Hawaii’s first cluster of health care workers infected with the novel coronavirus was discovered on Maui, which also reported its second death within days.

The outbreak among front-line workers at Maui Memorial Medical Center, which did not require use of personal protective equipment for all employees, is what state health officials have been dreading.

The virus has spread among at least 15 health care workers via patients or other employees and as many as 500 more people may have been in direct contact with the workers and are now at risk of contracting the disease. Eight of the 15 employees who tested positive for COVID-19 are connected to the oncology ward, where vulnerable cancer patients are at the highest risk of infection.

As health care workers battle an invisible enemy, the nightmare scenario has everyone on edge throughout the state’s medical facilities. After the Honolulu Star-Advertiser reported the hospital cluster, Maui Mayor Michael Victorino confirmed that employees at the facility, affiliated with Kaiser Permanente, were immediately sent home to self-isolate with plans to move them to a quarantine site away from their families.

A group of 25 doctors, medical assistants, nurse practitioners and volunteers with Premier Medical Group in Honolulu flew to Kahului on a complimentary Hawaiian Airlines flight Wednesday afternoon to do mass testing of hospital workers and set up drive-thru screening sites in Kahului, Lahaina and Hana over the next two days.

The concern is that employees being tested at the hospital will need to quarantine for 14 days, leaving a shortage of health care workers on the island.

“One of the problems was Maui Memorial not adhering to infection controls,” Health director Bruce Anderson said at a Senate briefing on COVID-19. “There’s no danger at this point of ceasing services, but obviously there’s a problem now in the process of identifying any staff that may have symptoms.”

The state Department of Health has not issued guidance on whether all health care workers should wear personal protective equipment, leaving it up to hospitals to decide when it is necessary.

Following the outbreak on Maui, DOH officials at odds with Lt. Gov. Josh Green and other community physicians, who called for more extensive testing, agreed to expand screenings statewide to all intimate contacts of coronavirus patients, regardless of whether they have symptoms. The Health Department previously argued that only people with symptoms should be tested, though new evidence suggests asymptomatic carriers can pass along the virus. People who are asymptomatic and not deemed close contacts of COVID-19 patients will still not be tested.

“Testing all asymptomatic individuals is not practical. It simply burns up supplies and staffing and has little value from a public health standpoint,” Anderson said. “It doesn’t make sense to just go out and test people. Testing doesn’t stop the spread of disease. Certainly it doesn’t change the course in terms of how persons are treated.”

Green acknowledged at the Senate briefing that testing has been a contentious issue.

“The feds in general told us to test people who are only symptomatic. I find that very problematic because we have multigenerational families,” he said. “The problem with just contact tracing people who are symptomatic leaves a large puka in what we find out.”

He added that the DOH has made mistakes in its policies and the Centers for Disease Control and Prevention “has failed us with testing, with kits and with a lot of their guidance.”

U.S. Rep. Tulsi Gabbard called for the resignation of Anderson and State Epidemiologist Sarah Park on Wednesday. Gabbard and Hawaii senators have admonished state officials for delays in airport screenings, traveler quarantines, the suspension of cruise ships, the issuance of stay-at-home orders, and policies on the wearing of masks and widespread testing.

“Every step of the way Dr. Park and Bruce Anderson have stubbornly resisted or delayed every action needed to contain and prevent the spread of coronavirus. Anderson and Park are either grossly out of touch or extremely negligent,” Gabbard said in a video on Twitter. “If Gov. Ige refuses to fire them then he should resign. Our lives and the lives of our loved ones are at stake.”

The state’s latest coronavirus fatality was a Maui man over age 65, unrelated to the cluster of cases at Maui Memorial. Total cases have risen by 25 to 435. A total of 113 patients have recovered since the start of the outbreak.

Of the 15,566 coronavirus tests so far conducted by state and clinical laboratories in the islands, 2.8% have been positive, DOH said.

The latest COVID-positive numbers include six crew members of the Pride of America cruise ship docked at Honolulu Harbor and two Hawaii National Guard personnel.

Still, Hawaii is not yet seeing the rapid peak health officials are anticipating.

“It is not clear that we’re out of the woods by any stretch of the imagination, but we have not seen an exponential spike,” Green said.