Preliminary Data on the Impacts of COVID-19 on Filipino Immigrants in Hawai'i.

Racial and ethnic minorities experience high rates of disease morbidity and mortality. Filipinos in Hawai'i have the second-highest coronavirus disease 2019 (COVID-19) cases and deaths. This exploratory study examined barriers to compliance with COVID-19 prevention practices for Filipino immigrants residing in O'ahu and Maui. Cross-sectional data were collected using mixed methods involving surveys and key informant interviews with Filipino community members. Survey responses (n=50) were collected identifying crucial factors to be addressed and preferences for receiving information related to COVID-19. Some Filipino customs and practices were a barrier to complying with COVID-19 prevention practices; nevertheless, cultural sensitivity was stressed for education messaging. In addition, family and community navigators should be equipped with the training and resources to disseminate COVID-19 information within their communities. Attitudinal, cultural, and linguistic barriers to promote health persist for Filipinos in Hawai'i. The COVID-19 pandemic has exacerbated these barriers due to the circulation of misinformation and lack of information among the Filipino communities of O'ahu and Maui regarding COVID-19 and local policies. Culturally appropriate support including providing tailored and linguistically appropriate COVID-19 information is recommended. Equipping or training a household member to help navigate COVID-19 policies as they change aligns with this community's emphasis on familial and social relationships.

Social Networks, Health Information Sharing, and Pandemic Perceptions among Young Adults in Hawai'i during the COVID-19 Pandemic.

Limited information exists about social network variation and health information sharing during COVID-19, especially for Native Hawaiians (NH), Other Pacific Islanders (OPI), and Filipinos, who experienced COVID-19 inequities. Hawai'i residents aged 18-35 completed an online survey regarding social media sources of COVID-19 information and social network health information measured by how many people participants: (1) talked to and (2) listened to about health. Regression models were fit with age, gender, race/ethnicity, chronic disease status, pandemic perceptions, and health literacy as predictors of information sources (logistic) and social network size (Poisson). Respondents were 68% female; 41% NH, OPI, or Filipino; and 73% conducted a recent COVID-19 digital search for themselves or others. Respondents listened to others or discussed their own health with ~2-3 people. Respondents who talked with more people about their health were more likely to have larger networks for listening to others. In regression models, those who perceived greater risk of acquiring COVID-19 discussed their health with more people; in discussing others' health, women and those with chronic diseases listened to a greater number. Understanding young adults' social networks and information sources is important for health literacy and designing effective health communications, especially to reach populations experiencing health inequities.

Pandemic-driven changes in the nearshore non-commercial fishery in Hawai'i: catch photos posted to social media capture changes in fisher behavior.

Using social media, we collect evidence for how nearshore fisheries are impacted by the global COVID-19 pandemic in Hawai'i. We later confirm our social media findings and obtain a more complete understanding of the changes in nearshore non-commercial fisheries in Hawai'i through a more conventional approach-speaking directly with fishers. Resource users posted photographs to social media nearly three times as often during the pandemic with nearly double the number of fishes pictured per post. Individuals who fished for subsistence were more likely to increase the amount of time spent fishing and relied more on their catch for food security. Furthermore, individuals fishing exclusively for subsistence were more likely to fish for different species during the pandemic than individuals fishing recreationally. Traditional data collection methods are resource-intensive and this study shows that during times of rapid changes, be it ecological or societal, social media can more quickly identify how near shore marine resource use adapts. As climate change threatens additional economic and societal disturbances, it will be necessary for resource managers to collect reliable data efficiently to better target monitoring and management efforts.

Gut microbial indicators of metabolic health underlie age-related differences in obesity and diabetes risk among Native Hawaiians and Pacific Islanders.

Native Hawaiians and Pacific Islanders (NHPIs) suffer from higher prevalence of and mortality to type 2 diabetes mellitus (T2DM) than any other major race/ethnic group in Hawaii. Health inequities in this indigenous population was further exacerbated by the SARS-CoV-2 pandemic. T2DM progression and medical complications exacerbated by COVID-19 are partially regulated by the gut microbiome. However, there is limited understanding of the role of gut bacteria in the context of inflammation-related diseases of health disparities including T2DM and obesity. To address these gaps, we used a community-based research approach from a cohort enriched with NHPI residents on the island of Oahu, Hawaii (N=138). Gut microbiome profiling was achieved via 16s rDNA metagenomic sequencing analysis from stool DNA. Gut bacterial capacity for butyrate-kinase (BUK)-mediated fiber metabolism was assessed using quantitative PCR to measure the abundance of BUK DNA and RNA relative to total bacterial load per stool sample. In our cohort, age positively correlated with hemoglobin A1c (%; R=0.39; P<0.001) and body mass index (BMI; R=0.28; P<0.001). The relative abundance of major gut bacterial phyla significantly varied across age groups, including Bacteroidetes (P<0.001), Actinobacteria (P=0.007), and Proteobacteria (P=0.008). A1c was negatively correlated with the relative levels of BUK DNA copy number (R=-0.17; P=0.071) and gene expression (R=-0.33; P=0.003). Interestingly, we identified specific genera of gut bacteria potentially mediating the effects of diet on metabolic health in this cohort. Additionally, α-diversity among gut bacterial genera significantly varied across T2DM and BMI categories. Together, these results provide insight into age-related differences in gut bacteria that may influence T2DM and obesity in NHPIs. Furthermore, we observed overlapping patterns between gut bacteria and T2DM risk factors, indicating more nuanced, interdependent interactions among these factors as partial determinants of health outcomes. This study adds to the paucity of NHPI-specific data to further elucidate the biological characteristics associated with pre-existing health inequities in this racial/ethnic group that is significantly underrepresented in biomedical research.

Vaccine-Associated Shifts in SARS-CoV-2 Infectivity Among the Native Hawaiian and Other Pacific Islander Population in Hawaii.

Native Hawaiians and other Pacific Islanders (NHPIs) across the country have experienced significant disparities because of the COVID-19 pandemic. The Pacific Alliance Against COVID-19 used a community-based participatory approach involving academic and community partners to expand sustainable COVID-19 testing capacity and mitigate the severe consequences among NHPI communities in Hawaii. We describe the approach of this one-year study, some of the results, and how the data are being used to inform next steps for the communities. Clinical Trials.gov identifier: NCT04766333. (Am J Public Health. 2022;112(S9):S896-S899. https://doi.org/10.2105/AJPH.2022.306973).

Genomic analysis of SARS-CoV-2 variants of concern circulating in Hawai'i to facilitate public-health policies.

Using genomics, bioinformatics and statistics, herein we demonstrate the effect of statewide and nationwide quarantine on the introduction of SARS-CoV-2 variants of concern (VOC) in Hawai'i. To define the origins of introduced VOC, we analyzed 260 VOC sequences from Hawai'i, and 301,646 VOC sequences worldwide, deposited in the GenBank and global initiative on sharing all influenza data (GISAID), and constructed phylogenetic trees. The trees define the most recent common ancestor as the origin. Further, the multiple sequence alignment used to generate the phylogenetic trees identified the consensus single nucleotide polymorphisms in the VOC genomes. These consensus sequences allow for VOC comparison and identification of mutations of interest in relation to viral immune evasion and host immune activation. Of note is the P71L substitution within the E protein, the protein sensed by TLR2 to produce cytokines, found in the B.1.351 VOC may diminish the efficacy of some vaccines. Based on the phylogenetic trees, the B.1.1.7, B.1.351, B.1.427, and B.1.429 VOC have been introduced in Hawai'i multiple times since December 2020 from several definable geographic regions. From the first worldwide report of VOC in GenBank and GISAID, to the first arrival of VOC in Hawai'i, averages 320 days with quarantine, and 132 days without quarantine. As such, the effect of quarantine is shown to significantly affect the time to arrival of VOC in Hawai'i. Further, the collective 2020 quarantine of 43-states in the United States demonstrates a profound impact in delaying the arrival of VOC in states that did not practice quarantine, such as Utah. Our data demonstrates that at least 76% of all definable SARS-CoV-2 VOC have entered Hawai'i from California, with the B.1.351 variant in Hawai'i originating exclusively from the United Kingdom. These data provide a foundation for policy-makers and public-health officials to apply precision public health genomics to real-world policies such as mandatory screening and quarantine.

Differences in COVID-19 Hospitalizations by Self-Reported Race and Ethnicity in a Hospital in Honolulu, Hawaii.

INTRODUCTION: The true extent of racial and ethnic disparities in COVID-19 hospitalizations may be hidden by misclassification of race and ethnicity. This study aimed to quantify this inaccuracy in a hospital's electronic medical record (EMR) against the gold standard of self-identification and then project data onto state-level COVID-19 hospitalizations by self-identified race and ethnicity. METHODS: To identify misclassification of race and ethnicity in the EMRs of a hospital in Honolulu, Hawaii, research and quality improvement staff members surveyed all available patients (N = 847) in 5 cohorts in 2007, 2008, 2010, 2013, and 2020 at randomly selected hospital and ambulatory units. The survey asked patients to self-identify up to 12 races and ethnicities. We compared these data with data from EMRs. We then estimated the number of COVID-19 hospitalizations by projecting racial misclassifications onto publicly available data. We determined significant differences via simulation-constructed medians and 95% CIs. RESULTS: EMR-based and self-identified race and ethnicity were the same in 86.5% of the sample. Native Hawaiians (79.2%) were significantly less likely than non-Native Hawaiians (89.4%) to be correctly classified on initial analysis; this difference was driven by Native Hawaiians being more likely than non-Native Hawaiians to be multiracial (93.4% vs 30.3%). When restricted to multiracial patients only, we found no significant difference in accuracy (P = .32). The number of COVID-19-related hospitalizations was 8.7% higher among Native Hawaiians and 3.9% higher among Pacific Islanders when we projected self-identified race and ethnicity rather than using EMR data. CONCLUSION: Using self-identified rather than hospital EMR data on race and ethnicity may uncover further disparities in COVID-19 hospitalizations.

Planning and Implementation of COVID-19 Isolation and Quarantine Facilities in Hawaii: A Public Health Case Report.

In response to the second surge of COVID-19 cases in Hawaii in the fall of 2020, the Hawaii State Department of Health Behavioral Health Administration led and contracted a coalition of agencies to plan and implement an isolation and quarantine facility placement service that included food, testing, and transportation assistance for a state capitol and major urban center. The goal of the program was to provide safe isolation and quarantine options for individual residents at risk of not being able to comply with isolation and quarantine mandates. Drawing upon historical lived experiences in planning and implementing the system for isolation and quarantine facilities, this qualitative public health case study report applies the plan-do-study-act (PDSA) improvement model and framework to review and summarize the implementation of this system. This case study also offers lessons for a unique opportunity for collaboration led by a public behavioral health leadership that expands upon traditionally narrow infectious disease control, by developing a continuum of care that not only addresses immediate COVID-19 concerns but also longer-term supports and services including housing, access to mental health services, and other social services. This case study highlights the role of a state agency in building a coalition of agencies, including a public university, to respond to the pandemic. The case study also discusses how continuous learning was executed to improve delivery of care.

Next Gen Hawai'i: Collaborative COVID-19 Social Media Initiative to Engage Native Hawaiian, Other Pacific Islander, and Filipino Youth.

The Next Gen Hawai'i social media project was initiated in the fall of 2020 to address ongoing public health concerns and the need for accessible and reliable information across Hawai'i's diverse communities by strategically amplifying the voices of Hawai'i's youth in their Native languages. The collaborative effort arose from conversations within the Hawai'i's Native Hawaiian & Pacific Islander COVID-19 Response, Recovery, and Resilience Team, composed of diverse public and private organizations involved in statewide COVID-19 response efforts for Native Hawaiian and Pacific Islander communities. Next Gen Hawai'i's focus was on Native Hawaiian, Pacific Islander, Filipino, and other populations disproportionately suffering from COVID-19. Five social media platforms were developed to spread messaging to youth and young adults about COVID-19. Public Health Ambassadors (from high school to young adults) were recruited and engaged to create culturally and linguistically rooted messaging to promote public health and prevention-based social norms. This strength-based approach recognized youth as important community leaders and ambassadors for change and empowered them to create content for dissemination on platforms with national and global reach. Messaging was designed to build individual, community, and digital health literacy while integrating core cultural values and strengths of Native Hawaiian, Pacific Islander, and Filipino communities. Over 250 messages have been delivered across Next Gen Hawai'i social media channels on topics including vaccine information, mask-wearing, staying together over distances, mental health, and in-languages resources in Chuukese, Chamorro, Marshallese, Samoan, Hawaiian, Ilocano, Tagalog, and other Pacific-basin languages. Reach has included more than 75 000 views from various social media channels, media features, successful webinars, and relevant conference presentations. This Public Health Insights article provides an overview of Next Gen Hawai'i's activities and achievements as well as lessons learned for other youth-focused public health social media campaigns and organizations.

COVID-19 heterogeneity in islands chain environment.

BACKGROUND: It is critical to capture data and modeling from the COVID-19 pandemic to understand as much as possible and prepare for future epidemics and possible pandemics. The Hawaiian Islands provide a unique opportunity to study heterogeneity and demographics in a controlled environment due to the geographically closed borders and mostly uniform pandemic-induced governmental controls and restrictions. OBJECTIVE: The goal of the paper is to quantify the differences and similarities in the spread of COVID-19 among different Hawaiian islands as well as several other archipelago and islands, which could potentially help us better understand the effect of differences in social behavior and various mitigation measures. The approach should be robust with respect to the unavoidable differences in time, as the arrival of the virus and promptness of mitigation measures may vary significantly among the chosen locations. At the same time, the comparison should be able to capture differences in the overall pandemic experience. METHODS: We examine available data on the daily cases, positivity rates, mobility, and employ a compartmentalized model fitted to the daily cases to develop appropriate comparison approaches. In particular, we focus on merge trees for the daily cases, normalized positivity rates, and baseline transmission rates of the models. RESULTS: We observe noticeable differences among different Hawaiian counties and interesting similarities between some Hawaiian counties and other geographic locations. The results suggest that mitigation measures should be more localized, that is, targeting the county level rather than the state level if the counties are reasonably insulated from one another. We also notice that the spread of the disease is very sensitive to unexpected events and certain changes in mitigation measures. CONCLUSIONS: Despite being a part of the same archipelago and having similar protocols for mitigation measures, different Hawaiian counties exhibit quantifiably different dynamics of the spread of the disease. One potential explanation is that not sufficiently targeted mitigation measures are incapable of handling unexpected, localized outbreak events. At a larger-scale view of the general spread of the disease on the Hawaiian island counties, we find very interesting similarities between individual Hawaiian islands and other archipelago and islands.

Mitigation Planning and Policies Informed by COVID-19 Modeling: A Framework and Case Study of the State of Hawaii.

In the face of great uncertainty and a global crisis from COVID-19, mathematical and epidemiologic COVID-19 models proliferated during the pandemic. Yet, many models were not created with the explicit audience of policymakers, the intention of informing specific scenarios, or explicit communication of assumptions, limitations, and complexities. This study presents a case study of the roles, uses, and approaches to COVID-19 modeling and forecasting in one state jurisdiction in the United States. Based on an account of the historical real-world events through lived experiences, we first examine the specific modeling considerations used to inform policy decisions. Then, we review the real-world policy use cases and key decisions that were informed by modeling during the pandemic including the role of modeling in informing planning for hospital capacity, isolation and quarantine facilities, and broad public communication. Key lessons are examined through the real-world application of modeling, noting the importance of locally tailored models, the role of a scientific and technical advisory group, and the challenges of communicating technical considerations to a public audience.

Persons tested for SAR-CoV-2 at a military treatment facility in Hawaii.

Health inequalities based on race are well-documented, and the COVID-19 pandemic is no exception. Despite the advances in modern medicine, access to health care remains a primary determinant of health outcomes, especially for communities of color. African-Americans and other minorities are disproportionately at risk for infection with COVID-19, but this problem extends beyond access alone. This study sought to identify trends in race-based disparities in COVID-19 in the setting of universal access to care. Tripler Army Medical Center (TAMC) is a Department of Defense Military Treatment Facility (DoD-MTF) that provides full access to healthcare to active duty military members, beneficiaries, and veterans. We evaluated the characteristics of individuals diagnosed with SARS-CoV-2 infection at TAMC in a retrospective, case-controlled (1:1) study. Most patients (69%) had received a COVID-19 test within 3 days of symptom onset. Multivariable logistic regression analyses were used to identify factors associated with testing positive and to estimate adjusted odds ratios. African-American patients and patients who identified as "Other" ethnicities were two times more likely to test positive for SARS-CoV-2 relative to Caucasian patients. Other factors associated with testing positive include: younger age, male gender, previous positive test, presenting with >3 symptoms, close contact with a COVID-19 positive patient, and being a member of the US Navy. African-Americans and patients who identify as "Other" ethnicities had disproportionately higher rates of positivity of COVID-19. Although other factors contribute to increased test positivity across all patient populations, access to care does not appear to itself explain this discrepancy with COVID-19.

The Impacts of the COVID-19 Pandemic on Service-Learning Experiences Among Undergraduate Public Health Students in Hawai'i.

Service-learning is a high-impact educational practice at the core of the undergraduate public health degree at the University of Hawai'i at Manoa (UHM). This practice provides an invaluable learning experience and professional opportunity for students to collaborate with community partners and make significant contributions in the field. The COVID-19 pandemic halted or disrupted service-learning experiences as community partners adapted to shifting mandates and emergency orders. Surveying the rapidly evolving landscape of partner organizations to support service-learning is a challenge. Assessing changes to the program mentorship or satisfaction is the first step to developing protocols to ensure standardization of service-learning during times of crisis. This study will address if and how the pandemic impacted students' satisfaction with required service-learning experiences. Furthermore, authors hope to create a comprehensive list of practicum partnering organizations, both focused on pandemic response and, more generally, of the service-learning students at UHM, with the intent to increase students and community partners in local service-learning. Assessments were conducted to assess the impact of COVID-19 on undergraduate students' experiences with service-learning through use of a program exit survey. The authors hypothesized pandemic-related adjustments would not affect student satisfaction or skill development. Despite challenges associated with the pandemic and emergency online transitions, students persisted in personal and professional growth associated with service-learning. This developed resilience supports students as they graduate and enter a workforce adapting to remote work demands and community needs.

Impact of the COVID-19 Pandemic on the Hawai'i Nursing Workforce: A Cross-sectional Survey.

The coronavirus disease (COVID-19) pandemic has placed extraordinary strain on health care systems. This has led to increased stress among health care workers, and nurses in particular, which has had a negative impact on their physical and psychosocial wellbeing. This is likely to negatively impact the nursing workforce at the state and national levels as the pandemic continues. The purpose of this study was to assess whether nurses licensed in Hawai'i have considered leaving the workforce. A cross-sectional online survey was conducted among Hawai'i nurses at all levels of licensure, with 421 responding. Of these nurses, 97 (23.0%) reported considering leaving the workforce, with safety (39.2%) and family/caregiver strain (32.0%) being the most common reasons. Reconsidering whether they should stay employed in their current roles (Odds ratio [OR] 2.05; 95% CI 1.56 - 2.69) and fear to continue providing direct patient care (OR 1.97; 95% CI 1.54 - 2.54) were associated with increased odds of having considered leaving the workforce. Based on these results, the State of Hawai'i and local health care organizations need to adjust their nursing workforce estimates and address how to alleviate nurses' stressors and safety concerns to mitigate a potential workforce shortage. Research is needed to develop interventions to support and empower nurses in their current roles but also address future emergency preparedness.

Experience of parents of preschool children in Hawaii during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic has resulted in major disruption to economic, health, education, and social systems. Families with preschool children experienced extraordinary strain during this time. This paper describes a qualitative study examining the experience of parents of preschool children in Hawaii during the COVID-19 pandemic. SAMPLE: Thirteen (N = 13) parents of preschool children living on the island of Oahu, Hawaii, participated in small group discussions occurring in February and March 2021, approximately 1 year after the start of the pandemic in the state. Discussion transcripts were coded and sorted into themes. RESULTS: Four themes emerged: stressors due to the COVID-19 pandemic, family coping and resources, meaning of the COVID-19 crisis to the family, and family adaptation patterns. Themes mapped to the Family Adjustment and Adaptation Response model. CONCLUSION: Families relied on various resources to cope with stressors experienced due to the COVID-19 pandemic, and adopted new patterns related to seeking healthcare and household emergency preparedness. Findings may inform policies and interventions to support families during the ongoing COVID-19 pandemic and future public health emergencies.

Disaggregating Data to Measure Racial Disparities in COVID-19 Outcomes and Guide Community Response - Hawaii, March 1, 2020-February 28, 2021.

Native Hawaiian and Pacific Islander populations have been disproportionately affected by COVID-19 (1-3). Native Hawaiian, Pacific Islander, and Asian populations vary in language; cultural practices; and social, economic, and environmental experiences,† which can affect health outcomes (4).§ However, data from these populations are often aggregated in analyses. Although data aggregation is often used as an approach to increase sample size and statistical power when analyzing data from smaller population groups, it can limit the understanding of disparities among diverse Native Hawaiian, Pacific Islander, and Asian subpopulations¶ (4-7). To assess disparities in COVID-19 outcomes among Native Hawaiian, Pacific Islander, and Asian populations, a disaggregated, descriptive analysis, informed by recommendations from these communities,** was performed using race data from 21,005 COVID-19 cases and 449 COVID-19-associated deaths reported to the Hawaii State Department of Health (HDOH) during March 1, 2020-February 28, 2021.†† In Hawaii, COVID-19 incidence and mortality rates per 100,000 population were 1,477 and 32, respectively during this period. In analyses with race categories that were not mutually exclusive, including persons of one race alone or in combination with one or more races, Pacific Islander persons, who account for 5% of Hawaii's population, represented 22% of COVID-19 cases and deaths (COVID-19 incidence of 7,070 and mortality rate of 150). Native Hawaiian persons experienced an incidence of 1,181 and a mortality rate of 15. Among subcategories of Asian populations, the highest incidences were experienced by Filipino persons (1,247) and Vietnamese persons (1,200). Disaggregating Native Hawaiian, Pacific Islander, and Asian race data can aid in identifying racial disparities among specific subpopulations and highlights the importance of partnering with communities to develop culturally responsive outreach teams§§ and tailored public health interventions and vaccination campaigns to more effectively address health disparities.

Assessing licensed nurses COVID-19 vaccine attitudes and intentions: a cross-sectional survey in the state of Hawaii.

Nurses are the largest single occupation of health care providers and at greatest risk for exposure to and acquisition of Coronavirus Disease 2019 (COVID-19). In December 2020, nurses in Hawaii were recruited for an online survey that measured perceived risk/threat of COVID-19, vaccine attitudes, and perceived safety of COVID-19 vaccines, as well as level of intention: primary, secondary (i.e., delayed), or no intention to vaccinate. The final sample consisted of 423 nurses. Participants were primarily Asian (27.9%) and White (45.2%). The majority were 18-50 years (65.5%) and female (87.0%), held an RN license (91.7%), and identified as a staff nurse (57.7%) in the hospital setting (56.7%). Among participants, 52.3% indicated primary intention, 27.9% secondary intention, and 19.9% no intention to vaccinate. The strongest predictors of any level of intention were greater positive attitudes toward COVID-19 vaccination and lower concerns related to COVID-19 vaccine safety. Findings can guide interventions to support vaccine acceptance for those who initially decline vaccination.