How Vulnerable is Hawaii in the Face of a Coronavirus Pandemic?

COVID-19 BlogCOVID-relevant
Written By Adriann Gin

This is part of a series of posts highlighting results from the Hawaii COVID Contact Tracking Survey conducted by the National Disaster Preparedness Training Center (NDPTC) and the Pacific Urban Resilience Lab (PURL) at the University of Hawaii at Manoa. The Hawaii Data Collaborative has partnered with this group to share regular analyses and updates from this survey in the coming weeks. If you have not done so already, we encourage you to participate in the survey here.

As Hawaii continues to flatten the proverbial “curve” during the current Coronavirus pandemic, there is growing confidence among our decision makers and the general public that, perhaps, we have taken back control of our collective health and can start relaxing shelter-in-place restrictions and even look for ways to restart the state’s economy.

While there is much for which we can pat ourselves on the back, the harsh reality is that we are still very vulnerable to COVID-19, according to data compiled by the Surgo Foundation. The foundation is a Washington based nonprofit organization focused on bringing the latest innovations in the study of human behavior, technology and data analysis to health and global development. They have developed an index that captures how vulnerable different states and communities are in their abilities to respond to the Coronavirus pandemic. In this way, the index identifies communities that may need the most help as they face outbreaks of the virus (see Map 1 below).

The index uses a simple composite metric based on six factors:

  • Socio-economic status

  • Household composition and disabilities

  • Minority status and language

  • Type of housing and transportation

  • Epidemiologic factors, and

  • Healthcare system factors

Use the (+) in the upper left corner of the map to zoom in to see detail, and click and drag the map to move around. Community colors show estimated COVID-19 community vulnerability (CCVI), with red indicating higher vulnerability and light yellow lower vulnerability. Click on the map to see the CCVI score for that community. You may view different layers by checking the boxes in the bottom left control panel on the map.

Socio-economic status is determined by the number of individuals with low-income, low education and without an occupation. Household composition and disabilities include single-parent households and those with seniors (over 65), young members (under 17), or with disabled members. Minority status and language are categorized by racially marginalized groups or those with limited English proficiency.

Type of housing and transportation include multi-unit dwellings, mobile homes, homes with crowded living conditions, and households without access to transportation. Epidemiologic factors include populations with underlying health conditions, including cardiovascular, respiratory, immunocompromised, obesity, diabetes, high flu and pneumonia mortality, or high population density. Healthcare system factors relate to poor health system capacity, their strength and preparedness.

Mississippi was the most vulnerable state according to the Surgo Foundation’s calculation. New Hampshire was the least vulnerable state. Hawaii was ranked 12th, putting us among the most vulnerable. Specific to Hawaii: Several neighborhoods on Oahu ranked among the most vulnerable, including neighborhoods in town as well as on the Leeward Coast. The least vulnerable neighborhoods were on Maui (Haiku-Pauwela and Olowalu), but also included neighborhoods in Honolulu, Oahu. Most notably for Oahu, neighborhoods with high and low vulnerability are often in close proximity to each other. According to the Surgo Foundation’s model, the differences in vulnerability are often due to characteristics of people and households, rather than the health system.

It suggests that, while Hawaii has done well by sheltering in place, other socio-economic factors could place us in a precarious position if we were forced to respond to a full-blown pandemic, disproportionately affecting certain segments of the population–even those who are our closest neighbors. Some have suggested that our decision makers are being overly cautious when considering when and how to reopen the state to business and life in general. They insist that we have turned the corner. And we have. But, as the Surgo Foundation’s index shows, we still have much to be careful about during a pandemic that has yet to show us its teeth and full bite in Hawaii.

We have significant portions of our population that are prone to high blood pressure, diabetes, obesity, heart disease, chronic poor diet and certain cancers. Our people are scattered across seven islands with with no network of interstate highways and with many who do not have easy or equal access to hospitals and healthcare services. With our high cost of living, nearly half of our families live either in or on the edge of poverty, according to an Aloha United Way report on financial hardship in Hawaii (ALICE Report). Our biggest industry, tourism, is among the hardest hit by the pandemic. The success we’ve had with sheltering in place has come at a very high price.

Moreover, some of the index’s key factors, such as the resiliency of our families (financial and socioeconomic), may have been made worse by the pandemic, further increasing our vulnerability going forward. We’ve been smart about our initial response to the pandemic. We are flattening the curve. There is optimism in the air. But a little discomfort and uneasiness could also be a healthy thing, because there is no turning back once we’ve let the cat out of the bag.

 
Adriann Gin
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