tests they’d conducted the day before had come back positive.
“We were really lucky because people have been very cautious overall,” said Shaw, the health center’s executive director. Direct Relief has supported the health center with shipments of medicines and supplies, including PPE, during the pandemic.
But “we unfortunately knew that our island would not be able to be clear of Covid, especially as they were opening up the borders” to travelers, which happened in October.
It’s not fully clear how Covid-19 arrived on the island, which Shaw described as a diverse community with pockets of close friends and extended family members within it. But once it spread, it spread quickly, reaching 106 cases by November 8.
“We knew the shoe was going to drop. We just didn’t know it was going to drop and hit as hard as it did,” Shaw said.
Life on Lanai
Many of Lanai’s residents work at one of the island’s two hotels, do land management or hydroponics, or work for the state, county, or school system, Shaw said.
“I would describe this as a working-class island,” she explained. “Many people are subsistence living. They hunt…and they grow their own vegetables.” Lāna’i Community Health Center, aimed at economically underserved patients, served nearly 70% of the island’s residents as of 2019.
A handful of restaurants, two grocery stores, and a single gas station serve Lanai’s population, said Jared Medeiros, Lāna’i Community Health Center’s associate medical director and a nurse practitioner.
Although the island has its own ambulance and a small hospital, Shaw said that expectant mothers generally choose to go to Oahu or Maui for birth. Some providers travel back and forth to the island to offer services.
Shaw said a number of the health center’s patients also live in tightly packed households of 10 to 15 people, increasing the odds of Covid transmission within the household.
But Covid hit Lanai economically long before the disease made its way to the island.
“Jobs are already hard to find,” Medeiros said. “When something does pop up, it’s like everybody trying to jump for it.”
Then tourism to the island slowed, Shaw said. Residents were cautious about eating in the few local restaurants. And the health center began seeing increasing numbers of patients on Medicaid – suggesting they had lost employer-sponsored health insurance.
And all the while, they awaited the inevitable.
“We knew the shoe was going to drop,” Shaw said. “We’ve practiced as if Covid has been on our island from day one.”
Ramping up, calming down
And drop it did. On the same day that Lāna’i Community Health Center received positive results – another medical center on the island also received them the same day, Medeiros said – staff members jumped into action.
Where they’d been testing 10 people a day, they began testing 100 – burning through their reserves of PPE in the process.
Contact tracing – which Medeiros said they quickly had to turn over to the Department of Health – was complicated by the community’s closeness. A staff member might call a patient with a positive test result, only to find their cell phone turned off and their address changed.
“When we do finally talk to people we find out, ‘No, they’re with their other cousins over there,’” Medeiros said.
And drive-through test clinics and other efforts came with their own challenges. Medeiros described a staff member holding an umbrella over test kits in the rain.
Four patients with severe symptoms have had to be transported off the island. “I have to figure out how to get them from their home in Lanai to the harbor,” Medeiros said during a conversation with Direct Relief.
Shaw explained that the local ferry would carry one couple from the island, but staff members were concerned about having sick patients out on the deck, in the open air.
When Shaw and Medeiros spoke to Direct Relief, the Covid situation was beginning to quiet. “Things have calmed down in that we’re not getting double-digit positives on daily basis,” Shaw said.
While the majority of the island’s residents had been tested, Medeiros said – the health center alone has conducted more than 1400 tests – retesting was needed to cover people who’d had a later exposure.
“My feeling is that what has been developed for the community of Lanai has clearly been a community roots effort,” with health care providers, public health officials, police, emergency teams, and more working closely together to make sure needs are met, Shaw said. “They have their marching orders.”
And plans they had of a large-scale response on the island have largely been unnecessary. People with Covid-19 are “not going to be going to a field hospital. They’re going to be stabilized and shipped out,” Medeiros said.
An outpouring of support
As Lāna’i Community Health Center has worked to keep routine services available to patients – they did briefly close the dental clinic, Medeiros said – they’ve also made a strong effort to keep in touch with patients living with Covid-19, from giving tips for self-care to providing pulse oximeters.
“It’s easy for these patients to feel shunned away because they’re positive, but we’re here for them,” he said.
If a patient needs to be transported off the island, Medeiros makes the call to the local ambulance himself, to ensure that everyone has the right information. “I feel this is really important, because it helps maintain this provider-to-provider relationship,” he said.
And if staff members have been disappointed by what they see as a lackluster official response to the island, Shaw said they’ve been overwhelmed by offers of support from other health centers and contacts in public health, public insurance, and even the private sector.
One person, a private individual, went shopping for Lāna’i Community Health Center and then put the supplies on the plane.
“We were very worried. Community health centers are always on a shoestring budget,” Shaw said. “It’s a huge display of people who have come to us.”
Direct Relief has supplied Lāna’i Community Health Center with a $50,000 emergency operating grant and over $190,000 in medication and supplies since the beginning of the year, including shipments of masks, gowns, and gloves to help the health center continue its patient care and testing work.
“We spend a lot of our time thinking about what we don’t have, but we have a lot and we’ve accomplished a lot,” Shaw said.
Since the start of the pandemic, Direct Relief has sent more than 24,000 shipments containing more than 43 million masks, 7 million gloves and millions of other PPE items, and more than $36 million in emergency operating grants, to more than 1,900 health facilities throughout the U.S. and world.