Dr. Scott Hoskinson

PH Just to introduce myself, today we have myself as the interviewer, Stephen Pono Hicks, and I'm here today with Dr. Scott Hoskinson. So thank you for your time, Scott. And today is November 9th, 2021. The time is 10:02 a.m. And we're doing an oral history interview over Zoom to talk about your life and specifically your experiences during the time of COVID-19. So just for the record, can you please state your full name?

SH Sure, it's Scott Dallas Hoskinson.

PH Thank you. And can you tell me where you were born?

SH Yeah. Missoula, Montana.

PH Ok. Who are your parents and where are they from?

SH Yeah, my dad was William S. Hoskinson, and he's from Big Timber Montana, but lived on Maui for years and years. And my mother was Gertrude Hoskinson. And again, born in Big Timber Montana but lived on Maui for years.

PH What did your parents do during their lifetime? What were their occupations?

SH Yeah, my father had a number of occupations, but my father ultimately was trained in medicine and specialized in OBGYN or obstetrics and gynecology. And he actually moved to Maui in 1971 and was there for the remainder of his career, some thirty years on Maui as one of the first OBGYN people there. My mom was a chemist actually by profession and trained in college as a chemist with a degree in chemistry and worked for several years in that profession. And then, of course, was married to my father and traveled to Maui with him and ultimately kind of ended up for years and years as his office manager for his private practice on Maui.

PH Your father was an OBGYN. Where was he based on Maui?

SH He was based in Kahului on Maui.

PH Can you talk about your ancestors, both on your father and mother's side a little bit?

SH Yeah. My mother's side is pretty interesting. My mother's father and mother, my grandfather and my grandmother on that side were immigrants from Norway, and they actually immigrated from a small town in kind of southern Norway to Montana, basically that Big Timber area that my mother was born in. My grandfather was actually a sheep herder when he first came over. And my grandmother was kind of an organizer of the house, housekeeper if you will, but actually worked for a number of years in one of the local restaurants there as a waitress. So kind of colorful history of the two of them immigrating from Norway and starting a family. Ultimately, my grandfather was able to buy a ranch in the Big Timber area and spend the duration of his life, ranching in the Big Timber area. My father's father and mother actually were there in Big Timber Montana. My grandfather on the father's side was a teacher in vocational agriculture there for the local high school, and my grandmother died at a very early age of complications, rheumatic heart disease. But my Hoskinson side of the family moved up from Missouri a number of generations ago, kind of coming across even some of them in covered wagon, if you can believe it ,across the mainland, the United States to settle ultimately in Montana kind of on homestead land and then ultimately ended up, my grandfather in Big Timber as a teacher. That's kind of the ancestry there.

PH Okay. And where have you lived during your lifetime?

SH Yeah. So I was born in Missoula, but lived there very, very short period of time. My father went to Portland, Oregon, for medical school and I lived there with him, obviously for that period of time, and then moved to the canal zone, Panama Canal Zone for training in OBGYN and ultimately back to "nowhere" Eastern Montana, Miles City, Montana for about eight years when my father got very tired of the cold and the snow, and wanted to return to the tropics, which he had in the Panama Canal Zone. So he looked for a position and ended up on Maui with Kaiser for a year if you can believe that and then decided to go out in private practice. And actually was in private practice for about 30 years from 1971 through like 1996. And he really was one of the first OBGYN doctors there on the island of Maui.

PH So you mentioned Panama. Do you have any memories of living there or adjusting to that life?

SH Yeah, no, I don't really. I was 4-8 years of age, and so I don't have very many memories at all of living in Panama. A little bit more memories of living in eastern Montana because I left there, you know, basically as a sophomore in high school and came to Maui with my father in 1971 and graduated ultimately from Baldwin High School. So some memories of Eastern Montana, but a lot more memories of Maui, obviously, since kind of grew up on Maui.

PH So you mentioned graduating from Baldwin High School. What did you pursue after high school? Can you talk about your education a little bit?

SH Yeah, you bet. From high school, I went back to Montana to Montana State University for training, and actually, I was really interested in plants, and I ended up with a major in botany. I did take the necessary number of courses to have a minor in pre-med just so you could fulfill those qualifications, and I don't know. I was always kind of interested in medicine since my father was in medicine. And of course, I really liked biology and physiology, so medicine was kind of a natural choice. And I had the chance after I graduated from college, I applied to the medical school, John A. Burns School of Medicine in Honolulu and ultimately was accepted there, and I moved back to Honolulu and spent four years in Honolulu going to medical school. And after graduation there, I went back to the mainland to Denver, Colorado, to complete a residency in internal medicine. And I took about four years and after that, I moved to Albuquerque, New Mexico to specialize in infectious diseases, which took another two year period of time. So that's kind of where I lived, and ultimately, my wife and I moved back to Maui since she was born and raised there. And of course, I'd been there for years and we had two children by that time, and we really wanted to raise our children back there and our family, both my side and her side were back there, so we moved back to Maui in 1988, and were there for 30 plus years.

PH I'm curious, was the educational and career track that you kind of followed on the mainland... Did you always sort of know that you wanted to go back to Maui, eventually?

SH Yeah, it was kind of always that plan that we wanted to go back to Maui, you know, since she was born and raised there and her family was there, my family was there and the community, of course, still is as a matter of fact, Pono, the community is wide open for doctors. There's always a huge need for doctors on the neighbor islands. So I always really planned on going back to Maui to practice medicine.

PH And you talked about your background in medicine and some of the positions that you've held, so I guess we can just go ahead and get into some of the COVID-19 questions. Can you first as an expert in infectious disease just state for the record, what is COVID-19?

SH Yeah, COVID-19 is, you know, too bad it's such a horrible disease because it's actually really interesting. So, you know, COVID is actually the disease, which is caused by the severe acute respiratory syndrome Coronavirus two. So it's actually the disease caused by the virus, and it was named severe acute respiratory syndrome Coronavirus two to distinguish it from the original Coronavirus, which was a SARS severe acute respiratory syndrome outbreak around 2000, 2001 or so. And that was really the original Coronavirus. And luckily, at that time, that epidemic was fairly easy to end. I mean, basically, with just some basic infection control techniques and stuff, that infection was well controlled and didn't get a chance to spread anywhere near as bad as the Coronavirus two has. It also distinguishes it from the Middle Eastern respiratory syndrome, which is caused by a Coronavirus, also. And all three of those coronaviruses are closely related to each other. But anyway, the SARS coronavirus two is the cause of the disease COVID-19, which is a respiratory tract disease. And unfortunately, as everybody knows, that respiratory tract disease can become very severe, resulting in severe pneumonia, respiratory failure, total organ system failure and death in a number of people. So it's been a very damaging virus, and unfortunately, Coronaviruses are with us and have been with us for years and years and years and years and years. But most Coronaviruses just kind of cause the common cold with the usual sore throat, stuffy nose and mild temperature elevation. And they've been around bugging us for years. But this particular Coronavirus is much more virulent than the other Coronaviruses that we've encountered. In addition, unfortunately, us humans really haven't had experience with this specific virus, which means our immune system has not seen this virus before and then leaves us wide open for infection because we don't have any natural defenses against it.

PH I appreciate you sharing your professional, medical understanding of the disease. Could you talk about when you became aware of COVID-19 and maybe when you became concerned it could threaten Hawaii?

SH Yeah, you know, we were all reading. I mean, we all were aware in the end of December 2019 that there was a new virus that was basically in the Wuhan province of China. And we didn't think that much about it because it was a very novel respiratory virus that seemed to be very far away. We were very confident of our public health system and we kind of thought, especially with our experience with the original SARS, the original Coronavirus, that we would just have to apply a few infection control techniques as we had previously. And this virus would not be a big problem for us. So when it kind of popped up in Washington state with the first case described there and treated in the hospital and then up in California and stuff, I didn't think too much about it but began to worry about it when a significant number of people in California are becoming sick. And then of course, across the mainland you started seeing a ton of people with Coronavirus. And it was obvious by that time in late January and February that this virus was much more widely spread than we could possibly have imagined and that it entered the mainland United States and possibly even Hawaii way before anybody even thought it had. So probably sometime around the end of January, beginning in February I was pretty concerned about the virus and about Hawaii and about Maui. Just because we, as you well know, have thousands and thousands of people on all of the islands of Hawaii and Maui in particular, any given day. And they come from everywhere in the world. And of course, we have a huge traveler base from the west coast and I was going like, Holy Moly, we have no idea what's really going on, we don't really have any good testing for this, and we have no idea how many people actually have this virus or how widespread it truly is. So I was pretty concerned about that time. And public health, unfortunately in hindsight, we were way behind the ball game for this Coronavirus and we really did not have the testing and CDC did not do a good job of putting out a good test. We did not have widely disseminated testing, such as someplace like South Korea and China did. And we had no idea how many people were truly infected, so not good. Probably worried about Maui sometime around the end of January, beginning of February, and started really getting excited in March when it was outbreaking all over the mainland.

PH And when COVID arrived on Maui, can you just fill us in on what you were doing at that time at the hospital or what your position was and maybe how that evolved and how your hospital changed or shifted to respond to the virus?

SH Yeah, I was working at the hospital as an infectious disease consultant. I was also Hospital's internal medicine, but I also was very involved with infection control. And prior to Coronavirus, infection control was kind of almost on autopilot. I mean, we had all the parameters that we knew we were supposed to be monitoring and we knew what infectious diseases we were supposed to be looking for. We knew what kind of isolation techniques each one of them had. Tuberculosis had to do this and that. So we knew, kind of had it all written down and all of our policy was developed and we knew exactly how to contend with each infectious disease that we ran into. And along came the COVID-19, and we really had no idea exactly what we were supposed to do with that virus, and we certainly weren't alone with that. Across the entire United States nobody knew exactly what the infection control policy should be for that virus. So once we started seeing cases on Maui and once people in Hawaii started seeing cases, we in infection control we're trying desperately to figure out what sort of policy we should have for these patients and also, more importantly, for everybody that was suspected of having COVID. And that was very stressful for infection control at that time. We really had to rewrite a whole number of policies. And the problem was that the Center for Disease Control and scientists across the world really had no idea exactly how that virus was spread. And everybody was learning week by week how that virus was spread from person to person and what kind of techniques might be a good idea. So we basically started implementing controls in infection control based on CDC information. But the information changed every week. As it turned out, we didn't really have the equipment to try to keep up with all the recommendations. And now I'm speaking specifically of all our personal protective equipment and stuff. We just did not have the supplies on hand to try to contend with that, which left us in a really poor position because we ended up having to try to ration our personal protective equipment and our rooms in the hospital. I mean, you couldn't literally take every patient you thought might have COVID and put them in a private room in complete isolation because you didn't have that many rooms at Maui Memorial to do that. In addition, we did not have the necessary N95 masks, gloves and gowns and so forth to basically use those on every patient all the time. So it was very difficult in infection control to try to figure out the rationing of rooms and rationing equipment and how we were supposed to isolate these people.

PH And you talked about PPE, can you share just how you tried to extend the life of some of those supplies and budget them as effectively as possible?

SH Yeah, it was very difficult, Pono. We kind of stumbled down the line. At the end of February beginning of March, across the nation everybody ran out of personal protective equipment, particularly masks but even gloves and gowns. It was really hard. It was really difficult for all of our health care workers and for us because we were unsure as to when we should really try to use our best equipment and when we could use less equipment. And we had multiple debates and angry health care workers about the use of that equipment. And it finally came down to the fact that we just didn't have enough N95 masks to use them all the time, and we had to acquire equipment much as everybody else did across the nation to try to reprocess our N95s. In addition, we had to buy reusable gowns and figure out how to reprocess those reusable gowns, too. And so not only did we have to reprocess N95s, we had to decide who was going to wear an N95 and when they were going to wear it. And then once we decided who and when they were going to wear it, we had to decide how many times they were going to wear the N95 mask. Could they do it one day? Could they do it three days? Could they do it five days in a row? And then after those number of days, we would then take the mask to reprocess it. It was very difficult policy. In addition, again, everybody was learning week by week and nobody knew exactly how good any given N95 mask was. Was it ruined after you sneezed in it? Was it ruined after some patient coughed on you. Could you still reprocess? Was it ruined when you got makeup on it? It was just a disaster trying to figure out what to do and then trying to translate that into policy and then trying to tell all the poor health care workers, all the nurses and the respiratory therapists and the radiology people, everybody, you know, this is how we're going to try to use it this week. And this is what you need to do with reprocessing. This is the sack you have to carry it around in and this is what you do to it when you go to lunch, this is what you do to it when you come back from lunch. I mean, it was a mess, Pono, just a mess. And the biggest problem with that was we just didn't have an adequate supply, particularly of the higher level masks, such as the N95. And that wasn't unique to us at Maui Memorial that was across the nation. Had we had an endless supply of N95, kind of what's flowing now, it would have been really easy because you just... Like tuberculosis, previously, we used an N95 mask one time. Period. And then disposed of it. So we'd use it one shift or one visit and then dispose of it. That was impossible in March, April, May, June, July, August of 2020 because we didn't have that kind of supply. So it was very difficult.

PH Yeah, I can only imagine. Wow. You talked about some of the difficulty of writing policies and guidelines and instructing health care workers, for example, on how they can use their PPE, proper disposal and reusal of that kind of equipment and also waiting on the CDC and following those guidelines. Were there times when you just sort of had to make executive decisions about certain policies? Maybe you couldn't wait on like a central source of information like the CDC and you just kind of had to go with your best understanding?

SH Right. Pono, there were times... It was really hard because everybody was busy reading, including all the nurses and everybody else, and everybody had an opinion on how we should be using our personal protective equipment and where we should be using it and when we should be using it. And we actually had to kind of move ahead with policy the best we could. Our nurses were very important, they were very frightened as you can imagine. It was a significant life-threatening disease to themselves and their family. We kind of had to move ahead and begin using our N95 supply and stuff earlier than the CDC actually put out any formal recommendations for that, simply because our health care workers were terrified and had read many things online, which this whole epidemic has been about reading online, but basically, they'd read many things online and everybody had an opinion on how this virus might be spread. The CDC was very conservative to begin with and kind of treated it like the original SARS, which was kind of a droplet thing where only large droplets and close contact were the way that the virus is being spread. As it turns out, unfortunately, the virus is probably spread much more easily than that. So we had to move ahead with our policy kind of ahead of a number of CDC guidelines. So kind of at the gunpoint of our staff.and As it turned out, they were right, too. But it was a very hard thing to do because the administration was busy trying to figure out what they were going to do when they ran out of everything, which you might remember, a number of hospitals across the mainland did run out of everything, and were using scarves and sheets and all kinds of stuff. And we just didn't want to end up in a situation where we had absolutely nothing left to protect our health care workers with. Yet, they all were demanding that they would get the best possible to defend themselves against the virus and the lack of knowledge that we had and the lack of guidance from the CDC at that time.

PH Yeah. You talked a little bit about some of the stresses that the health care workers were facing, but can you just speak maybe a little bit more to that? What were some of the common stresses and challenges that they face day to day that you observed during the pandemic?

SH It was and it still is an extremely stressful time for health care workers. I mean, the people admitted to the hospital, both those suspected of having the Coronavirus infection and those that actually have the Coronavirus infection were very... They required very intensive hands-on care by the staff. And to go into these rooms, you literally had to gown up, you had to glove up. You had to put the appropriate mask on, which oftentimes was an N95 mask. To get out of the room, you had to actually have somebody observe you to put on all that personal protective gear correctly, including eye protection with a mask or goggles. And then you had to have somebody watch you when you came out of the room to make sure that you properly took off all of that equipment in the proper order so that you didn't contaminate yourself taking off the equipment if the patient had sprayed you with droplets or whatever else. So you can imagine nurses and others trying to care for these patients how intensive it was to try to do this dressing and undressing every time that you went to care for these people, you know, just a huge amount of work just getting into a room and getting out of the room. In addition to that, I mean, nobody knew for sure exactly how that virus was being spread and how protective our equipment actually was. So they were terrified for themselves. They knew. They'd watched patients die before them with this Coronavirus. They were terrified for themselves, and they were especially terrified for their family members since they thought that they would potentially bring this virus home to their spouses and their kids and their mother and their dad, and on and on like that. So it was tremendously stressful. Not only that, then of course, we had staffing shortages, as did everybody with this type of intensive care. And so a lot of people ended up working overtime. It was amazingly stressful for health care workers, and they read all kinds of things online that just, you know, scared them more and more.

PH Yeah, I can imagine that exacerbated things. And you personally as well had contact and consultation with patients. Is that right?

SH Correct. No doubt about it. Yeah, that was kind of weird. Kind of like actually all of us health care workers, you know, we were kind of like quarantined from our family. My children were grown and on the mainland, so I didn't have kids to worry about, but my wife was at home. So in the first few months of the epidemic when we really had no idea exactly what was going on, we literally... I had to sleep in a separate bedroom. I wore a mask for two or three months around the house. I had to wash my clothes separately from her clothes, and I always, when I came home, had to take off my clothes and immediately take a shower and put them in a separate hamper and then, of course, wash them separately. So it was this really kind of weird alteration of lifestyle where I had to kind of be isolated both in the hospital and at home, and that wasn't uncommon. I mean, a number of the nurses and other doctors, I talked to the emergency room physicians and I mean, basically, some of them actually went to separate apartments, you know, separate living quarters. I luckily had an extra bedroom and an extra bathroom where I kind of, that was my bedroom and bathroom. Some people were put out in the garage. And a number of the nurses, absolutely, when they first got home, took off all of their clothes, their shoes their socks, and they immediately took a shower and stuff and had no contact with their family until they had completely scrubbed themselves up and stuff. So it was a real alteration of family dynamics and lifestyle. You know, since we didn't really quite understand it, and again, the personal protective equipment issue was a difficult one. We weren't really sure what protective equipment we should be using for how long.

PH And can you just talk a little bit about your work consulting patients? How were you helping them manage the disease and maybe, how did you observe them coping with COVID as well?

SH It was really hard, Pono. Basically, the first number of patients we had absolutely nothing to offer them. I mean, none of us knew of any treatments. And of course, there was no published literature. Basically, all of us were watching places like New York City, New Orleans, places that had large outbreaks going and were treating hundreds of patients, and they would post things online about what they were trying or what they were doing. You know, people are doing the hydroxychloroquine to start with. People were doing all kinds of stuff, trying to search for anything that might help these people out. And basically, most of us were just involved in supportive care, which is literally just giving them oxygen, put them on a ventilator if that was necessary, taking care of any secondary complications like blood clots or secondary pneumonias. So we really had no idea how to try to help them out, which of course, frustrated the patients tremendously and scared them since we didn't know what we were doing. And their family members were tremendously frustrated and irate with us because we didn't know how to treat them. And of course, everybody was looking on the internet, and so all family members were constantly bombarding us with everything they saw on the internet that was being done across the world, be it ivermectin or hydroxychloroquine or statin agents, or on and on and on. I mean, there was this huge long laundry list of medications that every country in the world was trying for this virus, and every family wanted us to use those medications on every patient, on every family member they had because of course, they were desperate. We were desperate. And you know, most of the stuff everybody was reading was of no value whatsoever. And trying to sift through all that information and reassure families that even though we had a lack of knowledge that a lot of stuff that they were reading was just going to be useless or potentially harmful was very difficult. We had lots of angry family members that were very frustrated with us in caring for their loved ones. In addition, of course, as infection control, we soon kicked everybody out of the hospital, which really made for a poor relationship between us and family members because we basically said, you know, "we just got too much COVID and we don't need anymore COVID. So therefore, visitors can't come into the hospital." So we have this huge population of very sick and dying people who didn't have any family members around them. And family members are tremendously frustrated and angry with us about those isolation policies. So it's difficult to support the people themselves is difficult. They were scared. They knew they could die. Many of them did die. Family members knew it was a serious illness. They were afraid for their loved ones. They were frustrated with us. They were angry that we wouldn't try things that they read about, be it vitamin D or vitamin E, or on and on and on. I mean, there was just this huge list of things that everybody wanted us to give their family members, their loved ones that were in the hospital. And then, don't even talk about the fact that we had several outbreaks in the hospital that were very difficult to deal with, especially when family members were going like, "what? Dad came into the hospital so you could treat his heart attack. And now he has COVID and he's going to die of COVID. What's wrong with you guys that you can't keep COVID out of the hospital?" So it was very difficult.

PH Yeah. Wow. It's interesting when you're talking about explaining the disease to the patients, and there's such a lack of information on the one hand and yet an overload of information and maybe just a lot of disinformation.

SH Right.

PH How did you try and manage that? And especially with patients just having all this information and various things that they might have read online. What was your general response to that?

SH You know something, it was really difficult, Pono, because we didn't have absolute evidence that whatever the family member was talking about was something that was not going to work. The best we could do is try to apply some science, you know, like we always have in medicine is that we just don't go running after every treatment that is posted on the internet that has no evidence based behind it. But, you know, trying to explain evidence based medicine to anxious family members was a very hard thing to do. And I mean, their point was very straightforward, "Dad's going to die. So why don't you give him mega doses of vitamin D. What's wrong with that since he's going to die anyway?" Well, yeah, I hear that and we heard that argument. We understand where that comes from. But in medicine, one of the very first things you ever do in medical school is to take an oath, to do no harm. And sometimes doing no harm involves not using treatments that seem to have very little to recommend them and potential harm with them. And even if the patient's dying, contributing to their harm while they die, this is not a good idea in medicine. But trying to explain that to a desperate family member, it was a very difficult thing to do. So we tried to be as evidence-based as we could, which led us to be slow about some things but actually right about other things. I mean, for instance, we got into big battles with family members about convalescent plasma and when to administer. That's basically a blood product that might have antibodies in it that might help somebody fight infection since they don't have the antibodies. But as it turns out, that needed to be used very early on in an infection and probably was worthless later on in the infectious process. And it carries a number of risks associated with that. But holy moly, the fights about that and about other various experimental therapies was difficult.

PH Yeah. And you also mentioned some spread that was happening in the hospital. What were measures that you took to try and mitigate that?

SH Yeah, that was a nightmare, Pono. Of course, what we found out now is that there's a large number of people that are asymptomatic with this virus. You know, we had no idea in the beginning. I mean, there was some suggestions out of Italy, but we had no idea in the beginning that such a large number of people could be so asymptomatic or minimally symptomatic and yet still capable of significantly spreading this virus. The CDC, when they first started admitting that asymptomatic infections actually existed, there was a significant period of time that we thought that asymptomatic infections were less likely to spread the disease than symptomatic infections. And that's probably still true to some extent. But asymptomatic people are very good at spreading the infection. So our first outbreak in the hospital, we had no idea that the virus was even in the hospital and patients and health care workers until finally, a couple of health care workers came down with symptoms and we tested them and they were positive. And then we started testing their contacts and we had all kinds of health care workers that were positive. We had patients that were positive, and many of these people had no significant symptoms at all. And all of a sudden, we had a couple floors of patients that were infected. We had, you know, 10, 20, 30 health care workers that were infected. And we were flabbergasted. We were just beyond belief that the virus so efficiently and so widely disseminated before we had any hint at all that we even had a problem. And then once we had that, it was a nightmare. We basically had to isolate several floors, meaning nobody, no patients could come into the floor and no patients could go out of the floor. And of course, no visitors. We had to basically send home a whole bunch of health care workers that were infected. We sent home a whole bunch of our health care workers for then a 14 day quarantine because they'd been exposed to their coworkers. So then we were short on staff. And then we're short on hospital beds because we had all of these units locked down and nobody could be admitted to them and nobody could go away from then. Nobody could be discharged because we couldn't discharge them back to their family members with an active infection. So we were in a very bad position with that virus in the hospital. And not only that, but of course, family members were on us immediately and were extremely angry with us that their loved ones had acquired that infection in the hospital. Not that there haven't been hospital acquired infections in the past, but this one was a standout. So of course, everybody was angry with us. The health care workers were angry with us. The family members were angry with us, administration hated our guts because we tied up a whole bunch of beds and closed floors. They had to cancel all their elective surgeries, they had to cancel colonoscopies, they had to cancel breast mammography. They had to cancel all kinds of stuff because we were utilizing all the resources to take care of these people, which wasn't just the outbreak itself that happens with the COVID itself also, but bad news all the way around.

SH And then, of course, our poor health care workers, once we finally developed increased capacity to test, we kept, oh my gosh, I have to hand it to all of our nurses and everybody else. We just went floor by floor, radiology, physical therapy, occupational therapy, speech therapy. We tested people over and over and over again because many of them were exposed over and over again, but also just because we knew asymptomatically the virus could be spread. And we really had no idea at any given moment who might have the infection and might be spreading it to their coworkers or to their patients. So we ended up testing the entire hospital population right down to all the custodians, maintenance people, everybody over and over again on a repetitive schedule. You can imagine the amount of money was spent doing that. Plus, everybody's nose was bleeding all the time. If you've ever had a nasopharyngeal swab, it's extremely unpleasant. And we tested those poor health care workers, some of them at least every week for three or four weeks in a row. But we rotated the entire hospital approximately every three weeks, testing all 1,000+ employees in the hospital. It was a nightmare.

PH And you mentioned testing, I know that was also a challenge that you talked about in the pre-interview. Can you talk about that a little bit? And when you were finally able to establish that?

SH That was so difficult, Pono. Number one, of course, the CDC screwed up in hindsight. They did. I mean, they thought they were going to develop an in-house test and their in-house failed, initially. When they first sent it out, it was inaccurate and unusable. Instead of just contracting with China or South Korea or with Europe or a number of other places that already had developed an adequate PCR technique for the Coronavirus, they had to get their own. So we were all way behind the ball. Public health people were hoarding their testing and we couldn't get patients tested in the first part in March and April. We had to call public health in Honolulu. We had to beg. We had to list all these criteria. We had to fight with everybody about trying to get a patient tested for COVID, which was a nightmare because we had to keep them in isolation. We had only certain groups of people who could work with them on and on and on. And then finally, of course, the CDC licensed several large laboratories to conduct the tests. Well, guess what, you and I, don’t live in Honolulu. We were on Maui. So we sent out a test. It took three to five days to get a result. What the heck are you going to do when you're trying to treat an infectious disease and you've got a bunch of people locked up, you know? And you have to wait three to five days to get an answer as to whether or not they have a COVID infection. It was very difficult. In addition, our health care workers were in the same situation. If they had symptoms and we tested them, they had to be out of work three to five days while we were busy waiting for results to see if they were positive or negative. And so finally, ultimately, we got the capacity to test. Which, you know, I have to hand it, clinical labs was very helpful in that, and finally, we had the capacity and then in-house capacity because when we first started testing, we had to send it to Honolulu and it had like a day or two days turnaround when we could actually do tests fairly rapidly, which is still a problem. And then finally, in-house tests where we could literally, in about a four to six hour period of time determine whether somebody was positive or not at that point. But man, testing was a nightmare throughout the entire of 2020. It was really a nightmare.

PH Yeah. You talk about just all these stresses that you're describing. I can't even imagine, you know, these experiences and for you as well, I'm sure as a health care worker, I mean, you'd never experienced something like this before.

SH No.

PH I can only imagine it took a toll on you physically, emotionally. Did you do anything to try and cope with it to try and relieve your stress? Or was there anything that you were able to do to? I don't know, just taking it all in it's so much, but...

SH Yeah, so on a personal note, I mean that's kind of medicine in general, Pono. I mean medicine is definitely a stressful field and early on in your career, you kind of have to try to learn how it's going to be, that you're going to balance that kind of work-life stress you know, with the rest of your life. So I don't know. I've been kind of blessed in the exercise and support department. Certainly, that was a huge stress reliever for me. Obviously, you couldn't go to a gym anymore. They closed all the gyms. But you know, Hawaii, blessed with this weather and stuff. You know, we could do a lot of outdoor activities like jogging and walking and hiking and so forth, swimming, which were very helpful in dealing with stress. But yeah, the workdays, certainly the hours, even though they're long to begin with, were longer and dealing with everybody that was angry was a difficult problem. There was no doubt about it. All of us had significant stress.

PH Yeah. And you even mentioned before, you know, sleeping in a separate bedroom from your wife, really isolating yourself.

SH Yeah.

PH When did you start moving back, I mean, not to total normalcy, but kind of recovering some of those things in your life?

SH Once we were about six months plus into it and we had kind of a better idea of how it was being transmitted and we had a better idea of kind of the isolation techniques that were necessary and so forth, then we kind of, you know, my wife and kind of more normalized our household. And you know, as it turns out, this virus isn't so much surface spread. I mean, I was really a very big fan of that in the beginning, but it's not really a real surface spread type of virus. It can. But you just don't pick it up from surfaces real easily. It's really spread through the air. Now once we had a good idea that it was significantly airborne and unfortunately, even smaller droplets, not just large droplets, and we kind of had a good idea of how to try to protect ourselves. And you know, living in separate bedrooms and wearing a mask around the house and all that kind of stuff. So that kind of helped to normalize the home situation some.

PH Sure. And then moving towards closing thoughts and just moving forward in this pandemic, you described a lot of the challenges and stresses that patients were facing in the hospital. But can you offer any insight on just the broad challenges that COVID-19 brought to our communities, especially here locally in Hawaii and Maui?

SH Yeah, for Maui, I think it was really difficult on Maui and all of Hawaii when Governor Ige decided to close down Hawaii. I mean, it was certainly helpful, in a sense that when he closed down Hawaii and closed down travel that certainly limited the amount of virus exposure we had. And I think at least at that time in 2020, we had lesser problem with Coronavirus than did many places on the mainland because of that real limited travel. But of course, on Maui, we're totally tourist dependent and tourist-based economy. And we had like 30% unemployment on the island, which is extremely hard for many of the people I took care of. There is huge number of family members that were out of work. And as you're well aware of, the cost of living is astronomical and you need two people working full time, many times two jobs in order to survive. And unemployment benefits were helpful and the extra benefits of unemployment was great. But it still caused a tremendous amount of stress in the community with so many people out of work at one time. And of course, that just was a snowball effect, you know, all the retail people that we're depending upon the people that were making wages took it in the neck too. So that was a big mess for everybody as far as the economy went. The economy took a huge hit on that regardless as to the stimulation that was used.

SH The other thing that I'm really, really, really sorry that we ended up and still are is that the politicalization, you know, the politics of COVID is just unprecedented in my career. I mean, in my career in infection control and infectious diseases, it was so accepted by society in general. So if you had tuberculosis, everybody wanted you to wear a mask. Everybody wanted you to stay at home. Everybody wanted you to take medications to treat your tuberculosis. And in fact, you could be locked up in Le'ahi Hospital by court order if you refused to take your tuberculosis medication. And nobody had a problem with that. You know, everybody understood that was just a public health thing and that if you let somebody with tuberculosis out in the community coughing, that multiple other individuals would also acquire tuberculosis. So nobody ever argued about whether or not somebody should or should not take their medication. Of course, they should take their medication and be locked up if they didn't or if you had infectious diarrhea with salmonella. And nobody argued that you should stay home and that you should wash your hands. And nobody argued that public health would monitor you and require a negative stools before you could ever return to a position of public service because salmonella is infectious. So therefore, you were limited. You couldn't go to work because you might spread salmonella. And you had to wash your hands. Sorry, that's the way it was. It was just a public health maneuver. And then all of a sudden, these kind of public health techniques that we've been using for 100 years in public health, you know, all of a sudden became political and wearing a mask or being asked to wash your hands or being asked to do this or asked to do that was all of a sudden a huge infringement on everybody's rights. And a significant number of people felt that they were, you know, that the government was trying to control them by doing certain things. And of course, it didn't help when Governor Ige basically closed down the economy. And he had good reasons for doing that. But of course, that was just another stick in the eye. So I've never seen an infectious disease that's become so political in all of my career, which has made it tremendously difficult to try to deal with this pandemic. And there's all kinds of conspiracy theories. There's all kinds of distrust of science. Social media has been a nightmare as far as information goes. Everybody has an opinion, and it doesn't seem to matter whether your opinion has any basis in science or not. It's still an opinion and it's put out on the internet, you know, and then you can get into arguments about cancelation, which has made this, a difficult, hard to treat, very infectious disease, really difficult because of the political implications of it. So instead of approaching this pandemic in a public health way, we've been tremendously sidetracked and fighting and arguing with each other about rights and about things and about control and on and on and on. And of course, the latest debates about vaccinations. That's actually not new. There's always been significant debate and argument about vaccines stretching all the way back to the 1600s with original vaccinations. But it's just made this pandemic a real standout to something like 1918 influenza outbreak. There were no vaccines then, but people basically used public health techniques. They were put in hospitals. They had masks on. And that was what happened because millions of people were dying. In this particular pandemic, wow. You know, everything you tried to say in a public health sense is a matter of political debate.

PH Yeah. I appreciate you acknowledging just some of those external factors that made responding even more difficult.

SH Tremendously so.

PH Yeah. You talked about early on just some of the chaos at the hospital and responding to COVID. How do you think hospitals, I mean, your hospital, but generally speaking, maybe for the entire state could have been better prepared for the pandemic?

SH You know, I think this has been a huge lesson, and I'm afraid we won't have learned this lesson because we didn't really the last time either, but it's a lesson about chain of supply. We unfortunately, for very good reasons, have a chain of supply that's very dependent upon a whole bunch of countries, China in particular. And that's where our personal protective gear got all screwed up, is that basically it was cheaper to buy it from China and a few other resources than it was to produce in the United States. So when it came time to use a huge amount of personal protective equipment, we couldn't ramp up the production of it because we have no production here in the United States. And it was all produced foreign, if you will, and obviously they needed it. So they're keeping a supply for themselves. So basically, to face upcoming pandemics of which there will be, we need some sort of guaranteed supply that we can both ramp up and ramp down to try to deal with needs in the hospital for personal protective equipment. So I see that as one of the huge things for upcoming pandemics of which there will be, and it will be viral. Again, it will be a viral infection because that's just the way it's been throughout the history of humanity be it smallpox or whatever you want to talk about, measles or... Bubonic plague was a little bit of, it was a bacterial infection, but the point is that there will always be a pandemic. There always will be a new virus. There will always be a new germ that our immune system isn't used to, that can spread rapidly, particularly with the interconnectedness of our world today. So guaranteeing that we have some way to obtain supplies, be it personal protective equipment or drugs that are necessary or whatever. It is something that hospitals need and the government really needs to help us with. I'm not sure how that's done because we're a capitalist based economy and we always go for the cheapest. We all go to Walmart. What can we say? And you know, the bottom line is that it's hard to convince people we should pay more money and support industry or something here in the United States to supply personal protective equipment versus getting it from someplace that's a lot cheaper, that personal protective equipment.

SH The other thing I'm just not sure of that maybe we should learn... I'm not sure how well lockdowns really work, and I know that's a really significant matter of contention. I mean, public health procedures, yes, but completely locking down. I'm just not sure how well that works. New Zealand did a really fine job of that as far as an island goes, you know, restricting people coming in and out and basically locking down their population. But I'm just not sure that the harming of our economy as much as we did, the consequences of that is is an excellent way to deal with an infectious agent in the future. I just don't know. That's a tough one for government to figure out. Hospitals really can't figure that one out. I think that money... Some sort of slush fund for hiring of extra personnel, you know, that was really difficult for us. When we have a number of health care workers that were sick and needed to be out, when we had a number of health care workers that were in quarantine and needed to be out, we needed traveling nurses. And we needed to pay a lot of money to hire traveling nurses from the mainland. So hospitals need some sort of backup fund one way or another to basically mobilize literally millions of dollars to respond to a pandemic. Because your pandemic is going to catch you just like this one did and you're going to need the money for not only the personal protective equipment and the isolation rooms, but you've got to have the health care workers and you're going to have a number of healthcare workers that are going out sick and exposed. And you're always going to be short. And you need to be shuffling healthcare workers round. And it involves significant money to be able to hire those resources for you. With the Delta surge, recently, Maui Memorial was able to utilize some federal money to basically bring in traveling nurses again, very expensive, but to try to spare the staff, which is overworked and overstressed and so forth and so on. So hospitals prepared with extra money on hand, as you know, they're going to have that right, Pono. But that would be, you know, some sort of slush fund to deal with an unusual outbreak that's going to require a lot of resources. It'd be great for hospitals to have.

PH And you mentioned the Delta surge where it kind of was a very sudden onset, increased number of cases. Do you feel like after the past year, for example, Maui Memorial was better prepared for that and maybe the experience of the initial chaos having COVID this second time around...

SH We were definitely better prepared for the Delta surge. I mean, the Delta surge really filled up the hospital again, for sure. But number one, they did not have to cancel all their elective surgeries. They were kind of better prepared for that kind of moving people around having designated floors and stuff. They already had the whole idea of policy. What are we going to do with all these COVID patients? The minute we start having this many COVID patients, we have a designated ICU. Bam. That ICU is designated as a COVID ICU. We need this floor, the fitfh floor as a COVID overflow, we have three south as an overflow, so forth so on. So kind of all of that policy was in place by the time that the Delta outbreak happened in Hawaii and on Maui. So even though there was a significant influx of patients, there was already all of this mechanism, basically, what to do with them. Not that that didn't cause significant stress for health care workers, a shortage of health care workers. Of course, demand tremendous resources from the hospital that you could not apply to your routine hospital population, which is very difficult. And one of the arguments you've heard over and over again for vaccination that people don't understand is that the hospital already was taking care of sick people. You know, that's what it's all about. Hospitals are there for sick people and particularly during given periods of time, like the winter, there's lots of sick people with all kinds of other diseases. And if you add on top of that a significant population of Coronavirus infections, then you're overwhelming the resources. But Maui Memorial definitely was in a better position in this Delta surge than we were in February, March, April, May, June of 2020. For sure.

PH I guess coming through this experience and obviously COVID isn't over, but are there permanent changes that you think individuals could take from this experience that from a public health perspective might be valuable, I guess, in the absence or presence of a pandemic?

SH You know something, it just shows that actually relatively simple public health maneuvers actually do work. And I realize that there's a whole population of people that don't believe that at all, which is one of the really hard things for us, particularly in United States. I mean, if you look at Asian countries like Japan, you know, the Japanese are already ahead of us in that sort of thinking. Even before the pandemic, if you went to Tokyo, you'd see a number of people wearing masks in crowded situations. They launder their money over there. They have money laundering machines where you actually... My point in that is that hygiene is very important to them. Washing your hands and cleaning surfaces and so forth are very important to them. You know, in Hong Kong, you can be arrested for spitting on the ground. I mean, that's excessive, but my point is there's a significant concentration on personal hygiene, be it cough etiquette, be it washing your hands, be it wearing a mask, be it wearing a mask in crowded situations, be it sanitizing of high touch surfaces. I mean, all of these things are there, and what's wrong with those public health maneuvers? I mean, those would be good things to avoid any viral or even a bacterial infection, but particularly viral infections. And coming out of this pandemic with an increased, heightened awareness that perhaps masks in crowded situations are a good idea. Or perhaps cough etiquette is a good idea. Or perhaps sterilizing high touch surfaces on a frequent basis is a good idea. I mean, all of these things are great. It's just again, we get back to this political aspect of this particular Coronavirus where people don't want to be told what to do, and they think that you're basically trying to control them in some sense rather than simply suggest a public health maneuver. So the future really is public health and future pandemics and even just simple things like influenza. I mean, look at the marked decrease in influenza in the 2020 influenza season, 2020 to 2021. The reason there was no flu was because nobody was around contacting each other and everybody had a mask. It wasn't that there was an increased vaccination for flu. It was predominantly those public health maneuvers. But I don't feel real optimistic about the future of public health for these simple maneuvers here in the United States, in our current environment. We seem unable to talk to each other or even agree to disagree or even compromise on simple public health techniques.

PH Thank you, Dr. Hoskinson. I just want to ask you one kind of closing question. Going back to here in Hawaii, obviously we're a little bit unique being an island. Were there any positive or negative aspects that you observed of our unique experience during this pandemic?

SH Yeah. Really positive was that we could actually close down. I mean, that was amazing. I mean, compared to some places like California or Texas or kind of the whole East Coast or New Orleans, the south and stuff. I mean, we literally just closed down our islands and we had a much lesser incidence, prevalence if you will, of Coronavirus than did anybody across the mainland. And I mean, we were one of the few states with the fewest number of cases per 100,000 always throughout 2020. That changed a little bit more recently in 2021. But the point is that we were. So that was one of the huge positives of being an island is that we can isolate ourselves that way. Much as I talked about New Zealand, which kind of led the world in fewest cases, and they just completely closed down everything and refused to let anybody in, you know, so they did kind of the same thing that we did. So isolation was a huge positive for us. The negative is what we've already talked about is we're isolated in the middle of the Pacific. How do we get any supplies? How do we get our personal protective equipment? How do we get our share of remdesivir, which was one of the first drugs that people thought might be of value? You know, public health was always saying, "well, we're going to get a shipment sooner or later and we'll give it to you when we get it." Or how do you get all those fancy manufactured antibodies that various companies have put out? Well, they'll be like, "it's coming. It's coming by shipment. It's coming." And then Maui is even worse than Honolulu, right. Any of the neighbor islands are even worse where our testing was a nightmare, where we have this huge turnaround time to try to determine whether somebody actually had the virus or didn't have the virus. So isolation in that sense is a big problem. And then as far as shifting of health care workers around, that was a difficulty, too. So the mainland, you know, you could kind of go like, well, okay, New York City has a huge outbreak, let's just shift a bunch of nurses from the Midwest to New York City, offer them a whole bunch of money, and they can travel over there and help us out with this outbreak in New York City. Well, outbreak in Oahu or Maui or whatever, it's much more difficult to get traveling nurses all the way over to Hawaii, house them and pay for them as isolated as we are, so negatives on health resources, so to speak, would be a negative for our islands.

PH Well, thank you so much, Dr. Hoskinson just for everything that you've shared in this past hour and for offering us your time and your insight. Is there anything else you'd like to add or any closing thoughts you want to leave with?

SH You know Pono, the only thing I can say is that everybody in infectious disease knows that there's going to be another pandemic. So it kind of grieves me a little bit that we don't tend to learn really well, and we're still so busy fighting with each other about this pandemic that it kind of worries me greatly as to where we're headed into the next one with the same distrust of authorities and distrust of government. Same distrust of science in dealing with these things, and I have to say that it has been shocking to me how quickly we discovered information and were able to produce a vaccine. And now, as you see, both Pfizer and Merck have a pill that they've trialed that isn't perfect, but certainly looks fairly good at preventing severe disease. But my point is we just barely knew about this in December 2019, and here we are in November of 2021 and we have all of this stuff that science has come up with to help us deal with this pandemic via vaccinations or be it the monoclonal antibodies or be it these new pills that are coming out or be it better information on how to support people in the hospital that have severe COVID.. But still, there's a huge distrust of science, as witnessed by people demanding ivermectin and taking veterinarian ivermectin and stuff. You know, it's a little bit depressing that we're going to move forward, and the next pandemic we're going to have the same exchange of social media information and argument and accusations and conspiracy theories and disbelief as what we've witnessed with this particular pandemic, as if we didn't kind of learn anything from moving forward.

PH Yeah, well, I hope maybe at least the listeners or anyone reading the transcript in this interview will heed your words (laughs).

SH (laughs).

PH And hopefully, learn some things from this pandemic to keep in mind for the future.

SH If anything, we definitely will be better prepared. And then we do have dynamite science. I mean, come on, developing a vaccine that actually is effective within a one year period of time. Shocking, shocking. Nothing ever has been done like that, ever in the history of medicine.

PH Well, thank you so much, Dr Hoskinson. Again, I really appreciate you spending, you know, going overtime for today, but also just your time for the pre-interview and looking over those questions and adding your answers. Everything that you've done to contribute is really appreciated.

SH You bet.

PH Especially for this COVID project, we really wanted to capture the voices of frontline workers and that was uniquely challenging because of course, during the pandemic, they're extremely busy as you just described during the interview. So even though we wanted to capture those voices, it was always very difficult, understandably, for people to have the time to contribute. So thank you for everything that you shared today.

SH You bet.

PH That will conclude the interview and then I'll hopefully have the interview transcript for you sometime next week for you to look over and make any changes that you'd like. And then it will be archived.

SH Ok.

PH So it'll go towards our historical record.

SH Ok.

PH But yeah, Ok.

SH Thank you, Pono.

PH Thanks so much for your time. It was a great conversation.

SH Ok, thanks Pono. Bye bye.

PH Bye.