Beyond Recovery: Reopening Hawaiʻi A strategy to reopen and reshape Hawaii’s economy May 18, 2020 Safe Practices, Safe Results Shaka not handshake Wash your hands with soap and water for 20 seconds Stay home when sick PHYSICAL DISTANCING Wear a face covering and physical distance more than 6 feet For more information about State Department of Health Reopening Hawai‘i Safe Practices, see slide 20 40 + days of downward trajectory in new cases 90% total cases recovered, and hospitals have significant surge capacity Hawaiʻi has the lowest fatality rate in the country and one of the lowest case rates per capita of transmission May 18, 2020 2 Living with COVID-19 One (or more) of these outcomes will occur while we learn to live safely with COVID-19 May 18, 2020 Treatments and disease containment methods increase survivability and decrease pressure on hospitals Hawaiʻi population develops natural “herd immunity” to COVID-19 A vaccine is developed, and the population is immunized to a sufficient level (>60%) to confer “herd immunity” 3 Now, we need to continue supporting our people and our economy 60% increase in foodbank demand ~220,000 estimated unemployed Many local famers have lost their customers, their cash flow, and had to lay off workers. Some are in danger of shutting down, shutting down forever. Local Business 72% lower small business revenue over January 2020 May 18, 2020 Hawaiʻi Farm Bureau We have expenses…and no income! And no idea when sales will return to normal. We don’t know what to do. 4 Creating a Stronger and More Resilient Hawaiʻi, Beyond Recovery Save lives, prevent suffering Empower individuals with Safe Practices Reopen and reshape Hawaii’s economy May 18, 2020 5 State Roadmap to Recovery and Resilience Healing Hawaiʻi Phase 1: Stabilization STAY AT HOME (Major Disruption) SAFER AT HOME (Moderate Disruption) Kamaʻāina Economy Phase 2: Reopening ACT WITH CARE (Minor Disruption) Renew & Rebuild Phase 3: Stronger Hawaiʻi Phase 4: Resilience Long-term Recovery RECOVERY (Minimal Disruption) NEW NORMAL (No Disruption) Impact Levels informed by health, economic, and community-based indicators (Impact level may vary by County. Phase durations not to scale.) May 18, 2020 6 6 How We Move to the Next Impact Level STAY AT HOME (Major Disruption) Moving forward SAFER AT HOME (Moderate Disruption) ACT WITH CARE (Minor Disruption) RECOVERY (Minimal Disruption) NEW NORMAL (No Disruption) • Minimum of 14 days of observation between decision points before moving to the next impact level • Decisions to be made by Governor and Mayors, informed by subject matter experts Option to move back May 18, 2020 • Proactive prevention practices such as hand-washing, face coverings, and physical distancing greatly reduce the spread of COVID-19 and other diseases • Depending on health, economic, and community-based indicators, the Governor and Mayors may consider stricter response measures (Impact level may vary by County) 7 State Estimated Timeline for Reopening (Strategy will be implemented by County and is subject to change) • March 26 – May 6: Stay at home, work from home • May 7 – 15: Reopened agriculture (non-food), auto dealerships, car washes, pet grooming services, observatories and support facilities, retail and repair services, and shopping malls ACT WITH CARE (Minor Disruption) • June: Reopen indoor gathering places, indoor exercise facilities, museums, theaters, personal services, and restaurants for dining-in RECOVERY (Minimal Disruption) • To be determined: Reopen large venues, bars, clubs STAY AT HOME (Major Disruption) SAFER AT HOME (Moderate Disruption) NEW NORMAL (No Disruption) May 18, 2020 In all cases, businesses and operations must follow applicable CDC, industry and regulatory guidelines related to COVID-19 prior to opening. 8 State Reopening Strategy for Businesses and Operations May 18, 2020 (Strategy will be implemented by County and is subject to change) STAY AT HOME BUSINESSES & OPERATIONS (Major Disruption) SAFER AT HOME (Moderate Disruption) ACT WITH CARE (Minor Disruption) RECOVERY (Minimal Disruption) NEW NORMAL (No Disruption) Accommodations Agriculture, non-food Auto dealerships, car washes Childcare Education facilities (K-12, higher) Healthcare, social assistance, government Indoor gathering places, including places of worship Indoor exercise facilities, including gyms and fitness centers Large venues, bars, clubs Manufacturing, construction Museums, theaters Office settings Outdoor spaces Personal services Restaurants Retail & Repair Shopping malls Closed Essential only with physical distancing and Safe Practices Open with physical distancing and Safe Practices Open with adjusted Safe Practices Fully open with adjusted Safe Practices In all cases, businesses and operations must follow applicable CDC, industry and regulatory guidelines related to COVID-19 prior to opening. 9 Impacts to Daily Life from Stabilization to Resilience (Impact level may vary by County) Impact to Daily Life STAY AT HOME (Major Disruption) SAFER AT HOME (Moderate Disruption) ACT WITH CARE (Minor Disruption) RECOVERY (Minimal Disruption) NEW NORMAL (No Disruption) Follow recommended Safe Practices Face Coverings Stay at Home Stay at home except for essential activities No gatherings Gatherings High-risk populations* and kūpuna recommended to stay at home No gatherings over 10 and maintain >6ft physical distance Gatherings up to 50 and maintain >6ft physical distance High-risk populations and kūpuna exercise caution when in public Maintain >6ft physical distance *High-risk populations are currently defined by CDC as: persons 65 years of age and older; people of all ages with underlying medical conditions (particularly not well controlled), including people with chronic lung disease or moderate to severe asthma, people who have serious heart conditions, people who are immunocompromised, people with severe obesity, people with diabetes, people with chronic kidney disease undergoing dialysis, and people with liver disease; people who live in a nursing home or long-term care facility. May 18, 2020 10 11 Impact Level: Stay at Home (May vary by County) STAY AT HOME (Major Disruption) SAFER AT HOME (Moderate Disruption) ACT WITH CARE (Minor Disruption) RECOVERY (Minimal Disruption) NEW NORMAL (No Disruption) Health Description • Cases surging and/or increasing • Risk of insufficient testing, hospital capacity, and/or contact tracing What this means for the people of Hawaiʻi • Essential businesses open • "Stay at Home" for all non-essential workers • Mandatory 14-day quarantine for out-of-state and interisland travelers What other states are doing • 42 states + D.C. and Puerto Rico issued Stay at Home order in March 2020 May 18, 2020 11 12 Impact Level: Safer at Home (May vary by County) STAY AT HOME (Major Disruption) SAFER AT HOME (Moderate Disruption) ACT WITH CARE (Minor Disruption) RECOVERY (Minimal Disruption) NEW NORMAL (No Disruption) Health Description • New cases occur, but overall trend decreasing • Near maximum capacity for testing, hospital capacity, and/or contact tracing What this means for the people of Hawaiʻi • Low-risk businesses and operations allowed to reopen with CDC guidelines and industry standards related to COVID-19 • Transition from "Stay at Home" to “Act with Care" where high-risk populations and kūpuna advised to continue staying home What other states are doing • 41 states have partially reopened or plan to reopen soon, as of May 2020 May 18, 2020 12 Impact Level: Act with Care (May vary by County) STAY AT HOME (Major Disruption) SAFER AT HOME (Moderate Disruption) ACT WITH CARE (Minor Disruption) RECOVERY (Minimal Disruption) NEW NORMAL (No Disruption) Health Description • New cases and/or clusters are manageable within system capacity • Improved capacity utilization for testing, hospitals, contact tracing What this means for the people of Hawaiʻi • Start with reopening of medium-risk businesses and operations, then move to high-risk businesses and operations based on indicators • High-risk populations and kūpuna should continue to stay at home when possible What other states are doing • When cases are "clearly declining," several states plan to open higher-risk businesses, with continued telework where possible May 18, 2020 13 14 Impact Level: Recovery (May vary by County) STAY AT HOME (Major Disruption) SAFER AT HOME (Moderate Disruption) ACT WITH CARE (Minor Disruption) RECOVERY (Minimal Disruption) NEW NORMAL (No Disruption) Health Description • New cases indicate sporadic activity • Optimized capacity utilization for testing, hospitals, contact tracing What this means for the people of Hawaiʻi • Highest-risk businesses and operations can reopen • High-risk populations and kūpuna continue to stay at home when possible What other states are doing • Most states plan for highest-risk business to reopen when testing and hospital capacity allows for control of disease clusters May 18, 2020 14 15 Impact Level: New Normal (May vary by County) STAY AT HOME (Major Disruption) SAFER AT HOME (Moderate Disruption) ACT WITH CARE (Minor Disruption) RECOVERY (Minimal Disruption) NEW NORMAL (No Disruption) Health Description • Treatment and/or natural "herd immunity" and/or vaccine What this means for the people of Hawaiʻi • Large social gatherings without limitation • High-risk populations and kūpuna exercise caution when in public What other states are doing • Most states have articulated that "new normal" will be possible when outcomes are met such as: treatment and/or natural "herd immunity" and/or vaccine May 18, 2020 15 Public Health Pillars to Ensure Community Safety Detection Prevention     Safe Practices Stay at Home Traveler quarantine Vaccines May 18, 2020      Safe Practices Disease surveillance Testing Diagnosis Disease reporting Treatment Containment  Safe Practices  Investigate, isolate and monitor cases  Trace, quarantine, monitor and test close contacts       Safe Practices Clinical care Treatments Symptom management Convalescence & rehabilitation Life support 16 Next steps to ensure the safe reopening of Hawaiʻi Participate in community dialogue to discover ways for businesses to operate safely, while renewing consumer confidence Monitor public health metrics to inform decision making that ensures the safety of the people of Hawaiʻi Identify and accomplish real-time priorities toward Hawaii’s resilient future May 18, 2020 17 Partnerships May 18, 2020 Hawaiʻi Emergency Management Agency Hawaiʻi Office of Planning Hawaiʻi Department of Health Hawaiʻi Office of Homeland Security Hawaiʻi National Guard Hawaiʻi Department of Business, Economic Development and Tourism Hawaiʻi COVID-19 Public Health Recovery Task Force Economic and Community Recovery Navigator with State & County Policy Leaders, FEMA Hawaiʻi Long-term Recovery Office, and Private Sector Stakeholders 18 State of Hawaiʻi COVID-19 Resources: State Department of Health COVID-19 Website Please visit hawaiicovid19.com State Department of Labor COVID-19 Website Please visit labor.hawaii.gov/covid-19-labor-faqs State Department of Human Services COVID-19 Website Please visit humanservices.hawaii.gov/ State Department of Transportation - Airports COVID-19 Website Please visit hdot.hawaii.gov/coronavirus Economic and Community Navigator Website Please visit recoverynavigator.hawaii.gov FEMA Public Assistance (PA) Program via HI-EMA Website For Questions about COVID-19 Exemptions To Volunteer Ideas or Resources to Assist in the Response Effort May 18, 2020 Please visit dod.hawaii.gov/hiema/rpa-covid-19/ Email CovidExemption@Hawaii.gov Email CovidKokua@Hawaii.gov Mahalo! 19 May 18, 2020 ACTION State Department of Health Reopening Hawai‘i Safe Practices DESCRIPTION Hand Hygiene Hand washing and/or 60% hand sanitizer facilities available in work and public settings for use by employees and the public Home if Ill Stay home if ill (except to seek care—call first) Face Covering Cloth face coverings worn at all times by employees and public when outside the home (except solo exercising), including when in transit other than personal vehicle Surface Cleaning Regular cleaning/disinfection of surfaces and objects touched by the public and employees Physical Distance Maintain 6 feet distance between ALL individuals to the fullest extent possible Protect High Risk Limited in-person visits to nursing homes, hospitals, congregate facilities. Those at higher risk for severe illness advised to minimize time and activities outside the household. Isolation Isolation of cases either in home or in facility, under DOH monitoring & direction Quarantine Quarantine of contacts of cases either in home or facility, under DOH monitoring & direction The guidelines serve as a baseline for safe practices. Industry-specific higher standards of safety and protection, such as those issued by OSHA, NIOSH, CDC, and Industry organizations, shall be observed as well. These guidelines apply to public-facing workplaces as well as to break rooms, mealtimes, and employee locker rooms. These guidelines are subject to change. 20 COVID-19 Health-based Community Response IMPACT DISEASE ACTIVITY Severity STAY AT HOME (MAJOR DISRUPTION) SAFER AT HOME (MODERATE DISRUPTION) ACT WITH CARE (MINOR DISTRUPTION) RECOVERY (MINIMAL DISRUPTION) NEW NORMAL (NO DISRUPTION) RESPONSE HEALTH DETERMINANTS Prevalence CAPACITY Healthcare Supply Contact Tracing Diagnostic Testing Number of new hospital cases threatens hospital capacity Median number of new cases per day per week indicates uncontrolled community spread Surge/crisis plans deployed and hospital capacity maxed out Max capacity of contact tracing is below the number of new cases/close contacts per day Max capacity of testing is below the number of new cases/close contacts per day • Safe Practices • Essential activities and their support services • Prepare to resume low-risk activities Number of new hospital cases requires consideration of hospital surge/crisis plans Median number of new cases per day per week indicates controlled community spread Surge/crisis plans considered and hospitals can increase capacity by at least 10% within 5 days 80‐100% of max capacity of contact tracing would be reached at current rate of new cases/close contacts per day 80‐100% of max capacity of testing would be reached at current rate of new cases/close contacts per day • Continue above • Resume low-risk activities • Prepare to resume medium to high-risk activities Number of new hospital cases requires preparation of hospital surge/crisis plans Median number of new cases per day per week indicates local, controlled clusters Surge/crisis plans in preparation and hospitals can increase capacity by at least 25% within 5 days 50‐80% of max capacity of contact tracing would be reached at current rate of new cases/close contacts per day 50‐80% of max capacity of testing would be reached at current rate of new cases/close contacts per day Median number of new cases per day per week indicates sporadic activity Surge/crisis plans in place and hospitals can increase capacity by at least 50% within 5 days <50% of max capacity of contact tracing would be reached at current rate of new cases/close contacts per day <50% of max capacity of testing would be reached at current rate of new cases/close contacts per day Number of new hospital cases is managed within normal hospital capacity • • • Continue above Start with mediumrisk activities; then move to high-risk activities Prepare to resume highest risk activities • Continue above • Resume highest-risk activities • Continue above • Adjust Safe Practices to new normal 21 References: American Enterprise Institute. 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