Statewide, there were shockwaves on Friday when Gov. David Ige announced the state’s COVID-19 infection count that day had reached four digits for the first time. State Health Director Libby Char was asked, “How would you define a health care crisis? How close are we to that?”
She did not hesitate with her answer: We are there.
The 1,167 total included some that were missed previously during a delay in the state’s accounting. But that was no consolation to Char: The frightening total of 2,000 new cases over three days is enough to signal that the state already has entered the danger zone.
The bottom line is the ability of hospitals to provide care, and that was already at risk. A breakdown in the health-care system, she said, will be a disaster.
Hawaii truly is, as the director described, “on fire.” And as in any kind of five-alarm emergency, the correct response is to throw everything we have at the inferno.
Restrict gatherings. Enforce the wearing of masks indoors and in crowded places. Ramp up testing so that the infections are identified as early as possible. There could be other changes that should be weighed, including possible rollbacks in the Safe Travels Hawaii program.
But the most effective way to combat the latest surge in the pandemic, here and across the country, is getting many, many more people vaccinated. There are numerous ways to make this happen, but one of them has to be vaccine mandates.
There already are private employers who are imposing some form of mandate for their workers. Hawaii hospitals led on this, but there are other larger companies — Hawaiian and United Airlines, to name two — that are stepping up with vaccine requirements.
Most consequential of all, the state and counties have announced that public employees will be subject to a soft mandate, meaning that in most cases, workers will have the option to subject themselves to weekly testing instead.
Char said on Friday that the state is in the process of ramping up as much free testing as possible. Access to free or subsidized testing will be essential in giving employees a reasonable choice at the start.
The reality, though, is that federal subsidies for the tests and state funds are limited; so is the capacity of health insurance plans to cover them. Ensuring a healthy workplace for employees and the safety of the public they serve is the paramount concern, even if that means the worker must pay something for the test.
The workers’ union representatives are arguing that they should have been involved in crafting the details of the plan. Would remote work excuse an employee from vaccination and testing? How the vaccination exemptions for religious or medical reasons work?
A carefully negotiated agreement would be preferable, of course. But that’s practically impossible in the context of a fast-expanding public- health crisis, which this certainly is. Ige has said the individual agencies will need to work out what concessions are possible to fulfill their missions and workforce needs, and the unions should be involved in settling those issues.
But the priority needs to be on bringing more of the state and county workforce into the vaccinated fold, and Ige clearly had to act quickly, given that the virus waits for no one. Hawaii remains a long way from sufficient immunization, so action must be accelerated.
The vaccines are free, which should be a point of persuasion for the holdouts. Even more importantly, they are safe and offer good protection against even the ultra- infectious delta variant of the virus, according to the consensus of medical expertise.
And medical expertise counts heavily among the legal foundations of a vaccine mandate. They date at least to 1905, when the U.S. Supreme Court ruling in Jacobson v. Massachusetts upheld the state’s right to order compulsory vaccination.
The complaint in that case dealt with a smallpox vaccine. The court finding that constraints on freedom can be necessary for the “common good.”
In more recent years, the courts have sought ways to balance this state authority with reasonable exceptions; here, the state is positioned to offer some latitude.
If anything, local governments can find support in this effort from the private sector. Businesses have carefully weighed the pros and cons of vaccine mandates and, increasingly, are coming down hard in their favor. Big names such as Microsoft, Google and Disney are signing on, and lots of smaller businesses are poised to join them.
A mandate won’t work for every private setting, but where it does, the business calculation is based on the best outcome for workers, clientele — and, of course, the bottom line.
There are important issues, such as the qualifications for religious or medical exemptions, to be settled. But few businesses are arguing about the basic science here, which offers incontrovertible proof of the public-health peril in which Hawaii now finds itself.
The alarm bells are clanging, compelling us to put out the fire.