Maui Memorial Medical Center is dealing with a growing cluster of COVID-19-infected workers and increasing distrust among staff at the island’s only acute-care hospital.

A patient and three more health care workers have contracted the coronavirus at the Wailuku hospital, bringing the total number of cases to 19.

“These individuals are in good condition and are being isolated to prevent the spread of infection to others. We are working closely with federal, state and local public health agencies to notify all those who may have come in contact with these employees,” said Mike Rembis, CEO of Maui Health, which is affiliated with Kaiser Permanente.

Maui Health said 126 patients, caregivers and physicians were tested following the revelation of the state’s first cluster of coronavirus infections. So far it has received results for 24 individuals: four positives and 20 negatives.

Hawaii’s coronavirus death toll rose to eight Friday, including an older, medically fragile Honolulu woman and an elderly male in the chronic-care unit at Maui Memorial, which is investigating to determine if it is related to the hospital’s cluster of cases. Meanwhile, statewide cases climbed by 23 to 465.

“There’s nothing more important than the safety of our employees,” Rembis told the Honolulu Star-Advertiser, adding that he met with staff members throughout the facility Friday to ensure they had adequate supplies of personal protective equipment to keep them safe from infectious diseases.

Medical staff members were previously banned from wearing personal protective equipment unless caring for coronavirus patients, leaving them open to infection, and have faced shifting policies on the matter, adding to distrust of hospital management.

“I did sense apprehension, the same anxiety I feel in my community. People are worried. You can feel the fear and anxiety, which is human,” Rembis said. “We need to spend more time listening to them. The more we can let them talk, we can alleviate some of their fears, not about the workplace but COVID-19. They’re concerned about their families, about their kids. This is a tough time for us all.”

A registered nurse who asked not to be identified for fear of retribution said that initially management officials did not want workers to wear masks because they did not want to scare patients. They later changed the policy to allow staff to wear their own PPE, and following the outbreak, began issuing surgical masks daily to employees.

“This is a deadly disease and people should be afraid,” she said. “We’re so scared there. Why are we the last to find out about this cluster? What’s going on is terrible and it’s a travesty,” the nurse said. “We’re sacrificing our lives to care for the community. We could die from the disease ourselves, but we still show up to work every day so we can care for our community. At the same time, we are being mistreated by an administration that we can’t trust.”

Another Maui nurse who asked not to be identified said hospital officials have been “so stingy about PPE supplies they have us signing them out and forcing us to use them for several shifts.”

Josh Masslon, an ICU nurse since 2011, said he was reprimanded and threatened with termination for wearing his own N95 mask this week after being told by a manager to take it off because it wasn’t issued by Maui Memorial. Masslon posted his experience on social media and the hospital changed its policy, allowing him to wear the mask and return to work after just four hours.

“We have been so lucky in Hawaii to have a slow start to this so we can observe the mistakes other places have made and learn from those and we can observe what good actions mitigated spread,” he said. “Morale is low, people are worried. Because they’re rationing masks in light of the global pandemic … we can’t even give (patients) a mask. I had a patient the other day … I gave him a pillow case because it was the best thing I could do.”

Masslon said employees work in such tight quarters and cannot effectively adhere to social distancing rules.

He added there “isn’t a lot of faith in the leadership,” who have been “flip-flopping back and forth making up the rules as they go along.”

“It’s very frustrating. We have been fighting for weeks just to do what other facilities have been doing: PPE for all people,” he said. “In the facility’s defense, I could understand the need to ration N95s because people would steal, but they were rationing everything: the surgical masks, chemical wipes used to wipe down stethoscopes and badges. They’re rationing stuff we use to keep stuff clean. That’s why they had an outbreak, because they were rationing supplies.”

He added that the hospital is not testing all the staff because because managers are “afraid that everybody’s positive.”

Maui Memorial said it has been following guidelines of the Centers for Disease Control and Prevention regarding the use of protective gear during the pandemic and has quickly changed policies to align with the latest recommendations. The hospital is currently issuing masks to staff at the start of each shift and distributing additional masks if needed.

The hospital said it must ensure “every piece of safety equipment is suitable and appropriate,” including N95 masks that must be fit-tested. It is now allowing staff members to bring in their own masks, but requires them to use hospital-issued PPE in COVID-19 patient-care areas. It has also enhanced cleaning requirements and added temperature screenings for employees and visitors.

“On a somewhat basic level they are following CDC guidelines, but they really don’t seem to be taking the staff concerns into consideration,” said Aaron Bear, a registered nurse in the ICU for 11 years. “The administration seems to be a separate entity from the rest of us. (Employees) are fearful that the administration is not gonna do everything in their power to ensure our safety.”