Leslie "LES" K. CHock

PH: Thank you. All right. Well, hello, today is July 6, 2021. This is an interview with the Center for Oral History at the University of Hawaiʻi at Mānoa for our Hawaiʻi Life in the Time COVID-19 project. The time is 4:03 p.m., and this interview is being conducted via Zoom. I'm in Honolulu on Zoom, and we are here today with Les Chock, who is my former microbiology instructor at Leeward Community College. Thank you for your time today, Professor Chock. It's a pleasure to be with you. Can you please state your full name just for the record?

LC: So my full name is Leslie K. Chock.

PH: Thank you. And where were you born?

LC: I was born in Hilo, Hawaiʻi.

PH: Okay. And have you lived anywhere other than your original birth place?

LC: Yes. When I was young or in middle school, we moved to Okinawa, Japan, and I lived there until I graduated from high school.

PH: Okay, can you describe kind of, I guess, your years from after moving to Okinawa and then from there up until high school or through high school?

LC: Sure, so my parents went to work for the federal government, and there were many civilians from Hawaiʻi that got hired to work overseas on Okinawa. So we actually had a sizable community of people from Hawaiʻi. So several of my childhood friends were same, like me, they were from Hawaiʻi. But then after we graduated, then we returned back home to Hawaiʻi and we attended the University of Hawaiʻi.

PH: Okay.

LC: And then eventually my parents also retired and moved back to Hawaiʻi. And I think that still happens today. There are still are some civilians who are recruited from Hawaiʻi to work overseas in Okinawa.

PH: Okay, and then over the course of your childhood, growing up, did you experience any public emergencies or natural disasters?

LC: Yes, since I was from Hilo, unfortunately, Hilo has had several tsunamis with devastating effects and loss of life. And of course, the big island with the volcano was fairly common. And then in Okinawa, they used to have what is called typhoons. So that's actually equivalent to a hurricane. And every summer, Okinawa would experience several typhoons that would sweep through the islands. Fortunately, they're used to it. So there isn't any.... There wasn't hardly any loss of life because they're prepared for it.

PH: Okay, and I want to kind of talk about that in terms of the preparedness, because we'll get to some COVID-19 questions later on, but I think at the onset of the pandemic, we saw a lot of panic. And so with these natural disasters that you experienced, how did the communities respond to these various natural disasters?

LC: Well, I think it's because like Hilo, or especially in Okinawa, because it happens all the time, the community is prepared. So most of the buildings are hurricane proof. They're very solid in structure. And every time during hurricane season or typhoon season during the summer, we would be asked to like, "Okay, hurricane is coming. You need to stock up on food and water." And usually we would lose power for two or three days or we'd lose water for two or three days. And I can tell you, if we were in school, they would actually close the school. So we get like a holiday. So that was kind of fun. But again, it's because it happens all the time. They're prepared for it, which is a good thing.

PH: Sure. And then so after graduating from high school in Okinawa, can you describe your experience transitioning to college? And did you wait at all? And then also, what made you choose or what led you to choose your UH Mānoa?

LC: Well, since I'm from Hawaiʻi and after graduating, then usually when you graduate from Okinawa, you have to.... Since you're losing your dependents status, you usually have to leave the island and return home. So most of us went back to UH Mānoa. And again, it was natural because we're from Hawaiʻi. I went to Mānoa right after graduating from high school again. Again, my high school had a counseling program and we would take a look at the different colleges. So actually, my first choice was UH Mānoa.

PH: And had your parents been to college before you?

LC: Yes, so both my parents were college educated, but back when they went to school, I think Mānoa was only a two year college. So I think my mom went to school in Colorado and my father went to school in, I think, University of Kansas because UH was not a full four year college at that time.

PH: And then what made you develop an interest in biology or microbiology? And then what later interested you in public health and epidemiology?

LC: I was always interested in biology. And my first choice was actually I was thinking of a career as a marine biologist. But what happened is I was working on campus as a lab assistant, and I did student activities in the microbiology class, in the microbiology lab. So later on, that's how I decided to go into microbiology because then I got to experience it.

PH: Over the course of your career, what positions have you held as they relate to microbiology and public health?

LC: I was a research assistant at the microbiology department and then I worked in research in the UH School of Medicine, the virology lab. And then after that, I transitioned to the Department of Health State Laboratory. And then I went to my current institution, which is Kaiser.

PH: Okay, and then fast forwarding to present day with COVID-19, when did you first become aware of COVID-19 and when did you become concerned it could threaten Hawaiʻi if those two events didn't happen in conjunction?

LC: Sure, because I was in the microbiology lab and also I am in infection control. So that's part of my responsibility. So working with the physicians, we did keep an eye on, you know, we went through the flu pandemic or a possible SARS pandemic or a MERS pandemic. So we first became aware of COVID-19 back in early January of 2020 before we even had a name. I was discussing with some of the physicians that there was an outbreak of some infectious disease in Wuhan, China, and we thought it might be a recurrence of SARS at that point. But they didn't know it was COVID. But it did make the news and we did discuss it. So we started preparing as part of our pandemic plan. We started tracking that early on and before most people knew what it was.

PH: Can you describe some of the things that go into preparing for a pandemic or as you anticipated COVID-19 or potentially coming to Hawaiʻi?

LC: Sure. What people don't realize is that the Department of Health has been planning for a pandemic for the last 20, 30, 40 years. It's Part of the Department of Health's Responsibility. And then all hospitals actually have to have a pandemic flu plan. So that's something that we we've actually prepared for or talked about though you never really can prepare for a true pandemic, but at least it was something that we had considered. So people don't realize it's been going on for many, many years.

PH: When COVID-19 first struck, what are some changes that took place in your workplace setting in response to COVID from the earliest case being reported on Oʻahu up until when the pandemic was in full force?

LC: Okay, well, I can even go before that. We get guidance from the CDC Center for Disease Control, and we also get guidance from the Department of Health and sends out alerts about any type of new emerging disease. So when COVID-19 started to happen in China, the CDC and the Department of Health sent out these medical bulletins saying, "Okay, there's a disease going on in China. Keep an eye out for someone coming back from that area." And as it started to increase, they also published travel guidance. So what we did is initially, we screened all people coming in to say, "have you traveled to COVID areas? Have you traveled to China? Have you traveled to Korea?" And we would take appropriate precautions for people coming back as a travel history. This is when there were no cases in the United States. We already started screening before that.

PH: Were these practices that you adopted to adjust to COVID... Were these already a part of your initial pandemic plan? Or can you talk about some of the things that were unexpected and the adjustments that you had to make that maybe you hadn't prepared for as COVID arrived?

LC: Actually, I would tell you, at least from my perspective, they're part of our pandemic flu plan. So the same things we did for flu season, a severe flu season, we did initially for COVID. And that seemed to work quite well in the early stages, of course, when we just had a few cases. Once the pandemic was full blown and we had multiple cases coming, then that was definitely a challenge. But for the initial patients, we followed our pandemic plan and it actually worked quite well. Again, I think that's to a benefit to all the people I work with, the doctors, the nurses, security, housekeeping, maintenance, they're all trained as part of that plan.

PH: Okay, and then you talk about pandemic planning, but can you also talk a little bit, especially with your work with the Department of Health and the CDC, about some of the policy decisions that you were involved in at the onset of the pandemic and then as the pandemic progressed how you advised in that process?

LC: So what happened was early on the health department, in addition to sending us alerts, they would actually have conference calls with infection control or physicians or pharmacists to discuss what the current situation was and how to prepare. And also, there's something called the Health Care Association of Hawaiʻi. And they started having meetings also to say, "Okay, how do we prepare for this possible pandemic?" We didn't know if it would turn into a pandemic, but we said, "we should be prepared."

PH: Yeah, and then could you talk about as the pandemic progressed and reached its peak in Hawaiʻi any of the policy decisions that you might have been involved with in terms of lockdowns or restrictions that the government was putting in place?

LC: Sure. As the pandemic started to grow and it became increasingly clear that we were encountering a pandemic. Our institution, just like other hospitals, transitioned to daily calls. So we had daily meetings on what was going on. We also had daily conferences with our national organization to say what is going on. So we kind of ramped it up like any type of disaster. We didn't think it would go on for a year and a half, though, it's still not over. But as part of our emergency preparedness or disaster planning protocol, we actually had daily calls to discuss what's our current situation.

PH: And with regard to those daily calls, both with hospitals locally but also nationwide, is that unique to the pandemic or is that something that you do in the day to day as an epidemiologist in terms of communicating with other hospitals and even nationwide monitoring maybe other outbreaks like the flu? Or did that communication line come about as a result of COVID?

LC: That communication was already in place as part of regular public health. But of course, the frequency increased. So I would say with Hawaiʻi Department of Health, we would have a pandemic call maybe once a month or every quarter. And then as it ramped up and it looked like it was going to be a COVID, then we started increasing the frequency to daily. But it was something that was already.... So it wasn't like we had new people involved or a new process. We already knew the players. We already had it. We just had to ramp up the frequency.

PH: And in terms of what you were communicating, could you talk a little bit about that? Was it how you were treating COVID? Just the status of your treatments in the hospital?

LC: It ran the full gamut. I don't know if you're familiar with something called the emergency operating center. So we actually have something called Incident Command, which is used for any natural disaster. And then you'd have an update, okay, this is the number of cases. Is it increasing or decreasing? And then they ask for status from all the hospitals. What's your bed status? How many patients do you have? They go over, what's your supplies? Who needs supplies? What's your status? We also kept track of if any of our employees had gotten sick. So that's all part of a regular Incident Command for any type of disaster. That was already in place.

PH: Were you involved at all in the process of disseminating information to the public about COVID-19? Can you describe that process if you were involved in that? And then also how you contain the spread of the misinformation?

LC: Communication is always a key for for any type of evolving situation. So we had our communications department and we had a public information officer and initially, we would have the messaging about what the current status was, how many cases, how many cases in Hawaiʻi. And I work closely with our infectious disease doctors and our communications people to send out probably weekly alerts. And as COVID actually reached our shores and the numbers increased, we would send out daily bulletins on what the status was. Here's what we know. Here's what we don't know. Here's where you can find out more information. The standard communication during a disaster.

PH: You've already talked about some of the ways that you've served through the course of this pandemic, but can you walk us through a day in the life as an epidemiologist? I'm sure that changed from day to day, but if you could just walk us through that process a little bit, maybe from arriving at work to going home.

LC: That's hard to quantify. Initially, it started off as, okay, this is what we're going to do. And then when the pandemic started increasing in frequency, everything started to blur together. But one of the things is when we actually had the surge, I would actually round on the COVID units every single day. I would visit the units and say, "Okay, talk to the staff, what's working, what's not working, how are your supplies?" And then our hospital also had daily briefings. Every morning we have what is called a morning huddle. We'd go over with the nurse managers and all the different departments. Here's our status. What's going on? So we did this every day. And this is typical of any other.... All hospitals did this. It's standard procedure to get a pulse of where we are. What you want to do on a pandemic is you want to stay ahead of the curve. Since we're in Hawaiʻi, it's like surfing a wave. You keep an eye out to see there's a swell coming, right. And you get ready for the swell and then you've got to stay ahead of the wave. You can't have the wave overtake you because then it'll be too late. So it's a challenge. But think about it. You want to catch the wave, and you want to stay ahead of the waves.

PH: Working so closely with hospital workers and nurses and doctors over the course of the pandemic, what was the general mood that you sensed from the onset of the pandemic to when things got more severe?

LC: I'm fortunate the people I work with and also with the health department is that they were very open and realized the possible consequences of the pandemic. So a lot of things were unknown. I can tell you there was some fear about the disease because we didn't know that much. But I'm grateful that everyone stepped up as professionals to take care of our patients and keep our staff safe. Again, a lot of it was unknown. The CDC would issue guidance and sometimes that would change from day to day. So we had to stay abreast of all the latest information. But communication is the key. And again, every day was different. I can tell you when we actually had the surge, I came in, and I worked three weeks straight every single day for long hours. And there are people who probably worked longer than I did, but that's something that in health care you just have to do it. I had the easy part. I didn't actually have patients to take care of. I worked with the physicians and the nurses to be outside the room and sometimes I would assist them in the room. But I didn't have direct patient care. But those people were definitely heroes.

PH: Yeah, that's incredible. Thank you. In terms of protecting those individuals and especially those who are on the front lines.... At the beginning of the pandemic, there was a nationwide PPE shortage, and I'm sure your hospital experienced that as well. Can you talk about what you and the rest of your team did to compensate for the PPE shortage?

LC: We were fortunate that for the last five years, we were one of five hospitals in Hawaiʻi that were designated an Ebola center. So we actually had some some extra stockpiles of PPE in the store room just in case of an Ebola patient. So we had a little buffer. But as the supply got shorter and shorter, we recognized that we need to stay ahead of the game. So believe me, our supply people purchased all types of PPE, whatever they could get. The larger institutions were able to do that fairly successfully. I think some of the smaller hospitals or smaller nursing homes, unfortunately, they experienced more severe shortages. So we came close to a shortage, but early on, we recognized that PPE would become a shortage. I should also mention that when we were fully in the pandemic, when there was a shortage, we started what is called reprocessing of PPE. So we were actually able to reuse PPE after it had been safely treated and safely sterilized or disinfected. We follow CDC guidance on that so that our staff are safe.

PH: What is the process for PPE sterilization and how long does that take?

LC: Intially, we worked closely with University, of Nebraska and Emory University. I had friends there and some of the doctors. So initially, we used ultraviolet light to disinfect some of our PPE. It's the same UV light that, if you take my micro course, we've used UV light to kill bacteria. So we used UV light for several weeks and then later on the federal government had another system, that I think it's called the Battelle system, and I think it uses hydrogen peroxide gas. But it was FDA approved and approved by the federal government, and then we would send our PPE to them, and they wouldsterilize it. So our staff were kept fairly safe. And we told them about the process, so they are confident that the PPE they were using was safe for them to use because that's the most critical thing.

PH: So even at the height of the shortage, you were able to provide your staff with PPE? They never had to bring their own or make any makeshift...

LC: No. We were fortunate in that. I do know that some of those, like I said, other parts of the nation or smaller nursing homes did not have that. But for us, we were able to safely provide them with PPE. We went off contract. So in other words, you may have several different brands of PPE, whatever we could get, again, as long as it was the correct PPE to be used to safely care for the patients.

PH: You also mentioned the Ebola crisis and your preparedness for that. Can you talk a little bit more about how that crisis prompted your preparedness for the COVID-19 pandemic? Were there other areas beyond just PPE that, that crisis prepared you and your staff for the COVID-19 pandemic?

LC: I don't think people realize that Hawaiʻi was just like all of the 50 states. We actually got an Ebola grant five years ago. And it was a small grant, but it went to the health department. So the health department had some training exercises. And then there were five hospitals in Hawaiʻi who also got a small, very small amount of money for Ebola. I think we started off doing quarterly drills on putting on the PPE. This is called donning and putting the suit on and then taking the suit off. So we actually had trained for taking care of a highly infectious patient like Ebola. So our CCU nurses were trained, are ED was trained, security was trained, the lab was trained. So the same process that we used for Ebola, we used for the first COVID patients. Now, COVID does not require that level of precautions, but at that time it was kind of unknown. So we actually did use the same process. And our first COVID patient went into the room we actually had designated for an Ebola patient. Of course, for Ebola, we only predicted one or two or three patients. We didn't expect hundreds or thousands of patients as the pandemic.... No one could predict that.

PH: Right. Going back to previous diseases and outbreaks, with COVID-19, a lot of people compare it to the Spanish 1918 flu. And with regard to that, as an epidemiologist, do you see COVID-19 becoming a permanent part of the population like measles or the common cold, or do you see it disappearing in a similar way that we saw the Spanish flu disappear?

LC: One of the things to mention about COVID, is this is an infectious disease and a microorganism always does what it wants to. So making a prediction about an infectious disease is probably (laughs).... Don't bet on it. You'll lose money. So it's hard to predict. At this point, it looks like COVID may turn into something that is around for a long time, and perhaps every year we'll have a new strain. But it's hard to predict. I can tell you, as part of our pandemic planning, we did base it upon the 1918 flu. So we looked at history, what happened in 1918, which unfortunately killed 20 - 50 million people. So some of those same things that were effective in 1918 were also effective for COVID. I did a presentation at work, and actually at Leeward that compared the 1918 flu, pictures from the 1918 flu with pictures from COVID-19. And they're quite striking when you look at the pictures of how people, what they did, it was basic public health. Don't forget your history.

PH: Yeah, absolutely. It's very important. Were there any specific lessons that you were able to apply directly from that flu to the preparedness to COVID-19?

LC: Sure. Basic quarantine worked in 1918. There were posters that showed nurses saying, "cover your cough, stay at home if you're sick, avoid crowded places." I had pictures of these 1918 flu posters, and I compared them to the posters that we used in 2020 for COVID and they were quite striking in the similarities of what you needed to do for a public health crisis.

PH: Yeah, these are tried and true practices, I guess.

LC: Yes.

PH: So with the possibility that COVID-19 would become a more permanent part of our population, do you see any positive changes that we might take out of this pandemic, such as mask wearing or social distancing that we could actually carry forward if COVID is potentially to remain a permanent part of our population or also with just the common cold and the flu season that comes around yearly?

LC: I think nationwide it's been widely accepted that because of all the COVID precautions masking, disinfecting, staying home if you're sick, avoiding crowded places, it actually had a dramatic impact on our seasonal flu. So the flu season this past year was actually almost zero. Again, because flu is also another virus, not as deadly as COVID, but the same precautions we took seemed to actually shut down the flu. So hopefully, people will remember that. So I think that's a good thing, right?

PH: Yeah. Going forward from COVID, and especially with your involvement as an epidemiologist and informing public health decisions, are there any key lessons that future policymakers can take away from this experience?

LC: I think one of the lessons learned is dealing with the pandemic, which, again, is unpredictable. Basic public health is important. So our health department is critical, and we need to make sure that it continues to get funding for basic public health. Maybe it's not glamorous. Maybe it's not high tech, but our public health people, my colleagues who work in public health, they are also heroes because it's what they do day in and day out. I worked closely with our disease investigation branch and our public health people, and we need to support them. And if this dies down, we still need to support them because this is not the last pandemic. It's been 100 years since the 1918 flu pandemic. But we are predicting that pandemics occur usually every 20, 30, 40 years. And after COVID tapers off, hopefully. There will be another one that will come. And we just need to be prepared. We need to not forget the lessons of COVID-19.

PH: Yeah, in terms of the preparedness, would you like to see, specifically, with your hospital perhaps preparedness in terms of the masks and having beds available, having those stored and ready for if we were to experience a pandemic that were similar to COVID? Going from 0-100, like when the pandemic was the most extreme, would you like hospitals to always be prepared for that worst case scenario?

LC: I think that will be one of the lessons of COVID-19. They're talking about COVID, that hospitals and health care systems need to be prepared for future pandemics. Unfortunately, preparation costs money. And after a few years, just like preparing for a hurricane. In Hawaiʻi, you should have 14 days worth of supplies for hurricane. But some people don't. Or they maybe they do and then after a year or two, it kind of fades from the memory, and it just fades. Hopefully, we can continue to remember that we need to stay prepared, and somehow balance the challenge of preparation with.... Preparation is expensive. So you need to keep that in mind to find a balance. And again, I don't I don't have the magic answer.

PH: Sure, going back to the beginning of the pandemic, can you talk about how your perception and understanding of COVID-19 changed? Were there any impressions that you had, initially, that were later maybe proven to be wrong or perhaps validated?

LC: When it first happened, we weren't sure how how deadly the disease was, what the mortality was, if you will. So there's a saying in disaster management. You should prepare for the worst and hope for the best, so we took the conservative route, and the priority was keeping our staff and our patient safe. So maybe some people would say we did a little bit overboard. I would say that when you have faced an unknown situation, you need to make sure that the staff are safe. And I think we did that appropriately. Later on, it turns out it wasn't spread by contaminated surfaces. And the CDC now has confirmed that not as likely, but at that point we didn't know. So it's prudent to take all precautions, again, because you just don't know. You can't go backwards. Sometimes I remember our staff fully gowned up, maybe even had worn more PPE than what was required. I always told them, "I'm not in the room. So if you feel that this improves your safety, I'll back you up on that." And later on then they kind of modified the practice. But when you deal with an unknown situation, the highest level of preparedness is the best.

PH: It's nice to see how you're looking out for your staff as well. In terms of the risk that you faced every day being in a hospital and your exposure, can you talk a little bit about how COVID-19 affected your family's day to day lifestyle and your personal interaction with your family?

LC: I think those of us that work in the hospital would be, in my opinion, I think because we took appropriate precautions, I think that we were fairly safe. I don't think it was risky. There was a concern about perhaps we would pick something up and bring it home to our families. So I know that's why we stress the importance of proper PPE. I know some of the staff.... Later on, our institution gave gave them scrubs and then they actually showered before they went home. That was a big psychological safety to say, "Okay, I'm leaving work behind, and then I can safely come back to visit my family." I do know early on in the pandemic that was a concern of many of our frontline staff.

PH: Sure, that makes sense going from the hospital and then returning home. Where there also disinfectant processes that the staff had to go through going from a COVID infected room to outside of that space.

LC: Certainly So just like we did for Ebola, we actually said that you have to properly put the PPE in. And early on, we stressed the buddy system. This is just like any other type of infectious disease or a chemical incident. We had someone observe them put the gown and the gloves and the mask on. And especially when they were leaving the COVID unit, we insisted that they also have a partner that observed them to safely take it off because sometimes you may not know that you're actually touching your face or you're doing something inappropriate. So we trained very hard on that. And we stress that you take your time, follow the sequence, put it on properly. That's called donning and doffing is taking it off properly. And again, if you stick to the protocol, then you should be safe or you are safe. So we really stress that. You wouldn't work on the COVID unit unless you had been properly trained.

PH: And all of that equipment you would later take and sterilize it and then reinstate it for use?

LC: Right, yeah. Besides the PPE we actually did a lot of disinfection, and we actually had UV lights that we disinfect the room with. We actually had like, foggers that we fog some parts of the equipment. So we were very diligent about making sure that any equipment that had to be reused was properly disinfected, so it would be safe for the next patient or the next staff member.

PH: Was the disinfectant equipment also one of the things that was in shortage, or did you already have enough of that to meet your need?

LC: At one point, and believe it or not, our disinfecting wipes we started to run out of because of the shortage. And then we started buying different types of brands. And then I think at one point our environmental services actually had to make our own disinfectant wipes. They actually got the disinfectant, and then we had to soak paper towels in it because the commercial product was not available. So we actually had a lot of things to do because of shortages of supplies. But thankfully, that didn't last for too long of a time.

PH: Yeah. Thank you. Going back to your family, were there any ways that this experience changed your awareness of family or friends or community health and maybe your general awareness of the risk that you might pose being in the hospital?

LC: I think like everyone else who's experienced this pandemic, it's made all of us refocus on what's important in life. And in addition to your work, also your family, your community, your friends. I would also say travel, but you can't travel right now. So it's important to have a balance. I think what you're hearing now as we come out of this COVID pandemic, you're hearing a lot about work-life balance. We need to make sure that we're in harmony with the entire life, and in addition to taking care of our patients also take care of ourselves.

PH: Yeah, thank you. And then with this pandemic, can you talk about, specifically, how it impacted some of the more underserved communities and especially in Hawaiʻi here with the native Hawaiian population and other Pacific Islanders? Could you talk about how COVID-19 especially adversely impacted those communities?

LC: Unfortunately, COVID has had a devastating effect on the native Hawaiian population and some of the Pacific Islanders. So I think if you look at the statistics, they have a worse type of outcome compared to some other populations. I also know on the continental United States or mainland, Native Americans on the reservation also had severe outcomes. It's a combination of factors, socioeconomic, maybe lack of resources, maybe poor public health. So, yes, that's a concern for us in Hawaiʻi. And that's something we're trying to address, especially with nowadays that we do vaccination. We've had a two-pronged approach to vaccination. We had mass vaccination centers that would do thousands of people. And we've also pushed community based associations. So go to the community that perhaps doesn't have the resources, and provide vaccinations where it's convenient for them. So I can tell you, we did the Native Hawaiian Council, we did papakolea, we did the long line fishermen. I did several events at the Filipino Community Center, and I was quite surprised that some of the people who came were very grateful to get their vaccine. But I would say, "well, how come you didn't.... It's three or four months later." It's because they don't really trust outside institutions. They feel comfortable with their own community association or their own community leaders. And if it comes from the community leaders, then they will follow those instructions. So that's a message for future public health. You need to actually reach the community to achieve medical success.

PH: In terms of that hesitancy that you mentioned with the vaccine, but also that might generally be present among native populations towards the larger institutions. Do you think that was possibly also a reason why these communities were more negatively impacted by COVID-19 being that they were more hesitant to come to the hospital?

LC: I think so. Again, it's a different perspective. I guess the social, economic or the social situation also has to be taken into account in addition to the medical. You know, hardcore medical treatment, you also take the social social aspect of medicine is probably something that's been overlooked. So I think that was important. It is important.

PH: I want to ask you a little bit about comorbidities because from the onset of the pandemic, we heard that people with preexisting conditions were the most vulnerable to COVID-19. So as an epidemiologist, did you observe many people that were perishing from preexisting conditions?

LC: Yes. Unfortunately, the CDC now has data that shows that and that they publish. That's been the recommendations. If you have a preexisting health condition, chronic pulmonary disease, diabetes, you're overweight, hypertension, obesity, some other type of chronic illness, if you get COVID, the outcome is not good. So general public health and also your own general health can actually play a big part in preventing a serious outcome from COVID. So that's where we need to address the inequity of the health care system in in the nation or in the world.

PH: Yeah, as a follow up, in terms of increasing pandemic resiliency, would treating and preventing these preexisting conditions early on be a legitimate tactic to preventing fatalities or severe illness to another pandemic?

LC: Yes. So it kind of exposes some inequities in our system. If we could do a better treatment of taking care of these chronic medical conditions then the pandemic would not have affected these populations as badly as it did.

PH: Can you describe some of the things that are being done or being considered to reconcile those inequities among these communities?

LC: I think I saw something recently, maybe the school of medicine and the UH School of Nursing. They've had some some grants where they're now trying to reach out to the native Hawaiian population to better serve their health needs. Again, I'm not part of that process, but I thought I saw something like that. Yeah.

PH: Now, as we are at the point in the pandemic where, hopefully, we can see a light at the end of the tunnel and many states are in the process of reopening, including Hawaiʻi. As an epidemiologist, what are factors that the state should consider in reopening especially as we consider the spread of new strains of the virus such as the Delta variant?

LC: That's a very tricky situation. And there is no magic answer. I do know, initially, the governor was trying to go for 70% vaccination. Now that's been modified. Other things that have taken place is they're also considering the number of hospitalized patients, not only the number of cases of COVID, but how many patients are being hospitalized, because COVID could range from a severe disease that could be fatal, to a mild disease, to some people are asymptomatic. They have COVID and they're fine. So I think you have to take in balance that the health care system could handle it. Also, you have to take into account the economy of Hawaiʻi was devastated by the economic shutdown. From a health care standpoint, I think it was correct. But from an economic standpoint, I think many of us know people that were severely affected by the shutdown. And I don't know what the balance is because it's still evolving.

PH: Yeah, I guess with some states on the mainland opening especially early, even though you may not have all the answers in terms of what to do, are there any lessons learned from looking at other states in terms of what not to do?

LC: Time will tell. The latest report is Israel did a very good job early on vaccinating their population. Then they kind of lifted most restrictions. But now they're starting to see an increase in cases, so it's hard to say. I think here in Hawaiʻi, we are fortunate that most people complied with wearing a mask. I guess maybe in the past we've seen so many visitors from other countries wear masks, so it wasn't that foreign to us. I do know other parts of the mainland mask wearing--they had a hard time complying, so it's hard to say. We are keeping an eye on the new Delta Variant. This pandemic, hopefully, is winding down. Like I mentioned it's hard to make a prediction. Maybe it's just getting ready for the next wave. Hard to predict. I hope I'm wrong.

PH: Living on an island, what are some of the positive and negative aspects of dealing with the pandemic?

LC: Well, that's a double-edged sword. So we're blessed to live in Hawaiʻi because by instituting quarantine and a lockdown, we kind of kept the disease from gaining a foothold in Hawaiʻi. So that was a positive thing. But the negative thing is.... Living in Hawaiʻi, usually our supplies come in, so we were competing for getting PPE or disinfectants, or at one point, we even ran out of alcohol for our hand sanitizers, and one of the alcohol companies actually made alcohol for us. Then, of course, if you ever went to Costco during the early days of the pandemic, run out of rice, toilet paper and everything else. So it's a double-edged sword. Hawaiʻi needs to be more self-sufficient, but I don't know how we will ever achieve that.

PH: Sure. You mentioned Costco and some of the initial panic with the pandemic. And I also kind of wanted to go back to your experience in Okinawa, where things like typhoons, that was just sort of common. So people were prepared for that. Are there things that the general public can do to be prepared for the next pandemic? I mean, should we be stocking up on masks and having stores of alcohol? I don't know what your perspective on that is as an epidemiologist.

LC: I don't think so because that would be a wide range of preparation. You can be people who say, "I'm not going to prepare" or you could be people that, pardon the term, they're preparing for doomsday. So I don't think you can adequately prepare for a pandemic. I do know it's a pretty well known consensus from the health department and the governor and many institutions that you should at least prepare for a hurricane, which would be at least 14 days worth of supplies. That's the general recommendation. You should actually have food, water supplies for 14 days just in case something were to happen. You know, trying to prepare for a year and a half pandemic, I don't think people can do that. But at least for a week or two weeks is something that is generally accepted that would be a acceptable level of preparedness for any type of disaster.

PH: Reflecting on this past year and a half, with your current knowledge, is there anything that you would have done differently in your personal life or in your work as a public health professional?

LC: I can tell you, back in January of 2020, I used the term, "I think there's a tsunami coming." So I think you have to be constantly on the lookout, or just like I mentioned, there's a swell on the horizon. You've got to keep your eye out for the swell. And then when it does come, you have to be prepared to try stay ahead of the wave. I think Hawaiʻi did a fairly good job of preparing for it. If there was something I think that we could have done better is, I think in the smaller hospitals or care facilities or nursing homes they had some challenges, maybe, perhaps they need a little more resources. But for larger health care hospitals, I think we are fairly well prepared.

PH: In terms of those long term and nursing home facilities, are they generally not connected to a larger health care institution and that's one of the reasons why they were less prepared?

LC: Yeah, at least in my limited knowledge, many of them are standalone companies. So they're not connected with a big hospital though we have contracts with them. So they had to get their own supplies and their own training. And in retrospect, I think that's been identified that maybe we could do a better way of outreaching to them to help them prepare to go to a higher level similar to what the hospitals are prepared for. I don't know if that economically is feasible, but nursing homes definitely had a bigger impact on COVID upon their residents, mainly because of the elderly and people who had underlying health conditions. So they were the most vulnerable, and whatever we can do to shore them up, I think should be the plan moving forward.

PH: Were there any actions that you observed either from your hospital or other large hospitals on island that were making efforts to shore up those smaller care facilities?

LC: Certainly. As I mentioned, we have something called the Health Care Association of Hawaiʻi, and I know they outreach to the some of those communities. And then some of my friends were in the National Guard, and the National Guard also got activated to help screen patients or deliver PPE to some of these smaller companies. So there was some effort. But that's something we should continue to work on.

PH: I want to quickly go back to your education and your platform as a professor. Can you talk a little bit about how you use that platform to raise awareness of public health, especially among your students during the COVID-19 pandemic?

LC: Sure. I'm fortunate that I teach microbiology at Leeward. I teach in my evening class. I've taught at Leeward for many years. When COVID initially started, I'm thinking that was the spring of 2020, we still had in-person classes, and I would tell my classes, "this is what's happening. This might be coming." So I gave them a heads up as much as I could do. And then in the middle of the semester, that's when Leeward went into lockdown, they canceled all the face-to-face classes. And then I think Pono when you took my class in the fall of 2020, I also tried to do my best to update my students on what the current state of COVID was. And then this past spring, I also gave updates to my students on our processes for vaccination. What's the risk of the vaccine? Who should get it? Where are the vaccination centers being done? So I think it's important to get the message out. And I tried my best because, hopefully, my students listened, and hopefully, then they went home and told their friends and their parents and their families of what can be done. So communication I think was critical during this pandemic.

PH: Yeah, certainly. I know I always appreciated those kind of briefings as a student.

LC: Ok, thank you.

PH: Yeah, absolutely. With the transition, were there any challenges for you going, as a professor, from this in-person environment to suddenly everything being virtual?

LC: Zoom is interesting. Just my personal opinion, I think Zoom will work well in a small classroom. But I can tell you that, like in my class, when there's like 35-45 students, I don't think Zoom works out well. That's just my opinion in that big of a setting. Perhaps if it were like 10 or 15 students, then I think zoom or distance learning would work. But I think when you start to get to a larger class, I think distance learning is not suited for every student. We tried our best because of the pandemic, but it's not for everyone. We're still learning.

PH: Sure. In closing, is there anything else that you would like to add or any final thoughts you want to share?

LC: I would like to say I'm grateful that we seem to be coming out of this pandemic, and I'm grateful for the people I work with, my coworkers, the doctors, nurses, like I said, everyone that works for the health care system. I'm also grateful for my colleagues at different hospitals. I'm grateful for my students and also the university. I'm also grateful for our people in the Department of Health, who I think faced.... This is one of the big challenges of their lifetime. And I think they did a good job. There's always a way to do better. But Hawaiʻi is a community, and I think we're fortunate that we need to work together as a community to solve our issues. So I think that was a strength as we come out of this pandemic. Hawaiʻi is a community, right. I mean, it's Pono right. Sorry for that, but do the right thing.

PH: Right. No, that's wonderful. Thank you. And thank you for your time today and contributing to the oral history project. I really appreciate you being so generous, especially with your work and everything else that you're doing in the community. So thank you for taking the time today.

LC: You're welcome, Pono.

PH: I appreciate it. All right. Well, I'll go ahead and stop the recording.