Hawaii Health team reports on positive COVID tests in repat staff
Pago Pago, AMERICAN SAMOA — An investigation by a Hawaii Health Department team found, among other things, that three staff members of the ASG Hawaii Office (ASG-HI) and ASG Health Department (AS-DOH) involved in the ASG repatriation program in Hawaii, had tested COVID-19 positive.
The investigation also found two events last month, which staff members attended and during one of the events, the Honolulu police were called to the quarantine site due to a fight that left a hotel television broken and tables over-turned.
This is according to a letter, dated June 1st from Dr. Sarah K. Kemble — the acting State Epidemiologist of the Diseases Outbreak Control Division of the Hawaii Health Department (HI-DOH) — to ASG Health director Motusa Tuileama Nua, who is currently in Hawaii. The letter also provides recommendations to ensure the safe return to American Samoa of travelers for the repatriation flight 5 that arrived June 1st.
Kemble’s letter, with the subject matter “Three COVID-19 cases at Ohana East Waikiki Hotel Quarantine Site”, provided at the outset background on American Samoa’s repatriation efforts and process of quarantine at the hotel.
AS-DOH oversees the quarantine site and provides medical staff while ASG-HI provides the support staff. AS-DOH tests all staff members 72 hours prior to the arrival of residents — who are the travelers — for quarantine, according to Kemble’s letter.
Residents are tested on day 2 of quarantine and 3 days prior to the departure date. Any resident (which is the traveler) and/or staff member who tests positive and their close contracts are referred to HI-DOH for isolation or quarantine and case management.
INVESTIGATION OF 3-POSITIVE CASES
Kemble then discussed the investigation into the three positive COVID-19 cases, that were identified on May 17th. She said that repatriation testing for ASG-HI and AS-DOH staff members was done 48-hours prior to the arrival of residents. Four of the staff members tested positive on May 16th: the first case is a 39-year-old male, “he is a historical case, is not being counted as an active case, is fully vaccinated, and was identified on the morning of 05/17/21.”
The second case is a 27-year-old male, who has not been vaccinated and was identified the morning of May 17; the third case is a 56-year-old male, he is fully vaccinated and was identified at the end of business on May 17th; and the fourth case is a 42-year-old male, who is fully vaccinated and was identified at the end of business on May 17th.
“The 3 fully vaccinated cases have been reported to the HI-DOH team as breakthrough cases,” she wrote, adding that the cases were at the hotel quarantine site from May 14th through May 17th.
She then revealed additional information during the investigation pertaining to ASG’s staff members at the quarantine site.
“The HI-DOH Pacific Islander Investigation Team found wide-spread exposure throughout the quarantine site due to staff meetings, parties, shared common areas where staff members congregate to eat, break, or smoke,” she wrote to Motusa. “Mask wearing was not enforced and little to no social distancing was done.”
Kemble points out that requests for a list of all AS-DOH and ASG-HI staff members were made but to date, a complete list has not been provided.
“The issue appears to be that those compiling the list are deciding who is a close contact and who is not,” she said. “Unfortunately, the investigation found that those names not provided were also in attendance at all or some of the events listed above.”
She recalled that registration for the 5th repatriation flight occurred on May 17th and May 18th and 216 returning residents — or travelers — from Hawaii and the US mainland checked in. The three-positive cases last day at the hotel quarantine site was May 17th - [which was date the three cases tested positive].
“We have requested AS-DOH and ASG-HI send home all non-essential employees and one clinical staff member who is partially vaccinated,” she said. “All fully vaccinated clinical staff members and some essential support staff are continuing to work.”
Another revelation by Kemble during the investigation also found that two-events occurred on May 8th and possibly May 11th. At both events, she said ASG-HI and AS-DOH employees were in attendance, there was alcohol on site, but “it is unclear if the employees drinking, were on the job at the time.”
For the event on May 8th, Kemble said “Honolulu Police Department was called to the quarantine site due to a fight that left a hotel television broken and tables over-turned.” At the second event, an AS-DOH employee who was part of the quarantine process, held a party, breaking the rules set in place by AS-DOH and the American Samoa COVID-19 Task Force.
Kemble outlined for Motusa, “prevention recommendations” which she says “are provided to ensure that those returning residents to American Samoa can do so safely.” She also noted that the hotel is a quarantine site that “mostly houses Medicaid patients returning home” and mitigation measures are based on current US Centers for Disease Control and Prevention (CDC) guidelines for healthcare facilities.
Among the recommendations:
• Cooperation with HI-DOH contact tracing is required, as mandated by Hawaii State law.
• AS-DOH testing protocol should be in place for all clinical and non-clinical staff members that work at the quarantine site or each new repatriation event.
• Access to the quarantine site should be limited to clinical and essential support staff only - i.e. nurses, support staff, and security (which is provided by ASG-HI).
• Protocol for all staff members entering the quarantine site should include daily temperature and symptom checks and a sign-in sheet. This ensures that if exposure occurs, all close contracts can be easily identified and contacted.
• All staff members working at the quarantine site should be fully vaccinated.
• Rooms at the quarantine site should be limited to ASG staff members who are not residents of Hawai’i and the attending physician only.
• Designated break areas should be provided with best practices posted and social distancing clearly marked.
• Personal protective equipment worn during interaction with residents in quarantine should include masks, face shields, gowns and gloves
• Any person who is determined to be a close contact of a case will be quarantine for 14days
Also recommended by HI-DOH is for AS-DOH to develop a testing protocol for their clinical staff at the quarantine site that are determined to be close contacts and this should include testing and monitoring that is in-line with CDC guidelines.
“HI-DOH understands that ASG-HI and AS-DOH does not have additional nursing staff or essential support and that without their presence, 216 returning residents would be left unattended and without resources,” she wrote.
“Based on this, HI-DOH has agreed to allow clinic staff and essential support staff who we have determined to be close contacts of a case to continue working at the quarantine site,” she points out. “This means the attending physician, nurses and essential support staff that deliver food, and provide security.”
She recommends daily monitoring for symptoms should be conducted at the quarantine site, and all staff who were designated as close contacts by HI-DOH must wear masks and maintain at least 6 feet of distance from coworkers and residents at all times while at work.
However, masks are permitted to be removed only during lunch or other break times, and only in designated areas where quarantined individuals can be isolated from other staff and maintain at least 6 feet of physical distance from each other.
For those who are clinical and support staff at the quarantine site, after their shift is completed, HI-DOH will advise them that they are still in quarantine and they are required to follow current quarantine guidelines.
“Based on the level of exposure at the quarantine site, HI-DOH is recommending that quarantine for the returning residents be a full 14-days from the last date a positive case was on [quarantine] site, 05/17/21 through 05/31/21, and release and flight departure date be 06/01/21,” she said. “This will allow for additional testing.”
In conclusion she said informed Motusa that this “guidance is provided to ensure that all activities at the quarantine site are conducted to limit COVID-19 exposure and ensure the safety of all returning residents”.
PREVIOUS ASG STATEMENTS
Previous press statements by the COVID-19 Task Force regarding repatriation flight #5, made no mention of specific information and recommendations made in Kemble’s letter pertaining to ASG-HI and AS-DOH staff members in Honolulu.
The 5th repatriation flight was initially scheduled to arrive in the territory on May 28th. But on May 20th both the American Samoa Medicaid State Agency and the AS-DOH issued separate messages and postings on social media that, “In light of recent break-through variant positive cases in Honolulu” the flight was postponed to June 1st.
In a news release following its May 31st meeting, the task force made a last minute announcement that all passengers on the 5th repatriation were to undergo quarantine upon arrival.
According to the news release, after further review of the discharge plan and the discovery of two new positive COVID-19 cases at the Hawaii quarantine site over the weekend, the COVID Task Force scrapped the idea of sending fully vaccinated passengers home.
The two new positive COVID cases were discovered during a swab testing on May 28th.
They are called “breakthrough cases” which is the term to describe a small percentage of those that are fully vaccinated and still get COVID-19. According to the Centers for Disease Control and Prevention (CDC), breakthrough cases are expected because no vaccine is 100% but there is evidence that COVID-19 vaccines make the illness less severe for those that get the virus. (See Samoa News online June 1st for details of the task force press release)