Hawaii’s unlicensed care homes represent a significant public health risk to our entire community because they are beyond the reach of our state Department of Health.

The outbreak of COVID-19 in a nursing home near Seattle was the first evidence that this virus is capable of causing real trouble. In the USA, 2.2 million people live in long-term care settings. These seniors are at heightened risk because of age and underlying health conditions. The Seattle facility was not prepared for the outbreak that overwhelmed it.

So far, the Centers for Disease Control and Prevention reported at least 129 COVID-19 cases linked to that facility: 81 residents, 34 staff members and 14 visitors. The total number of deaths linked to that outbreak was recently reported as 35.

The outbreak served as a warning to long-term care facilities nationwide to redouble their infection control efforts. Today it is unacceptable to be unprepared.

We need to take proactive precautions in Hawaii to assure the safety of the 12,300 residents in Hawaii care facilities. But there is a problem with that number — it does not include residents of the unknown number of unlicensed care homes with no oversight by the Department of Health.

It’s difficult if not impossible to know just how many there are. According to a news article, “We continue to see new unlicensed care homes opening at a rapid rate … ” (Star-Advertiser, Nov. 30, 2019). A new law giving DOH the power to enter and inspect these homes won’t help if they remain unknown to the state.

Each licensed operator is required to have an infection control plan. We don’t know whether the unlicensed care homes do or not. These homes may not have access to protective equipment. There’s no inspection. The caregivers may not be professionals. It’s a completely underground industry.

The state is unable to reach out to advise them on proper procedures and they cannot be monitored. Without inspections, violations of law may be rampant and safety precautions may be ignored.

Would these rogue operators be willing to call for COVID-19 testing if it meant they would be discovered? Would they arrange for hospitalization if residents became ill? Can they even isolate residents showing such early symptoms as fever or cough?

As happened in Seattle, there is a danger of community transmission through visitors, contractors or staff. An infection in a care home that is unregulated can endanger other facilities and the entire community.

The unlicensed care homes still operating in Hawaii represent a ticking time bomb that can blow up as community transmission increases over the next few weeks. An infected relative visiting or an infected staff member (often family of the operator) can not only endanger the health of the residents, but can start a chain reaction of infection in the community.

It is imperative that the Department of Health immediately redouble efforts to identify and close every one of the unlicensed care homes still in operation, safely moving residents to other placements. COVID-19 doesn’t tolerate half-way measures.

Larry Geller is president emeritus of Kokua Council, writing in his individual capacity.