He Ma‘i Makamaka ‘Ole

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By Dr. Keawe Kaholokula, Dr. Robin Miyamoto, Dr. Andrea Hermosura and Dr. Nicole Aurellano

The Social Consequences of COVID-19

He ma‘i makamaka ‘ole means “the disease that deprives one of relatives and friends,” as translated by Tūtū Pukui. This ‘ōlelo no‘eau from the mid-1800s, in response to the leprosy outbreak in Hawai‘i, sums up what many are experiencing today with the COVID-19 coronavirus crisis. The social-distancing we are practicing today to stop the spread of COVID-19 is nothing compared to the experience of our kūpuna and their ‘ohana who were afflicted with leprosy. Nevertheless, COVID-19 is a highly infectious disease that is depriving us, in the short-term, of our relatives and friends, impacting our physical and mental health.

The United Nations expects the COVID-19 pandemic to pose a serious health threat to Indigenous peoples throughout the world. Public health agencies in the United States also expect the burden of COVID-19 to be greater for Indigenous communities. Data from Hawai‘i, California, Oregon and Washington show that Native Hawaiians and Pacific Islanders have the highest rates of confirmed COVID-19 cases, as high as 189.5 cases per 100,000, compared to other ethnic groups in those states.

All Indigenous peoples share similar concerns that put them at an increased risk for COVID-19 and other related problems. These include limited access to healthcare services, more chronic and infectious diseases, and poorer economic and living conditions. These are all long-standing health concerns for Indigenous people that predate the arrival of COVID-19, but they are even more concerning now.

Aside from the publicized physical threats caused by COVID-19, the public health measures of “shelter in place” and “social distancing,” although necessary to stop the spread of COVID-19, can pose serious physical and mental health problems for many.

“Aloha from Afar”
Original artwork by: Margaret Rice for Every1ne Hawai‘i

Kūpuna are the people most negatively impacted by COVID-19 should they get this virus (since they often have multiple preexisting age-related medical conditions). People living with chronic medical conditions, such as diabetes and heart disease, are also at greater risk, but sheltering in place makes eating healthy and getting regular exercise more difficult. Another group at risk are people who smoke and vape; behaviors particularly high among our ‘ōpio and mākua. Because COVID-19 is a respiratory illness that attacks the lungs, people with a preexisting respiratory illness, such as asthma, and people who put too much stress on their lungs by smoking or vaping, are at risk of having severe symptoms should they get COVID-19.

Sheltering in place and social distancing can also have an impact on a person’s mental health. It can cause depression or sadness, anxiety or fears, and increase stress levels, which, in turn, can result in substance abuse and domestic violence. Many people are out of work due to the closing of businesses. Parents are homeschooling their keiki while managing their household and finances. Kūpuna are unable to leave the home and are in need of extra care. And, everyone is disconnected, physically at least, from their extended families, friends and coworkers – the people we most often turn to for help during difficult times. Being at home under these conditions can place a physical and emotional toll on anyone.

Our personal emotional wellbeing is critical, and being self-aware of your feelings and behavior is key. Here are signs to be maka‘ala (alert) to and for which you might want to seek help: excessive fear and worry about your health and the health of your ‘ohana; changes in sleep or eating patterns; difficulty sleeping or concentrating; worsening of chronic health problems; increased use of alcohol, tobacco products, e-cigarettes or other drugs or; increased anger and arguments with others in the home.

A person’s emotional wellbeing also affects their ability to take good care of their physical health, including proper care of any chronic medical conditions such as diabetes or heart disease. People often smoke, vape or drink alcohol more than usual to deal with their stress or negative emotions, which are not good coping strategies under any circumstance, but even more so now. Too much alcohol coupled with frustration can lead to hurting others and can threaten the safety and wellbeing of the ‘ohana – behaviors not consistent with our cultural values.

Staying mentally and physically healthy means finding positive ways to cope and to deal with sheltering at home and social distancing. Here are some ideas:

Be creative. Haku (compose) a mele, pule, oli or poem, or journal your experiences to memorialize this time as our ancestors did in the past; start a new hobby or home project; try new recipes or; learn a new language (like Hawaiian!) at home online.

Stay socially connected using technology. Host or join a live concert over social media – many of our talented musicians have already done so; host “happy hour” or get-togethers over social media or videoconferencing and; call or text friends and family often – reconnect with old friends and distant relatives.

Reconnect with ‘ohana. Create family challenges with board or video games; film a TikTok; spend time with your keiki and teach them how to do something new (make a lei or a family recipe), or let them teach you how to do something or; get to know your mākua and kūpuna better – revisit your mo‘okū‘auhau (genealogy) and share family mo‘olelo.

Help others. Check-in with kūpuna to make sure they are safe and fed or reach out to keiki or at-risk members of our community who may not be safe at home.

Practice self-care by creating a schedule that includes playtime and exercise. Eat healthy and balanced meals with more fruits and vegetables; go outside and spend time in the sun walking (while maintaining a safe distance!) or gardening, or swim, surf or hi‘uwai in the ocean; exercise – there are so many online and free programs – use cans of food or water bottles as weights or some Hawaiian music to hula your way to health; pule, practice breathing exercises, or meditate (there are free apps for meditation including, Headspace, Calm, and Buddhify) or; manage your breathing through blowing bubbles, practicing oli, or by blowing a pū.

We can and should draw on our Hawaiian values to deal with the COVID-19 crisis. Aloha, Mālama, and ‘Ohana, and the affection we hold for our keiki and kūpuna, are needed more than ever to overcome our current situation. Social distancing changed one way we express our Aloha: honi. Although we need to temporarily refrain from sharing a honi, there are many other ways to express our Aloha for one another. We can reach out to each other over social media or phone to show we care by checking-in with our family and friends. We can express our value of Mälama by helping our kūpuna and keeping our families and communities safe – all while wearing a mask, washing our hands, and maintaining some distance. We can express our values tied to ‘Ohana by treating everyone like they are family members, friends and neighbors. Most of all, this means that we do not harm the ones we love.

We also need to extend our Aloha and Mālama to the most vulnerable in our communities – the homeless and incarcerated. The homeless are already stigmatized and experience social avoidance and rejection by others while living under threats of physical violence. They lack access to healthcare, education, housing and employment. Incarcerated individuals are vulnerable to COVID-19 because of the overcrowded and unsanitary conditions of the prisons. There is a local and national call to release prisoners sentenced for non-violent offenses and who are close to completing their sentences. These people are part of our ‘Ohana and need our Aloha.

As we deal with the COVID-19 outbreak, remember that our küpuna overcame many disease outbreaks in a similar fashion. In 1881, a smallpox epidemic broke out in Hawai‘i while King Kalākaua was on his world tour. The future Queen, Lili‘uokalani, served as Regent in her brother’s absence, leaving her to respond to the outbreak. To contain the spread of smallpox, she ordered the closing of ports to prevent ships filled with passengers, possibly carrying the disease, from entering. She ordered a quarantine of the infected and asked all citizens to shelter in place. Our Hawaiian community is resilient and looking to our history and culture can help us overcome even the most difficult of circumstances to protect and grow our lāhui.

Kihe, Mauli Ola!

For assistance call:

24-hour Crisis Line of Hawai‘i – 832-3100 on O‘ahu or toll-free at 1-800-753-6879
Visit hawaiipsychology.org to find a psychologist, including pro-bono services
Aloha United Way
– Call 211 or text ALOHA to 741741
Domestic Violence Action Center – Call toll-free 1-800-690-6200 or text (605) 956-5680 (Monday-Friday 8 am to 5 pm)
Hawai‘i Tobacco Quitline – Call 1-800-QUIT-NOW (784-8669)

For kūpuna care resources visit:

ourkupuna.com for help with meals, groceries, and errands
malamameals.org for free meals
helpisontheway.org for delivery services


Joseph Keawe‘aimoku Kaholokula, PhD, is a Clinical Health Psychologist and a Professor and Chair of Native Hawaiian Health at the John A. Burns School of Medicine, University of Hawai‘i at Mānoa.

Robin E. S. Miyamoto, PsyD, is an Assistant Professor with the Department of Native Hawaiian Health at the John A. Burns School of Medicine, University of Hawai‘i at Mānoa. She is also a practicing Clinical Health Psychologist with University Health Partners, Departments of Native Hawaiian Health and Family Medicine and Community Health.

Andrea H. Hermosura, PhD, is an Assistant Professor with the Department of Native Hawaiian Health at the John A. Burns School of Medicine, University of Hawai‘i at Mānoa. She is also a practicing Clinical Psychologist with the Queen’s Medical Center and University Health Partners, Department of Family Medicine and Community Health.

Nicole Aurellano, PsyD, is an Adjunct Assistant Professor with the Department of Native Hawaiian Health at the John A. Burns School of Medicine, University of Hawai‘i at Mānoa. She is also a practicing Clinical Psychologist with University Health Partners, Department of Native Hawaiian Health.