More than five years since COVID-19 was declared a pandemic, throwing Hawaii and the world into chaos, memories of the traumatic events for many have become a blur in the rearview mirror.
There were sick COVID-19 patients, isolated in a hospital room, who could only communicate with loved ones via an iPad. There were emergency stay-at-home orders and extended lockdowns, resulting in empty streets and shuttered businesses.
There was fear and uncertainty of a new disease and how long it would all go on — with initial expectations of just a few weeks to a few months or so.
The World Health Organization declared COVID-19 a pandemic on March 11, 2020, and declared an end to the pandemic emergency on May 5, 2023. The U.S. ended the emergency earlier, in April 2023.
Tim Brown, an infectious disease expert following developments closely, recalls being asked how long the pandemic would last and saying it could be up to five years. Now, five years out, he said “it’s still with us” and is here to stay.
But Hawaii is in a very different place now from five years ago, with many of the greatest concerns about COVID-19 having subsided.
The state Department of Health has recorded consistently low average case counts since Thanksgiving, with no significant spikes since the omicron wave in the summer of 2022.
The average positivity rate — or number of tests that are positive — on March 20 was at 2.2% statewide.
The most recent number of COVID-19 patients in Hawaii hospitals has been consistently low, at an average of just six per day, and just one in the ICU. So far this year there have been fewer than 10 COVID-19-related deaths.
“I think the reality is now, virtually everyone in the world has either been exposed to COVID — in many cases multiple times — or been vaccinated multiple times,” said Brown, an adjunct senior fellow with the East-West Center in Manoa. “So now our immune systems are primed to deal with COVID. Most people are not going to get severely ill or die from COVID infections today.”
Though the virus continues to evolve, no significant, new variants have driven another spike.
Even if there was another evolutionary jump, Brown said he would not expect another large death wave due to long-term T-cell immunity most people now have against COVID-19.
Virus not harmless
Still, Brown said he thinks it is important to stress that COVID-19 is not harmless.
“A lot of people — the elderly, the immunocompromised, those with heart disease, high blood pressure and obesity — they’re still at severe risk from COVID,” he said. “I would still strongly recommend that people get vaccinated, especially if you’re in one of the higherrisk categories.”
Nationally, more than 1.2 million Americans have died from COVID-19, according to CDC.
And there are still people, an estimated 3.5%, who develop long COVID, which endures for months to years after an infection, said Brown. Some have recovered but others never have, resulting in permanent disability.
“It’s not just a respiratory virus,” said Brown. “It’s a systemic infection. It affects not just the neurological system, but the gastrointestinal and cardiovascular system. It affects your blood vessels.”
Studies have shown the risks of heart attack and stroke, for instance, are elevated for three years after a COVID-19 infection.
But COVID-19 is in the rearview mirror for most Americans.
According to a recent Pew Research Center survey, most Americans have moved on, with only 1 in 5 considering COVID-19 a major threat to the health of the U.S. population. Most, 56%, think it’s no longer something we need to worry about.
Just 4% regularly wear a mask, and fewer than half of U.S. adults planned to get an updated COVID-19 vaccine last fall.
Today only 12.6% of Hawaii’s population has gotten the 2024-25 COVID-19 vaccines, in stark contrast to the days when people lined up at large-scale events to get the initial rollout of the vaccines.
Front-line workers
Memories are still vivid for those worked on the front lines of the pandemic.
Daniel Ross, a nurse at The Queen’s Medical Center, remembers the fear of working with this unknown virus and the inadequate personal protective equipment that staff was initially provided. Nurses were putting their masks in a paper bag for a few days, then reusing them.
And yet, nurses and health care workers showed up to work, he said.
Ross, who was president of the Hawaii Nurses’ Association during the peak COVID-19 time, also recalls having to advocate for ICU nurses dealing with three patients at a time, which the union considered unsafe. He also counseled many nurses who went through the trauma of caring for COVID- 19 patients at their worst and away from their loved ones.
Many got burned out and left the profession, or sought positions away from bedside nursing. Yet others, including a colleague who suffered a COVID-19 stroke, tried to return to work but were unable.
Today there are fewer COVID-19 patients overall, he said, having cared for just one the prior week. Their illnesses are not as severe as previous years, and many were admitted with other ailments and then tested positive for COVID-19.
But hospitals are still overflowing, Ross said, with patients sick from other ailments. Those in emergency rooms sometimes are waiting for up to 48 hours for hospital beds to open. These patients are sometimes placed in hallways, with no additional nurses added for the extra load.
The high volume of patients to staff continues to drive HNA to advocate for safer working ratios today at every contract negotiation.
HNA President Rosalee Agas-Yuu said the pandemic took a toll on nurses who worked overtime on those front lines. She said that they went to work with the fear and risk of bringing the virus home to their own families, with many keeping a change of clothes in the car.
Agas-Yuu said nurses were stretched thin during the pandemic emergency and that normalcy still has not returned. She said nurses continue to struggle with staffing shortages and patient overload.
During HNA’s various strikes over the year, one of the signs that striking nurses held said, “First we were heroes, now we are zeroes.”
Collective amnesia
Were lessons learned during the pandemic?
Unfortunately, said Brown, there seems to be a collective amnesia that only resulted in more division among Americans than in lessons learned.
“When people face traumatic events, they develop an amnesia around it, and they kind of push it out of their minds,” said Brown. “People have forgotten what that period was like. They forgot that our health care system nearly collapsed. They forgot that doctors and nurses felt like they were on a battlefield and were exhausted with dealing with a level of death they’ve never dealt with before.”
Brown said it’s important to remember Hawaii hospitals were over capacity during first the delta and then the omicron surges.
Hawaii fared better than most of the U.S., which recorded more than 1.2 million American deaths due to COVID-19. In Hawaii the death toll as of Wednesday stood at 2,276 — 2,217 Hawaii residents and 59 visitors.
According to the Pew survey, most Americans say the pandemic drove the country apart, which continues to play out in politics today.
CDC and WHO were blindsided, according to Brown, and gave inconsistent advice on the virus.
Would masking help? The answer should have been yes, he said, and Asian countries were already masking, but the U.S. hesitated to advise it due to a mask shortage.
Was it airborne? Yes. Could it spread from people without symptoms? Brown said experts at the time responded that it was rare, but the answer was yes.
Today there is a distrust of government agencies such as CDC, and a growing backlash against science as well as vaccines that seem to have spilled over to other vaccines, including longtime childhood vaccines.
The U.S. experienced record-high levels of flu cases and hospitalizations this year amidst declining vaccination rates. Measles is also having a comeback, with a recent outbreak in Texas resulting in the death of a child — the first in a decade.
All eyes are on the highly pathogenic avian influenza, more commonly known as bird flu, as the virus continues to evolve and infect a growing number of dairy herds.
Brown fears that in the next potential pandemic, the U.S. will be much less equipped to respond quickly. As for COVID-19, it’s here to stay, and needs our attention because people still could get long COVID, get ill and suffer health effects such as increased risk of heart attacks, and some still die.
“It’s not going anywhere,” he said, “and we ignore it at our peril.”
