The first weekend in August, Maile Alau and her ʻohana were moving into their new home. Saturday was a busy day spent moving boxes and furniture. On Sunday the work continued but as the morning wore on, Alau started to feel unwell; her throat was scratchy and she had started coughing. She ignored her symptoms, intending to power through, but by 1:00 p.m. she felt so weak that she had to lay down and sleep.
Alau awoke on Monday morning with a fever and body aches. She called her doctor and they were on a tele-medicine call when Alau realized she could no longer smell the diffuser on the table next to her. Her doctor scheduled a COVID-19 test for her the next day.
On Wednesday Alau learned she was positive. Later that day she went to the emergency room because she was having trouble breathing. The doctor ordered a chest x-ray and checked her oxygenation, which was fine at 97%. Her chest x-ray seemed clear and Alau was sent home with an oximeter and instructions to return if her blood oxygen levels dipped below 92%.
“It came on really quickly,” said Alau. “There were probably seven days of really high fever and super horrible fatigue. I couldn’t taste or smell. I could not breathe. I was laying in bed panting like I ran a 5k. Then the fever started going down but my cough, which had gone away, came back with a vengeance and I started coughing up blood.”
Alau called her regular doctor again. Her doctor reviewed the x-rays taken when Alau visited the emergency room the week before and found a few tiny spots that had been missed, indicating pnuemonia. Alau was prescribed a course of antibiotics.
Although Alau’s husband, Jason Teaney, also tested positive for COVID-19, he never had any symptoms. And Alau’s 14-year-old son and their housemate were negative. “It’s weird because we hang out together and we eat together,” said Alau, who is not even sure how she became infected.
By the end of August, Alau was well enough to resume working from home. Her fever and cough had subsided, although the fatigue persisted into September. Eight weeks after being diagnosed, Alau’s lungs are still not working right. “I used to be able to walk three miles easily. Now I’m up to about three-quarters of mile before I have to rest.”
Shane Keliʻi Valdez is a surgical nurse and a self-described “super O.C.D. germaphobe.” So when he tested positive for COVID-19 on August 26 it came as a shock.
“At work we are so careful and diligent about wearing our PPE. And I’m the one with Clorox wipes constantly wiping doorknobs, handles and code buttons. But the one place I let my guard down was at home,” said Valdez.
Valdez lives next door to his parents. His mother is ill, so he does the grocery shopping for both households, going between the two homes. His cousin also lives in the home, so when her boyfriend tested positive for COVID-19, Valdez’ first concern was for his parents. He wanted them tested immediately but was told that they should wait a few days because it might be too early. But Valdez got tested right away since he was over at the house every day and often cooked for his parents. When his test came back positive, his fear was for his mother.
“I was just so worried that I had given it to my mom and that she would not survive it,” Valdez recalled. “So those first five days were pretty nerve wracking. I couldn’t even focus on myself; compared to my parents, my chances of survival were greater. So, when my mom’s test result came back negative it was a huge relief to our whole ʻohana.”
Valdez was fortunate to have very mild symptoms. But that is an important part of the story that he wants to share. “At first I had a little bit of a headache – but it could have been caffeine withdrawal from not having coffee that morning; I was a little short of breath – but I’ve put on a few pounds because I haven’t been exercising. The symptoms are vague, so they are easily dismissed.”
About a week after his diagnosis, the headaches got worse and his lungs weren’t working at capacity. He had an oximeter at home and was monitoring his blood oxygen levels, which were low, but not dangerous, at 91-92%. But the day his oxygen saturation dropped to 88% he got nervous. “I’m a medical professional but I wasn’t sure when to seek medical help,” Valdez admits. “Any nurse would put you on supplemental oxygen if your sats are 88%, but I didn’t want to occupy a hospital bed for a little bit of oxygen in my nose. There were more critical patients needing care.”
The next day his oxygen levels were up to 94-95% and for the most part he felt okay. He returned to work in mid-September, but his oxygen levels have continued to hover between 95-97%. His doctor says that may be his new baseline.
Three years ago, Chasity Peters’ mother suffered a massive stroke that has left her confined to a nursing home, unable to walk or speak. It has been extremely difficult for the family. “She loved to sing,” said Peters about her mother. “She was a stay-at-home mom, caring for the six of us kids and then 15 grandkids. She was the rock of the family always praying for everybody, always there to listen. For her to go through so much and still be here with us is a testament in itself.”
The ʻohana has been unable to visit Peters’ mother since nursing homes were locked down in March; their contact limited to video chats. In early July, Peters’ father got a call from the nursing facility asking for consent to have his wife tested for COVID-19. The family assumed it was routine. When they received another call a few days later saying she was positive, they were shocked and angry.
“It was a roller coaster of emotions,” Peters shared. “My mom’s condition put her in the high risk category. One of the reasons she’s in a nursing home is because she lived on a respirator when she first got sick. Everything hit the fan. For the first two to three days it was the blame game: How did this happen? Who messed up? Who gave it to her? Honestly, that was the hardest thing – the rage.”
They later learned she was infected by a nursing facility staff member. “I couldn’t sleep. My dad couldn’t sleep. It was super scary. We kept calling to find out what was happening,” said Peters. “Everyone just got on their knees and prayed.”
Remarkably, Peters’ mother was asymptomatic despite her serious medical conditions. “Our family is 100% blessed and thankful,” Peters reflected. “We believe God answered our prayers. We don’t understand why she’s still here on Earth while others are not.”
Charlie Iona lost his brother, Eddie Bissen, to COVID-19 in early April. Bissen, a limousine and Uber driver in New York City, was 63 years old. He was most likely infected with the virus by one of his passengers.
“I was browsing Facebook and saw a post by my brother saying he contracted COVID but was doing okay,” Iona recalled. “So, I called him and said, ʻHey what’s going on?’ He told me he had a high fever – between 103-104. Too high. I told him that until he was over it, I was going to call him every day. That was on March 29. A Sunday.”
The following day when Iona called his brother didn’t pick-up.
On Tuesday, Iona received a call from Bissen’s girlfriend, Mary Freda. She told Iona that Eddie was in the hospital and that she had never seen him look so scared. Freda promised to keep Iona updated. She also had COVID-19 but her symptoms were mild.
The next day Freda called saying Bissen would be dialyzed (on dialysis) 24 hours a day and that the doctors were trying hydroxychloroquine. But hydroxychloroquine therapy was quickly discontinued after it adversely affected Bissen’s heart. Then the dialysis filter began getting clogged because Bissen’s blood was so thick. “That’s the first time it was revealed that he had blood clots,” said Iona.
By Friday, Bissen was in a coma and on life support, not responding to any kind of stimulus. For two long days Iona waited for news about his brother.
Then early Sunday morning Iona got a call from Freda. “At first I couldn’t understand her, she was crying so much,” Iona said. “She finally told me that the doctors had taken Eddie off life support to determine whether there was any brain activity, and that he passed away within a minute. He was already brain dead.”
In an effort to inform, educate and change behaviors, after his brother’s death Charlie Iona partnered with Mel Rapozo, to co-host a nightly show they call COVID Discussions. The show runs Monday through Saturday at 7:00 p.m. and streams live on their individual Facebook pages. Both men are retired police officers with backgrounds in investigation, and over the past six months have hosted a remarkable array of guests including physicians, politicians, government officials and coronavirus survivors. They use their popular platform to provide first-hand information about the disease from experts and survivors, and to debunk rumors and conspiracy theories.
Nearly ten months into the pandemic, a great deal has been learned about this highly contagious and potentially deadly virus. But even as researchers race to develop a vaccine, much about the disease remains unknown, not the least of which is why some people get so sick and others do not.
The way COVID-19 affects people can seem random. While kūpuna and those with chronic illnesses are the most vulnerable and account for the majority of deaths, there are glaring exceptions. Young, healthy people, including children, have also died from COVID-19.
As of press time, more than 31 million people worldwide have been infected with the virus, and nearly one million have died. Deaths in the U.S. have surpassed 200,000 people, and COVID-19 is now the third leading cause of death in America.
Dr. Jordan Kalenakai Lee, an ICU physician with The Queen’s Medical Center, says it’s important for people to understand that COVID-19’s mortality rate is only part of the story.
“COVID-19 is a ʻnovel’ virus, meaning the human body has never seen it and doesn’t know how to react. So, it turns up the immune system and goes unchecked, which leads to a lot of multi-organ damage: the heart, the lungs, the blood vessels, the brain,” Lee explained. “It can cause strokes. And the majority of hospitalized patients develop a form of acute respiratory distress syndrome.”
Lee notes that 15-20% of people infected with COVID-19 require hospitalization. Of those who are hospitalized and recover, most will have permanent heart or lung damage. A smaller number will suffer strokes or experience some loss of cognitive function, or early dementia.
Although infection rates continue to soar, new medical therapies are resulting in better outcomes for the sickest patients. However, there is no cure for COVID-19 and a safe, widely available vaccine is months away at best. Given the unpredictability of anyone’s individual response to the disease, the fact that it is highly contagious, and the risk it poses to our kūpuna, it is in the best interest of our lāhui to reduce the spread of the virus and avoid getting infected.
Reducing community spread of COVID-19 is also critically important to ensure that sufficient hospital beds are available and so that health care professionals are not overwhelmed.
“During the height of the second wave in August, our hospital was near capacity,” said Lee. “Our COVID ICU was full and spilling over into other ICUs when hospitalizations peaked. Thankfully they have started to drift back down.”
Continued Lee, “Hospital beds and ventilator capacity is not the issue. It’s staffing – particularly nurses to care for critically ill patients – not just for COVID-19, but for every critical patient admitted, whether for heart attack, trauma, strokes…once the health system gets strained it can affect the quality of care all patients receive.”
According to Lee, hospitals are cooperating to share the COVID-19 patient load and FEMA has flown in relief critical care nurses for two weeks to help offset the nursing shortage and to allow Hawaiʻi nurses time to recover after working multiple double shifts.
At this point, preventing the spread of COVID-19 is key. And because of our family-oriented culture, and our many multi-generational households, difficult behavioral changes are required.
“Living in Hawaiʻi, we hug and we honi. Aloha is just ingrained into our psyche,” reflects Lee. “To be isolated and not touch is really hard for everyone, myself included.”
Regardless, restraint is important. Adds Alau, “If there is a chance you could hurt somebody, wouldn’t you do whatever was needed to avoid that? If we claim to have aloha, if we claim to care about our lāhui, then we have to do what we need to do to protect them. Period.”