One thing is crystal-clear as the state jumps from one public health investigation to the next, the latest being hepatitis A: The state Department of Health’s Disease Outbreak Control Division risks becoming overwhelmed by the challenges it faces.
On Monday, the DOH announced that its exhaustive investigation into the state’s worst hepatitis A outbreak in decades has led to the temporary shutdown of Genki Sushi restaurants that served suspected tainted frozen scallops.
While the public may feel a sense of relief that the likely source of the 168 confirmed cases has been identified, it likely won’t be long before state epidemiologists are tackling a new outbreak.
“If we’re in this new norm of outbreak after outbreak, we need more skilled staff and we need to resource them properly,” said state epidemiologist Dr. Sarah Park.
This seems obvious. Even though the state is not out of the woods with dengue fever, and the threat of the mosquito-borne Zika virus still looms large, nearly all resources were focused on hepatitis A.
DOH had dozens of workers involved in its hepatitis A probe — interviewing patients, churning out reports and analyzing data, among other duties. But there came a point during the investigation when Park realized there was more work than the department staff could handle, said Janice Okubo, DOH spokeswoman.
With resources stretched thin, the department requested help from the Centers for Disease Control and Prevention (CDC), which last week sent a team of experts in epidemiology and infectious diseases to assist in the DOH investigation. The department needed additional staff to pore over the rapidly growing pile of data more quickly, Okubo said.
DOH also needed to free up its staff to tackle other pressing issues, including working on plans to prevent Zika and dengue outbreaks, and to conduct the annual Stop Flu at School program, which has been delayed.
Some critics argue that the CDC should have been called sooner, long before the DOH staff was pushed to exhaustion.
They have a point, especially if the DOH staff remains at current numbers, about 50 people for a population of 1.3 million.
Any postmortem review of the hepatitis A investigation needs to address the timeliness of DOH’s call for help.
The first hepatitis A cases were reported in June. Park was pushing the CDC for extra help several days before a formal request letter was sent on Aug. 3.
“Everyone is an armchair epidemiologist,” said Park, who has grown weary of the second-guessing.
Park, a former CDC epidemic intelligence service officer, believes she called for CDC assistance at just the right time.
She noted the CDC staff is available to states for only two to three weeks. Her staff was already close to pinpointing the source, she said, which is the best time to bring on extra hands to handle the heavy volume of work that comes after the source is identified.
On Monday, the department announced it had shut down all 11 Genki Sushi restaurants on Oahu and Kauai. The restaurant chain had purchased scallops distributed by Koha Oriental Foods.
Because everything in each restaurant is subject to cross-contamination, the entire facility must be sanitized, said Peter Oshiro, DOH environmental health program manager.
Hepatitis A is difficult to track down. Symptoms of the viral ailment that affects the liver can appear many weeks after exposure, which made it all the more difficult for investigators to identify a common thread among cases. There are cases in which the source of hepatitis A outbreaks were never found.
More hands on deck would have been helpful, and it’s time the state takes a serious look at the division’s needs.
Focusing almost all the division’s resources on one outbreak leaves the state vulnerable to other problems — something Gov. David Ige and state lawmakers will need to consider in the coming legislative session, if not sooner.
“All I can do is just ask for the help and to keep asking and hope that some of the things I ask for will be rewarded,” Park said.
Moving forward, the DOH has requested that the CDC review its Zika response plan. That’s encouraging. As we’ve learned, the more proactive, the better.
