Effective Pandemic Response: Lessons from Kauai.

Local health jurisdictions have struggled to protect their communities during the pandemic, and successes are few. The Kauai District Health Office (KDHO) of the Hawaii Department of Health serves a rural island community of 73,000 residents. As a state agency, KDHO works closely with the county mayor and administration. Kauai has experienced comparatively low COVID-19 case and case-fatality rates while maintaining strong community and leadership cohesion. Kauai's response was highly rated by residents in a recent Community Assessment for Public Health Emergency Response survey. In this article, we describe examples of local response efforts in the areas of (1) policy and regulations, (2) health-directed isolation and quarantine, (3) case investigation and contact tracing, (4) testing availability, (5) vaccine rollout and availability, and (6) public information, as well as the factors that have contributed to Kauai's successes. KDHO regularly prioritizes agencywide initiatives that cross program silos; staff have experience using the incident command system in real-world situations; the community health worker team is multicultural, multilingual, and well established; and staff are integral members of the community they serve. Preexisting partnerships were strong, including those with county agencies, healthcare partners, and nongovernmental organizations, which facilitated early and effective collaboration. Response successes include implementation of unified command, coordinated public messaging, early protective measures, effective disease control and outbreak response, attention to secondary impacts of the pandemic, free community testing, mass vaccination, and mobile vaccinations and testing. The value of local health departments engaging regularly and authentically with partners and communities cannot be overstated. It has saved lives on Kauai. Local health jurisdictions should focus on all-hazards and all-staff endeavors to enhance their disaster response effectiveness.

A Report on the Impact of the COVID-19 Pandemic on the Health and Social Welfare in the County of Kaua'i, Hawai'i.

The Hawai'i Emergency Management Agency Community Care Outreach Unit (CCO) conducted a survey to gauge the impact of coronavirus disease 2019 (COVID-19) on the health and social welfare of individuals and their families across the state of Hawai'i. A mixed-methods framework was utilized for survey distribution. This article presents a descriptive analysis of the data to provide a basic overview of the impact of COVID-19 in Kaua'i County (KC), as assessed in August/September 2020. A total of 420 participants in KC responded to the statewide survey. Approximately one-third reported that they or their family members experienced reduced work hours or lost their job because of COVID-19. Many reported difficulties paying for many types of living essentials and expected these difficulties to increase in the near future. Prevalent challenges for the fall school semester included access to funds for school supplies and face-coverings. About one-third reported feeling nervous more than half the time or nearly every day in the past 2 weeks, and one-fourth reported feeling worried more than half the time or nearly every day in the past 2 weeks. The majority perceived the severity of COVID-19 to be moderate/very high and most had at least a moderate level of knowledge about risks for contracting severe COVID-19. Less than half said they would know how to provide care for someone in their family with COVID-19. Half of the respondents in KC reported maintaining social distancing usually/all of the time, the majority reported wearing a face-covering usually/always when needed. The results provide a baseline for understanding the impact, needs, and threats to the health and social welfare of households and their families in KC as a result of COVID-19. Local stakeholders can utilize this information for developing priorities, strategies, and programs to address the pandemic where needed and also to assess progress in areas of need.

Rapid Implementation of a Statewide Observational Surveillance System to Monitor Wearing of Face Masks in Public Spaces.

This report describes the rapid implementation of a statewide observational surveillance program to monitor the public's wearing of face masks in public spaces during community spread of Coronavirus disease 2019 (COVID-19). It describes how the Hawai'i State Department of Health partnered with University of Hawai'i faculty to develop and implement the surveillance program. The surveillance program involved organizing volunteers to conduct weekly direct observations in designated locations. A smartphone application (app) was created to record real-time observational surveillance data. From September 5, 2020, to March 13, 2021, a total of 84 577 observations were conducted across the state. Eighty-three percent of those observed were correctly wearing a face mask, 7% were wearing a face mask incorrectly, and 10% were not wearing a mask. Following the 2-week pilot phase of the project, volunteers were surveyed regarding facilitators and barriers for conducting observations and motivations for volunteering. Feedback was used to refine project procedures. With few states having implemented such a surveillance program, the information reported in this article may inform communities interested in tracking mask-wearing behaviors in the context of the COVID-19 pandemic.

Childhood leprosy and social response in south India

This paper reports a field study of childhood leprosy in the state of Karnataka, India, as encountered through a private, secular leprosy hospital and its rural outpatient program serving some 60 villages. Symptoms of leprosy among children are subtle, ambiguous and not readily distinguishable from those of relatively innocuous skin ailments with which villagers of the region commonly lump them. In addition, severe stigma attaches to the disease. As a result, diagnosis tends to be resisted, rendering effective treatment difficult. The research focused on the hospital's comprehensive program of diagnosis, treatment, education and rehabilitation, and the responses of people of it. Three categories of response to diagnosis and treatment, as defined by the hospital program, were investigated: regular acceptors, irregular acceptors and refusers. Contrary to expectation, those who accept treatment irregularly and hence ineffectively, express greater awareness of the cause, symptoms and treatment of the disease than either those who accept regular treatment or those who refuse treatment. Despite frequent verbal denials of belief in, or fear of, contagion, people's behavior regarding leprosy and its victims indicates that such beliefs are indeed harbored. The effectiveness of the program is assessed with reference to its policies and procedures as they affect the rural population. Especially effective is the policy of not confronting people with diagnoses of leprosy in problematic childhood cases, but of asserting instead that leprosy can be averted if treatment is accepted. Resistance generated by the fear and stigma of leprosy is thus mitigated by presenting its childhood symptoms as pre-leprous rather than as early leprosy. The research concludes that the program has achieved notable success in each of its aspects and is therefore worthy of emulation elsewhere.