Hawaii is bracing for 50,000 to 70,000 cases of flu this year, but a surge in influenza is being complicated by fears of the coronavirus.

As patients inundate emergency rooms and hospitals with more cases of the flu, many are also worried about contracting the deadly coronavirus sweeping across the globe.

“I’ve seen more flu this year than any year in the last 10 years. Obviously on their minds is if there’s any possibility that they have contracted coronavirus. Each and everyone needed reassurance,” said Lt. Gov. Josh Green, an emergency room doctor on Hawaii island who treated about a dozen patients for the flu last weekend. “There is an obvious psychological component to the flu this year complicated by the coronavirus. None of our Hawaii residents have had coronavirus, but it’s still a very real thing on people’s minds.”

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While the U.S. has already seen 22 million influenza cases in the four months since flu season began, only about three dozen Americans have been reported to have the new coronavirus. One in 1,000 people typically die of the flu.

“That’s not an insignificant number at all. That’s thousands of people that have died from the flu. That’s 50 to 70 people who could die from complications of flu in Hawaii each year alone,” Green said. “Of course coronavirus is killing 25 people out of 1,000. It’s much more lethal, but you still have to be super mindful of the flu because so many people get it.”

The peak of flu season comes as health officials trace the steps of a Japanese couple who tested positive for COVID-19 after traveling to Hawaii Jan. 28 to Feb. 6 to identify anyone who may have been exposed to the virus. To date, the Department of Health has found no indication of transmission and insists Feb. 20 was the last day anyone exposed to the pair would have developed symptoms.

Local monitoring

Still, officials are monitoring 69 individuals — 59 on Oahu, eight on the Big Island and two on Maui — who traveled to China within the past 14 days. A man who traveled to Hubei province, the epicenter of the outbreak, was released Saturday from quarantine at Joint Base Pearl Harbor-Hickam. None have been tested for the coronavirus because they have not exhibited flu-like symptoms, including cough and shortness of breath, but the state is scrambling to get kits to test for the virus locally.

“Sooner or later we, like Japan or South Korea or Hong Kong who have few to no cases, will have to check people,” Green said. “Because of the flu season and because of the lack of testing we feel vulnerable as health care providers that we can’t give people all that they need. We don’t want people walking around thinking they are the needle in the haystack.”

Kapahulu resident Joy McGee could barely get out of bed last week with fever, severe body aches, congestion and coughing that lasted about 10 days. She is recovering from what she describes as the worst virus she’s had in years. While she was not actually tested for the flu, her doctor said her symptoms matched that of influenza.

“This is the sickest I’ve ever been in years. I’m still struggling with fatigue. It wiped me out for close to two weeks,” she said. McGee, who’s husband also caught the virus that has kept him out of work for 12 days, said she did not leave her house for eight days until finally seeing a doctor when her condition wasn’t improving. “It was so bad that we asked our daughters not to come to our house. We had minimal, minimal, minimal contact with anyone because we were so fearful of it spreading. It just makes people realize that the flu is a lot more deadly than anyone really believes. Everyone kind of downplays the flu.”

After her bout with what appeared to be a more severe flu than in years past, the thought that people in the community may have been exposed to the coronavirus is worrisome, she said. Both viruses have the exact same symptoms and is transmitted the same way — through airborne droplets when coughing or sneezing.

“We don’t know where they went, where they ate, where they slept. How many people they really came into contact with. I mean all of that has to be considered,” McGee said. “The scary part about that is we’re confined to an island. Maybe that’s a good thing so another deadly virus wouldn’t spread even bigger. But it’s such close quarters, to me it could spread faster.”

The flu is running rampant at local health care facilities. At least one day last week a handful of hospitals were diverting ambulances because they were overwhelmed beyond capacity.

Dr. Julius Pham, interim chief quality officer at The Queen’s Health Systems, said the emergency room at The Queen’s Medical Center treated around 44 cases of flu per week in the last month, compared to an average 36 at the same time last year.

What’s more, Queen’s has seen a nearly 40 percent increase in the number of hospitalized patients with influenza. About 120 patients have been hospitalized since the season began, compared to 88 patients during the same period last year.

“We’re at a very high level. We’re seeing a lot of very sick patients with influenza. I don’t know if we’ve peaked,” he said, adding that the hospital was at over 100 percent capacity at least one day last week. “We were holding so many patients in the emergency department because both the hospital and emergency department were full. When we …. divert (patients) as the state’s largest hospital, then the other hospitals quickly go on divert too because they can’t handle the load either.”

Although the hospital is seeing a significant number of patients with influenza, “the scare in the community is more around coronavirus,” he said.

“They have much more to be concerned about influenza than coronavirus. We’re seeing a lot more illness and morbidity … based upon influenza. The good news is everything they would do to protect themselves from coronavirus would help with flu too,” Pham said. “In any case, we’re glad people have a heightened awareness of respiratory illness and contamination.”

Regional influenza

Hawaii is only one of three states that is considered to have regional — instead of widespread — influenza, though it is reporting a high level of flu in the community, according to the Centers for Disease Control and Prevention. Since flu season started in October, 29.4 percent of 16,627 residents tested positive, according to the latest DOH influenza surveillance report from Jan. 26 to Feb. 1. An estimated 227 of the 3,831 deaths in Hawaii were related to pneumonia or influenza, statistics show. The Health Department didn’t provide year-over-year comparison data.

“The problem is because everybody’s worried about coronavirus there’s a lot more testing going on. We got an awful lot of people worried about being sick right now. It’s a very confusing situation,” said Dr. Melinda Ashton, chief quality officer for Hawaii Pacific Health, parent company of Kapiolani Medical Center for Women & Children, Pali Momi Medical Center, Straub Medical Center and Wilcox Health on Kauai. “It’s on everybody’s mind, but the flu is really what’s making people sick. Right now we have no coronavirus passing around in our community. I don’t think it would stay hidden for long because patients who get significantly ill would end up in the hospital then we would begin looking at the likelihood or possibility they’ve been exposed.”

Green added that if the coronavirus were to hit Hawaii with the same prevalence as the flu, “it would be catastrophic.”

“If we had a full outbreak of coronavirus … like they had in China, it would completely overwhelm the health care system,” he said. “Even a handful of coronavirus cases means a lot of people get hospitalized. We have to be mindful to not let it happen … but first things first, keep people from getting the flu.”

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HOW TO STAY HEALTHY

>> Wash hands often with soap and water for at least 20 seconds or use an alcohol-based hand sanitizer.

>> Avoid touching the eyes, nose and mouth with unwashed hands.

>> Keep away from sick people.

>> Stay home when ill.

>> Cover coughs and sneezes with tissue.

>> Clean and disinfect frequently touched objects and surfaces.

Source: Centers for Disease Control and Prevention

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HOW VIRUSES ARE SPREAD

>> Through coughing and sneezing.

>> Close personal contact, such as touching or shaking hands.

>> Touching an object or surface with the virus, then touching your mouth, nose, or eyes before washing your hands.

>> Going to work, school, or running errands when sick.

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INFLUENZA

Illness usually comes on suddenly, bringing with it some or all of these symptoms:

>> Possible fever or feeling feverish/chills

>> Cough

>> Sore throat

>> Runny or stuffy nose

>> Muscle or body aches

>> Headaches

>> Fatigue (tiredness)

>> Vomiting and diarrhea, though more common in children than adults.

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COVID-19

Reported illnesses have ranged from mild symptoms to severe illness and death and can include:

>> Fever

>> Cough

>> Shortness of breath

>> Difficulty breathing

>> Severe Illness

The Centers for Disease Control has said symptoms may appear in as few as two days or as long as 14 days after exposure.