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HomeMy WebLinkAboutMIN COUNCIL 2015/12/02 2014-2016 Special County Council th 28 Session 25 Aupuni Street Hilo December 2, 2015 CALL TO y Council was called to order at ORDER: 1:06 p.m., in the Council Chambers, Hilo, by Mr. Dru Kanuha, Chair. ROLL CALL: Present: Mr. Dru Mamo Kanuha, Chair Ms. Valerie T. Poindexter, Vice Chair Mr. Aaron S. Y. Chung, Member Ms. Karen Eoff, Member Mr. Greggor Ilagan, Member Mr. Danny Paleka, Member Ms. Margaret Wille, Member Absent & Excused: CHR. KANUHA: Thank you, and again real briefly Council Member Onishi is on the mainland representing our State in the National Association of Counties. They have a annual meeting in Colorado, so he is there currently. And will be efore we begin just wanted welcome everybody. And say big mahalo to all of you for coming and being part of this special meeting. You know, this is something that we are really concerned about, and wanted to open it up more to public information, education, and how to mahalo, to each and every one of you, to come out and spend your time with us here today. So if we can Mr. Clerk, Communication 575. COMMUNI- The Chair directed the Council to proceed to the next order of business, CATIONS: Communications. Comm. 575: REQUESTS A SPECIAL MEETING TO DISCUSS THE DENGUE FEVER OUTBREAK ON HAWAII ISLAND From Council Member Aaron S. Y. Chung, dated November 20, 2015. Motion to Close File: Mr. Chung moved to close file on Comm. 575. Seconded by Ms. Eoff. -28 December 2, 2015 CHR. KANUHA presentations and some questions, and answers with the Council Members first. And so the community can ki discussions are taking place. So just on appreciate everybod. If they would like to testify to go after the presentation, so mahalo, everybody. Mr. Chung, go right ahead you have the floor. MR. CHUNG: Oh, yes. Thank you very much, Mr. Chairman. And yeah, I really do appreciate your efforts in putting all of this together. You know, this is a matter of great concern for I would say for most of the people on this island. And you know, having made the request, you know, there was several reasons why I thought it would be useful to have all of these people come here today. First of both the Civil Defense and the Department of Health have been working jointly in setting up these community meetings. on the TV, you know, the one that was in Kona. And I know you guys are doing as much as you can in terms of outreach. But you know, in this particular situation, I think I stated it in my memo to the Chair, redundancy and . And you know, ed the Clerk to arrange with Na Leo. I see a person from Na Leo back there you know, because we want to get as broad of a reach as possible to underscore all of this by giving just a story. You know, I was in court at the courthouse the other day. And a number of people, including a judge, asked me questions about dengue. And I was able to answer them, because of the informational meetings and the stuff I was able to obtain at the Hilo High School meeting. But it also indicated to me that we got to do whatever we can to get people more informed. reasons. This is our effort as you know. We have our viewership too, right, for whatever reason. But you know, I talked with Chief Oliveira about this earlier, and then I asked him if he could be the one to make the initial presentation. And unlike what has been presented at these community informational meetings, I said if he could just maybe give an abbreviated or truncated version of the Fight the Bite. You know, what the public can do, and you know, little bit about you know, I was educated by Representative Creagan. What do you tie, right? He kept on saying that over and over, and over, and at first I was thinking , of these vectors. have to go through your whole presentation. Page 2 -28 December 2, 2015 I think what is really of interest to us is, what is the game plan, right? Operationally, logistically, and you know, maybe using a medical term. W the diagnosis right now? W see a lot of numbers on websites, you know, how do we read these numbers? I mean are we on the upswing, leveling off, is that normal? You know, things like that, and also I read that we have a person from the CDC (Centers for Disease Control), or several people from the CDC who are on island. hoped that they would be here, but they have more pressing things. And we understand, but Chief, and what they found out so far. And I guess we also want to know, you know, y Council side. And if there is, please let us know sooner than later, okay. And then finally, you know, we have our distinguished legislators, Senator Josh Green, Representative Richard Creagan, who have really been at the forefront, I think, at asking questions and being concerned for their constituents, you know, not just in South Kona, but really for the whole island. And you know, I thought it would be useful to have them present too, so that they could share their perspectives on this matter and perhaps even ask questions, if you saw fit. So really Mr. Chairman, I give it back to you. I just wanted to state what the reasons CHR. KANUHA: Thank you, Mr. Chung. And before we get started, I just got a message. I mean the point of this meeting is to disseminate information to the public. And we have a pretty good live streaming option, available to those that w, but if we can take a brief recess. I know time is of very much value, so that back on and continue with the meeting. So I just want to make sure our live stream is working before we continue. So thank you recess. Recess: At 1:14 p.m., the Chair called for a recess. Reconvene: The meeting reconvened at 1:26 p.m. CHR. KANUHA So back to the meeting. Mahalo, Mr. Chung for the introduction of this communication, and for bringing this to the communit attention. First off, like to just welcomemaybe we can start with Chief Oliveira. You want to come up and do a little presentation, and maybe address a few of what Mr. Chung said? Dr. Pressler we have from Department of Health, is available as well. Page 3 -28 December 2, 2015 (Note: At this time Civil Defense Administrator Darryl Oliveira came forward to address the members of the Council.) MR. OLIVEIRAPressler to introduce this. CHR. KANUHA: Exactly. MR. OLIVEIRA: I mean, Department of Health and Civil Defense, has been basically joined at the hip. (Note: At this time State Department of Health Director Jenny Pressler came forward to address the members of the Council.) CHR. KANUHA: Thank you. MR. OLIVEIRA as we do the presentation. Ws happening locally as well as the oversight that the Department of Health is providing. Again, I cannot stress th start. When we were notified of the outbreak initially on November 4 again, if you could imagine there were only a few cases identified at that point. And a collaborative discussion on a proactive measure. Close down the park, and limit access or restrict any access. In an attempt to get a better understanding of where this site may have beenfor lack of a better way, say ground zero for the introduction of virus. And where there was a potential for continued exposure to people visiting the park and becoming infected. So that was one of the first steps or first decisions, and actions taken collaboratively between the County and Department of Health. helpful to look back at the history of this event as it unfolded, and some of what the public with more information about the action, and the done up till now. So as I mentioned, since that date we started the public information dissemination with messages coming out of our office. The Department of Health was producing a lot of the public information materials that were then disseminated and shared through the community. sure those flyers, brochures, informational releases, are in multiple languages, to Page 4 -28 December 2, 2015 have as much saturation in the community, as far as the protective measures, the Fight the Bite Campaign, and what people can do mitigate or abate things around their homes and businesses. So in addition to the public education and outreach, and information dissemination, we quickly assembled an incident management team structure, locally on island, a unified approach to this. So although our office, myself, has a lead as far as the unified command, it is a joint command, that we have Keith Kawaoka out of Oahu is like my pier or my counterpart in that command. As well as locally we have Aaron Ueno, the District Health Officer in our office regularly discussing the operation. So we are working very closely together throughout the whole event and response. We wrote the operations into four basic areas, one would be with the surveillance eam out of Oahu are evaluating all the cases that are indentified. The lab does all the analysis, communication from the lab to the vector control folks, so that the spraying can be coordinated, based on the confirmed cases. And just getting a really good picture of the overall evolution of the virus. Where are we seeing cases? Are there any hot spots? Are there points of interest or concern that we need to visit? Ss what that surveillance branch is doing. The next branch under operations is the vector control. So as they get information about confirmed and suspect cases, the Department of Health vector control team, goes out and does an assessment as well anticipates spraying. Why I say anticipate, one of the steps needed to actually conduct spraying is consent from the property owner. But they go out, they make contact with the property owner, tnt of the environment around that particular residence or business, identify areas of concern that might be habitat or breeding grounds for mosquitos. They also use it as opportunity for education with the person they make contact with. What you can do to protect yourself? What can you do to minimize or control the environment in and around your home to lessen the breeding opportunities for the mosquito? And then they get consent, and they currently the practice out to 25 yards from that residence around the property, and treating the mosquito As I mentioned, if they encounter any kind of standing water, or other habitat the working with the property owner on addressing that. That same team is also supported with additional personnel from the medical reserve core, and as well as other staff, maybe from our Public Works and Parks Departments, but at initial point of reference or that house, and the potential that dengue is in their area, and what they can be doing on their properties to eliminate habitat, and breeding grounds for the mosquito. Again, trying to control the vector, or that mode of transmission which is the mosquito. Page 5 -28 December 2, 2015 very fortunate the Mayor has been extremely supportive of everything, and aggressively encouraging us to do everything that we can to get control of this outbreak. So to supplement or provide additional capacity to the vector teams, we had Parks and Recreation and our Public Works Department personnel get trained on the application of the particular pesticide as well on how to conduct those sights surveys, and assessments. So they been supplementing the Department of Health vector control teams. We been conducting additional training through the vector control branch of DOH with DAGS (Department of Accounting and General Services), and the purpose there was to give some additional capacity to the school system to assess school properties at the campuses. Are there any things there that they can address or mitigate, as well as open the opportunity up for possible treatment of the schools as a proactive measure? of Trans, Highways and Airports Division Maintenance personnel come through and receive training so they can also participate in controlling the vector in their properties and areas of responsibilities. capacity as we go, in anticipation that this could continue to grow, and we want to make sure that we have sufficient capacity to continue to be effective in the response. The other branches that we have are public education, and a risk reduction branch. The risk reduction branch, we have teams going out based on calls or complaints being brought to our office. For issues such as standing wate property or a public property: abandoned tires, abandoned vehicles. So these teams go out and investigate the complaint, they employ whatever initial mitigation measure can be done, which includes simple things like spraying soap water on standing water in vegetation. They may take that opportunity to educate property owners, on what they can do to be part of the solution. And they also identify things that we need to go back and correct, with other resources. If lets ge tires that cannot be moved off the property, how can we go ahead and get those things off the property through other means and partnerships? Tied to that is the efforts made by our Department of Environmental Management. As you know, they waived the fees for collecting or receiving tires to be recycled. And this is in an effort to help residents turn in tires, where previously there was a charge or a fee. As an incentive, bring them in now under this particular response to this outbharge, the only caution or caveat we have there is wthere to be taking advantage of this offer by some of the commercial operators in bringing in truckloads of tires. This is meant for the residents, and those who have a challenge with bringing in tires because of the financial constraints. working very aggressively with commercial operators, to make sure that theyre Page 6 -28 December 2, 2015 doing what they can to minimize breeding grounds with the storage of tires on their properties. working very closely with the Big Island Visitors Bureau, we working very closely with our faith-based community, many different organizations, in just trying to saturate the community with as much information as possible about this. And we have identified some, I would say, difficult to reach groups in our , as well as, you know, our migrant work force, that maybe English is not their primary language. So going back to the partnerships with the faith-based community, they are an excellent conduit, as we learned with the lava flow, to reach out to our migrant population, arough the Research and Development Department of the County, in their context in the agricultural community. Warehouse Union), which represents both the agriculture and some of our resort employers or employees. So trying to find as many conduits out to people, to provide information outreach. certain if that they have dengue, make contact with a health care provider, talk to your doctor. of the clinics, urgent cares, community medical centers. We met with all committed to accepting anyone regardless of ability to pay. Because the value , some of these individuals may be suffering from other issues that are way more serious, and if undetected or unchecked, could have worse outcomes, such as leptospirosis, and other things. to encourage people to come in , it will help us get a better understanding on the spread and evolution on the virus. But it will also insure, th with. On the of many organizations that does outr had several events or what we call a multidisciplinary team. These are teams of personnel comprised of Fire EMS, Department of Health, and also Hope Services personnel and staff. They go out and make direct contact with the homeless population, and identify anybody symptomatic. Can we offer you an opportunity to be checked or assessed? Do you need transportation? Hope Services has been providing transportation to some of the health care facilities for these individuals. And then providing some additional follow up. individual, and make sure they get checked in, b someone off, they may walk away. But to give them assurances that our goal is to Page 7 -28 December 2, 2015 make sure you get the proper assessment, proper care, get diagnosed, and to have the test done to confirm whether or not you have dengue. S to take up too much time, because I e time for questions. But I definitely want to give Dr. Pressler an opportunity t b overseeing this and providing great guidance for us. CHR. KANUHA: Thank you, Chief Oliveira. Dr. Pressler, if you could press the button at the bottom, if it comes red, perfect. DR. PRESSLER CHR. KANUHA: And just introduce yourself for the record. DR. PRESSLER: Certainly, aloha. CHR. KANUHA: Aloha. DR. PRESSLER: Thank you, Mr. Chair and members of the Council. My name is Dr. Jenny Pressler, I am the Director of the State Department of Health. And I am very, very happy to be here today, along with my colleague Chief Oliveira. I want to say first of all that we share your concern, and we take this very seriously. The Governor will be over here later this afternoon, meeting with the Mayor. My own family, all of my family, lives here on the Big Island, throughout the island. So not only do I care about this as the Director of Health for the State, but also for my own family. I have a personal vested interest in this. I think, , in spite of all of the things that Chief Oliveira is have the message. And so we really are encouraging people with the Fight the Bite campaign, 211. They can call 211, Aloha United Way, for general information. And then they, in turn, if they need to get services or something, can make sure that they follow up. Or go to our health.hawaii.gov website for the Department of Health. T information there on frequently asked questions, which we are updating, by the way, on a regular basis. When we have these community meetings, and we get new questions, or we get questions by email or however we get it. We update the questions on our website s. But to be perfect. So we welcome these opportunities, this Council meeting, anything we can do to help spread the word. Our projective is to protect the health and the wellbeing of Page 8 -28 December 2, 2015 our population, and the whole idea with the Fight the Bite is to take away some of the angst. And help people appreciate what they can do, to help protect answer questions. CHR. KANUHA: Thank you, Dr. Pressler. I think I kind of want to make it like a question and answer-type of situation. With Council Members asking both questions, and just try and get as much information as possible that either we it up to Council Members first. Ms. Wille. MS. WILLE: Thank you, for being here. One of my questions is with regard to the migrant population. And I know just from other experiences that many of themnumber one, you know, might be concerned about their immigration status and that. And second, just in terms of their employment status, in other words there are, I think, people that in my view should befarm workers who should be nder the table and then if something came up, who do you work for, what do you do? It might jeopardize their employer, and job. And I just see them as a really vulnerable population, and I also see you know, the way the map goes, you know that movement over the past month with the migrant population. And just, you know, I know we the language barrier, the cultural barrier, and just all of that additional fear. Even not just themselves, but jeopardizing other people. And so how we can sort of address those obstacles to really communicate with who I consider probably the most vulnerable, susceptible, as to who do we go, where do we try to do our prevention. DR. PRESSLER: Yes, and we certainly share that concern. That is one of the how d, their employers not going to be prosecuted. Our whole intent and focus is on getting people the health care that they need, and to put an end to this outbreak. So prosecuting But I think Chief Oliveira, has more information as far as the actual outreach , and the language translation, and all of those things. MR. OLIVEIRA: Thank you. So on the issue of the migrant population that again there may be barriers language-wise, cultural-wise, as well as many other things, you know, the reason why we chose to work through lets say R & D with the contacts for our or agricultural community, because of that mutual benefit relationship between the employer and farm worker, we felt that would be an Page 9 -28 December 2, 2015 just as much as that worker needs his employer. So we felt going that route as come across as threating government trying to find you, fears of either immigration or other issues. The other one was through the faith-based community, as I mentioned. T lot of trust with people in there, their faith-based organization. So we saw that as a good way of reaching out to the community in a manner that they felt maybe comfortable coming forward. And lastly, consider is maybe cultural leaders in the community or representatives. At one of the Kona meetings, a woman stepped forward and said she is a conduit to the Hispanic community, b viewed as someone that is in a position to help bring them together, and get information back and forth. So there was a meeting held with the Department of Health representative from our office and Dr. Pang. They met with that woman and a large contingent of the Hispanic community that make up a lot of the coffee pickers in the Kona area. So we are looking at different strategies Health Care Association, HH, with Toby Clairmont, the possibility of establishing, a capability of a, if you want to call it a field clinic. If it comes down to that need that needs to be deployed to provide access to health care with a combination or variety of different providers comprising or making up this team and going out and being accessible in the rural areas where there is no health care facility there. T en working really hard reaching out to his groups and organizations, and at least identifying that capability. W concept of using some of the medical vans that are out there in the community. are. MS. WILLE: Okay. And so I assume, say with the homeless population, youre similarly, how do we get out there, and not just how do we wait for them to come in to us. DR. PRESSLER: And let me address just one thing related to the migrant workers. W. T this is all Type 1 denguethe virus, and so far in Type 1. And many of these individuals will already be immune to it, because they had dengue from where they came from. So it may be a littlecause Page 10 -28 December 2, 2015 it may not be spreading the disease as much as some may think. important to know. MS. WILLE: re coming in, and put them at alert so that if they potentially are bringing it in, we can address that. the schools. I did ask Director Oliveira, because . Just in terms of sort of using that discriminately and at the schools, and where youhether there could be an impact also on you know, dogs or cats or that. MR. OLIVEIRAUeno, up from , again, instrumental in this response, and can give the subject matter expertise answer to that question. T case. This is very selective Aaron explain that. MS. WILLE: And what chemical is being used, and just sort of a little bit about it. (Note: At this time, State District Health Officer Aaron Ueno came forward to address the members of the Council.) MR. UENO: Yeah, the chemical CHR. KANUHA: Aaron, just real quickly sorry, if you could just introduce yourself. MR. UENOUeno, District Health Officer for the Big Island. CHR. KANUHA: Thank you. MR. UENO: Thank you, for having me. The chemical that is being used for spraying for adulticide is aqua- Department of Health programs only. MS. WILLE restricted to you all purchasing, m restricted pesticide. MR. UENO: Correct. -restricted MS. WILLE: So I just wanted to get that really clear. Page 11 -28 December 2, 2015 MR. UENO-restricted pesticide. MS. WILLE: Meaning? Can you just sort of, since this is going out to the public I translate some of these terms. MR. UENO a general use-type pesticide, but unfortunately the public cannot purchase it. MS. WILLE: Right. But I think that the director has spoken doing it as a fog, and in limitedi suspect the possibility of a problem at that location. MR. OLIVEIRA: Right. I want to stress that there established, between any school campus and the outbreak. The spraying that was done around the campuses primarily in the Kona and Hilo areas, off top of my head there where the Konawaena campuses, high school, middle school, and elementary. There was also a charter school, or an immersion school on that campus; the Hnchools; and on the Hilo side, the Hilo High School, Hilo Intermediate School, and Waiakea Elementary and Intermediate Schools. And the decisions to spray and treat areas around those campuses was, because those campuses were in proximity to confirmed cases. And as I mentioned, treatments. The vector control team goes out, surveys the campus, identifies potential breeding grounds or habitat for the mosquito treating. And we do that in partnership with the Department of Education, or the principals at these schools. We make sure that if they have school gardens, many of them have school farms, areas where you have fruits and vege been in coordination with the school administration, and support of DOE. MS. WILLE: Okay, and lastly, I just want to bring up two things that I think have come up repeatedly. And one is, if someone feels that their neighbor, they , tires around or their gutters are full of water a concerned, my understanding is they can call your office and get help from you, I think that was an important question. And the other is where people have animals, like horses, cattle, or farms, you know, or do they have to go change that water everyday? So just in my district those have been two frequent questions, if you could just have any comment on that. MR. OLIVEIRA: Right, as we mentioned prior, if someone has a neighbor or a neighboring property that they see concerns for mosquito breeding grounds or habitat, a maybe approach their neighbor, m Page 12 -28 December 2, 2015 even have contact with their neighbor. You could have an absentee property owner, or that property could be in foreclosure, a number of different reasons why cases so that we can bring closure to them. B the complainant know when they provide us that information what were some of the actions taken. Because it could be something as simple as, getting the tires off the property. It could also be putting holes in the tire if there too large to lift at that time, so that they drain. It could be treating any ponds of standing water with the soap solution, if there small ponds, as well as putting in larvicides in some of these larger ponds. The other thing we would try to do from our office in partnership with our property tax office is, reach out to the property owner. Even if it is a financial institution that now has a title because of a foreclosure, let them know a health and safety concern, and ask for their help in correcting that. Obviously the County does not have the resources to address every single need, help. W community for support with what they can do for themselves, and how can they help their neighbors if possible. You know, we can go back to neighbor helping neighbor, like we saw with the response to other disasters in our community. ke to ask for that help. MS. WILLE: And just for like farm owners who are putting out water for their horses, for their cattle, what concerns about that? Just try to change it as often as possible? Or whatever. MR. UENOhave any product that we could recommend, not only for water troughs for large animals, but also for catchment tanks. MS. WILLE: Okay, and I just want to thank you DR. PRESSLER: One thing that we might be able to tell them is to flush the water tanks not being used, or something to minimize the mosquito population. MS. WILLE: Okay, and I hope that model. You know, if we had used this approach, and proactive with the little red fire ant, we would probably be in a big different place. So I appreciate how proactively you all are acting in collaborating. Thank you. CHR. KANUHA: Thank you, Ms. Wille. Ms. Poindexter. Page 13 -28 December 2, 2015 MS. POINDEXTER: Yeah. When we talked about being proactive, I know you spoke little bit about vector control. And if I look at the map, and there are a lot ed cases yet. Are we taking that proactive approach, and continually doing some spraying in areas to makeand of course the people have to take some responsibility in taking care of their property and some breeding grounds. But like even in , and throughout Hmbreeding grounds. And right now with a lot of rain, a lot of mosquitos. So what are we doing or what are the plans, to make sure that those places that have not had any reported cases stay minimized with breeding grounds for mosquitos? MR. UENO: In regards to mosquitos on the island, there is absolutely no way that the mosquitos is going to disappear from spraying. So the Department of Health is recommending that you take care of your own property, remove the breeding sites and protect yourself from getting bitten from mosquitos. So our spraying, so far has been to track cases, and suspect cases. Andgo ahead. MS. POINDEXTER: So if my community says we have a lot of mosquitos, even if I take out anything around my home, and mosquitos are just swarming in. in Hmkua, like I said the camps are built in areas where gulches and streams run. So if they would put out a call, would the Department of Health come out and help spray those areas at least to keep it down? Is my question, because we can clean our area, but mosquitos are going to come no matter what, they flock over to the homes with the lights especially in the evenings. So MR. UENO: As you explained to other mosquito, MS. POINDEXTERt to know. So night time mosquitos that are around, are not the ones that can carry the dengue. MR. UENO are the night time bitters. MS. POINDEXTER? MR. UENO: The two daytime biting mosquitos, the elbow piquetes, and the aegypti. MS. POINDEXTER Page 14 -28 December 2, 2015 see a mosquito in my house. And we start chasing it all over until we get it. I like stay up, you know. MR. ILAGAN: Council Member Poindexter? MS. POINDEXTER: Thanks. Point of MR. ILAGAN: Just point of information too. Information: MS. POINDEXTER: Yeah. MR. ILAGAN: wake up the daytime mosquito. MR. UENO: Right. MS. POINDEXTER: Yeah, okay. So MR. ILAGAN you wake up the daytime mosquito. The daytime mosquito will possibly MS. POINDEXTER: Okay, so then back to my original question. There we go back to the original question, thank you, for that Council Member Ilagan. Back to as that are not confirmed cases to make sure we spray those areas, so that we keep it down as well. Or there are no plans, if you have no plans, just say you have no plans to come out to my Hmkua. DR. PRESSLER we have the entomologist out here from the Centers for Disease Control. As we speak they are out doing trapping and trying to assess the kinds of mosquitos that we have, and how dense the mosquito population is throughout the island. l know how to address those particular mosquitos, that ed about that carry the disease. MS. POINDEXTER: Okay, please them to Hm them just testing in the areas that are confirmed, because we want to make sure, if , then we need to make sure to keep those places safe. I, all of a sudden, DR. PRESSLERan entomologist or vector control specialist, and I do appreciate the anxiety that this creates. We are trying to not only identify where the risk is, so that we can address it, but are trying to help educate the individuals in their own communities, to flush out the water tanks. If they have standing water, Page 15 -28 December 2, 2015 MS. POINDEXTER as we can, but we cannot control places that are not ours. Like in the gulches, So just saying please make sure, have the people from the Federal Government w, those areas that are not being confirmed cases, so that we kind of keep it DR. PRESSLER: Right. A s protect mosquitos in that gulch, right. MS. POINDEXTER: Yeah. DR. PRESSLER: But around your home, you certainly can help eliminate the breeding grounds. MS. POINDEXTER: But like I said in Hmkua in the camps and all, close by gulches, ymkua is a very that we keep in mind. Thanks. MR. OLIVEIRA: I want to add to that. n emphasis, if someone is feeling ill, staying indoors avoiding getting bitten and mosquitos, but the mosquitos may not be infected. But someone being infectious can then help that happen by being outdoors, and exposing themselves to being bit. MS. POINDEXTER: Right. And I truly appreciate that, but you know that a lot of our workers, a lot of our parents, go catch the bus to work at the hotel. So we have a lot of times children who are at home, and you know, to tell them, ey, you guys got t y that would happen, but in Hmkua especially our workforce is away, miles and miles away, and our children are home, so I appreciate that. But we know that in not like Honolulu you can walk to work, or ride a bike to work or something, and then monitor your children at home. So these are unique situations here on DR. PRESSLER: s are out here from CDC. To help us assess that, and figure out the most effective way to try to protect the population. Page 16 -28 December 2, 2015 MS. POINDEXTER: Thank you very much, I appreciate it. Aloha. CHR. KANUHA: Thank you, Ms. Poindexter. Ms. David. MS. DAVID: Yes, thank you, Chair. Mahalo for coming and providing us with Beach which is in my district, and the area where I live, could you give me a status on how the area is. Is it still closed, are we getting any more cases from that area? And have you folks been able to identify what you folks refer to as the ground zero? Just wanted a status on Hookena Beach area. MR. OLIVEIRAthe beach is the mosquitos down there, as well as we have had repetitive spraying of the mosquitos at the beach park. Reason why we refer to it as ground zero is that, with the original 23 cases if you recall awhile back. There was evidence that they were campers, visitors, residents who went there for the day. There was evidence that they all had at one point, , that beach park was probably the source of the exposure. So keeping it closed has allowed us to, with the Department of Health, conduct additional assessments of the mosquito population, do trapping. Because the spraying and treatment was very aggressive, counts were the area and the teams that are going down and spraying, since been a significant drop in the mosquito population down there. So the spraying what a quantitative analysis how But as Dr. Pressler the sites going to be going to. And conducting trapping, reviewing the specs that are trapped, and see what the population of the mosquitos are. Our goal is to keep the park closed long enough to outlive the life cycles of the months, we appreciate the problem that causes for our community, b very prematurely, and expose additional people. MS. DAVID: So I understand that the park is closed, but I do also know that there are residents in the area. And are tourists still being allowed down there? Page 17 -28 December 2, 2015 MR. OLIVEIRA as well as we put up a message board that basically sayseach park closed due to dengue outbreak. Working with one of the, I guess, park rangers if you want , h been sharing with us that people have been sneaking in or going in. W to provide as much information down there on the barricades and on the signage, it lets people know why the park is closed. Unfortunately, access completely, so public education is a big part of that. MS. DAVID wondering how you folks were going to handle that. Whether it was going to be closed from the top of the gate for just the residents. But thank you for that update. standing water, so if I put out a bucket of water, how long will it take for standing water to develop mosquito larvae op. MR. UENO: Generally speaking it would take about two weeks from egg, to wigglers, to pupa, to adult. MS. DAVID: Two weeks? MR. UENO: Yeah. MS. DAVID: From fresh? So if I forgot a bucket of water out in the back of my MR. UENO: Yeah. MS. DAVID DR. PRESSLER: We would recommend that you flush it at least once a week, and not wait for two weeks, right. MS. DAVID the timeframe was, so you have to empty it out basically all the time then. Okay, CHR. KANUHA: Thank you, Ms. David. Mr. Ilagan. MR. ILAGAN: Chair Page 18 -28 December 2, 2015 figured out where dengue has originated from. The last time I was in one of the , r where dengue had originated, youre not sure yet, so could you clarify on that? DR. PRESSLER: Certainly. T mainland is helping us. W terms, the genetic makeup of these particular m worldwide, so they can try help us identify where did this index case originate? the more samples that we can send to them, the more information they get to try and track down the genetic makeup of the particular dengue virus. MR. ILAGAN: Okay, so currently still not sure exactly where? DR. PRESSLER: Correct. MR. ILAGAN: Okay, to stay on subject with the CDC, has there been other recommendations that you are following through, or taking into consideration? DR. PRESSLER: Well Dr. Lyle Peterson, who is the Director of the CDC. The vector control division of CDC, is here now, out with the entomologist, and the other teams doing surveys, right. And disease investigation, the vector control, our laboratory all of those things. And will be giving an independent analysis, and report back to the Governor and to the Mayor before he leaves. And then in addition entomologist that will continue to be here and continue to work with Aaron and his team. MR. ILAGAN: Okay. The other thing I wanted to talk about, Darryl opened up th with understanding or got involved with this dengue fever on November 4 what I heard you say. I looked back into the newspaper, and they started covering this story on October 30. And that was confirmed two cases and probable four cases say 34 days since then, and I just wanted to find out, because currently right nowI look at it in a different sense, that your department has limited resources, a deal with this outbreak as soon as possible, as fast as possible, as effective as possible. And what they been telling me is that, currently the only way to confirm these cases are through the State clinical ljust confirm them, here on the island. And the public has mentioned that there is a Asia Gen test kit on dengue, and you cawithin 30 minutes. Are you aware of that, Page 19 -28 December 2, 2015 . I would like to relay it to you. DR. PRESSLER: Sure, I am aware of that. That was one of multiple helpful comme appreciate the input from the community. We immediately checked with CDC on that, is that something that would be useful for us to go out on the field, and be testing right on the site? A; and in fact, since we have a State Laboratory on Oahu, where we are getting results within 24 hours, is that correct Chief? Saround on these tests. So that is the way we want to go. Plus we can then take those samples from the lab to share with CDC on the mainland, after the fact for them to be evaluating to help identify where this came from. CHR. KANUHA: Mr. Ilagan, real quickly, briefly. I want to continue with your questioning, we have our Senators here that we invited. And one Senator actually, but he has to leave at 2:30. So I want to bring him up, and then we can get him Health and other entities about wh okay, with you? MR. ILAGAN: Well, Mr. Chair, I was in a groove there. CHR. KANUHA: I know, I know you were. Tuld see it going for awhile. MR. ILAGAN: I just want to say the Senator outranks me right now. So definite comments at a later time. CHR. KANUHA: I appreciate it, and mahalo. If i bit and bring you back up for more questioning. Yeah, definitely I want to welcome, we also invited our Senator from the west side, as well as our representative. Senator Josh Green, and Representative Creagan if you could come up as well. Senator Green can just say a few words first, and present what working on, if you could just press the button, and introduce yourself for the record. (Note: At this time State Senator Josh Green and State Representative Richard Creagan came forward to address the members of the Committee.) Page 20 -28 December 2, 2015 MR. GREEN: Thank you Chair, and distinguished colleagues, Council. Thank of Health, and the team here, the Chief. They are working so hard. So that has been very, very important for us to recognize, and we appreciate you guys. Couple things I wanted to mention, first of all let me say something a bit abstract, which is that in public health matters knowledge is power, and information is p that is probably the most important take away from much of this discussion. The more people know, this is my perspective, the more they will be equipped. Our community is very intelligent. The way they can Creagan and I have. People that have been reaching out to me, have been hungry for information about not only where the mosquitos are, where the outbreak began, what the consequences of dengue might be for themselves or their children if they become infected, but they really want to know in a comprehensive way, how it would affect our future here in the island. Let me put my physician hat on, early on in the outbreak when I first was reading stories, I had a patient who ultimately did not test positive, but he had a very high fever, and he had aches, and he had the pain behind his eyes, which are classic symptoms for dengue. He also had problems with his platelets. A lot of these symptoms were consistent with dengue, but they were also consistent other infectious disease. Two months before that I had an individual that had again the same symptoms in the ER, he proved to have leptospirosis. Which was mentioned, he ended up having a very severe form of leptospirosis. And had to be life flighted to Queens, where he survived after having respiratory distress. It would have been very difficult at that point to even imagine ordering a test, this was back in August, for dengue fever. So things are happening very quickly, and people in the community want to know, do I have to worry about a modest infection like dengue with high fever, severe aches in my bones and joints, possibly this headache, or maybe no symptoms, and what will happen if my children get it? So I think that the reason outspoken behavior from myself and Richard, is that we as your State Representative, and State Senator and colleagues, are like you getting emails from people, getting questions. Many of them are technical questions, but most of them are questions about, what would their family experience? s going to get yet another layer need to hear these things six, seven, eight times. One of the things that we tried to impress upon, and tried to be respectful about it to our Oahu colleagues, and our Page 21 -28 December 2, 2015 Oahu administration is the people on the Big Island, do disseminate information very differently than some of the other parts of the State. In my community, in your community, we know that people are much more likely to get information from a conversation at the farmers market, then they are from the 6:00 p.m. news. conversations in serial with relatives and family members around the island then they are perhaps, to have a social media they get on all the time. And the visitors in hotel and they sign-off from their lives. rgy, and I know the Department of Health and Public Safety folks, and the entirety of the team are aware of that. But it took me many years after moving from the mainland in 2000, to understand different. And that is why I think it is necessary to have the meetings, which I really commend Chief Oliveira and Director Pressler, and Billy, smart, to ask for those meetings around the island with you guys. to take a concerted effort for a long time, to make sure everyone understands what dengue is, and what the capacity for it to spread is. opinions. And I would tell you this, one of the things that Richard and I have begun to think is that we have hamstrung in many ways the Department of Health over the years. Many years ago positions were cut, and positions need to be restored. Not just for the times when we have outbreaks, but for constant study. al with an acute outbreak, as we all know too well now. take up too much time b o defer to my excellent colleague, think that there is going to be need over time, and I know that has begun now, to get deep into the community for testing. I think that though the outbreak is acute two or three times that many cases, because I have taken care of individuals in the rural setting t will suffer a lot of inconvenience adoctor sometimes. The physician shortage as we all know has been one of the conversation points that f Health, who commented very intelligently to me before our meeting today here that this kind of put a bright light on the impact of having a nursing and physician shortage, and a shortage of facilities to go to. We have a lot of individuals that live off Page 22 -28 December 2, 2015 left long standing ways of being completely connected. They also need health care, some of these lessons will be learned from the dengue outbreak. , that we all are aware that the consequences of a large and expansive outbreak would be too difficult to bear. Which is why, occasions perhaps to those on Oahu or in the newspaper, w human perspective or an economic perspective, to have dengue persist year over year, or to break into Puna, break into Hilo. With our very large dense get deep into the community where some care, w. And so we are trying to impress upon the governors team the 200 or 300 percent response maybe necessary to help us on the Big Island for a short period of time. ng us this additional opportunity to share what our experience has been on the ground. CHR. KANUHA: Mahalo Senator, really appreciate it. Maybe I could just give it over to Representative Creagan, then we can kind of go with questions and answers. MR. CREAGAN after he leaves I can follow up if you want, later. You know, Josh and I have been involved for a lot of reasons, there our constituents; it started in our district. And we know the Big Island, I worked for the Health Department for about 11 months as an epi (epidural) specialist. You know, in the past I was medical director of a vaccine company, so I know a lot about it, Josh knows a lot about it. And we had to provide a voice to educate people. Now, principally tourism, and if this becomes endemic on our Island, our economy is going to be devastated. It had a story today; and . We have to have some sense of alarm, so people do to panic people. Now the problem is, you know, in terms of response only our island has aedes aegypti mosquitos. The other islands been eradicated. For whatever reasons economic or political it was left on our Island. And when the vector control was dropped from 14 to 2, not even any monitoring. Page 23 -28 December 2, 2015 S It shows that aedes aegypti was all around our Island, including the Hmkua Coast, back in 66 when they started the final push to get rid of mosquitos, on the other i, in 2002, is almost all around the i really test Hmkua. weeks, months, maybe even a year. So we need to do to turn this over to Josh to finish up, b alright, so MR. GREEN: Richard in his first couple years has learned to dive into issues extraordinarily. A yesterday on the television doing a show, and some of the historical things are fascinating about dengue, which I think you guys will be able to unveil today and in future meetings. MR. CREAGAN: Okay, well that was my clue I guess. Alright, so historically dengue, the aedes aegypti mosquito, vectors for dengue. But aedes aegypti tends to be very anthropophilic; in other words, it likes people. So it bites people, it bites multiple times. Whereas albopictus would bite almost anything, and it tends hangout in the boonies rather than around s. Now that may be changing, but aedes aegypti is still the prominent vector of dengue worldwide, okay. Historically, in 1903 thereabouts, . Thirty thousand cases, thaislands with this mosquito when dengue comes in, okay. It died away principally, beca people left to get it, and it was principally on Oahu. So after that there was some effort to get rid of aedes aegypti mosquito, in part because it also transmit yellow yellow fever mosquito, okay. Dengue and yellow plague or viruses closely related, but dengue, you know, the first time you get it does not kill you. The second time you get it, if you get it with a different strain, it has a 20 percent chance of killing you. I know of only one case of the second type on our island, and that person died. S Okay, so during World War II, there was an outbreak, and 43, 44 on Oahu, and because of the critical nature of Pearl Harbor and everything, the CDC at that time or shortly thereafter sent 1,500 people. Not one or two, or a team of four whatever, they sent 1,500 people, because at that time CDC was principal involved in mosquito control. They wiped out anopheles mosquitos, the vector for Malaria from the south, and then they moved on. So they sent 1,500 people to Page 24 -28 December 2, 2015 So you know, back then we had some other these days, like DDyou know, it could be harmful to the environment perhaps. today, very effectively. So what do we have today, we have some other tools, and some of tools were mentioned, biotech mosquitos, and this will happen again. Now Maile, you asked ou know, there was an outbreak in 93- was, right. But in retrospect, it was dengue, because the Health Department did test 10 people who came forward in 2005. And they were all positive for dengue. I saw people who had all the symptoms for dengue. All the testes were suggestive of dengue, but . We thought leptospirosis and we thought tick borne diseases, so we never knew what happened. After a few months the cases stopped coming. Okay, I talked to someone in Puna just this week who said oh yeah, well we had that 93-94 outbreak over in Puna. I said what do you mean? He saideah, we had an outbreak of dengue ba I saidere people tested? He said Now, naunau area, and they were all positive. about what happened, because that outbreak did go away. It was never confirmed as dengue until, you know, the testing in 2005. Bu on by any attempt to eradicate aedes aegypti on this island, which you know, I think should of happened. Anyway, that outbreak went away because there was a two year severe drought on this island. And with that drought apparently the mosquito population diminished t have any water in them. So the outbreak died away You know, we may be facing a drought with El Nino right now, and prediction is we will have it, and frankly we better hope we have it. Because that may be the only thing to clean up this epidemic. , but it could become an epidemic. And insee, there was a huge epidemic alright, it w much denser population, more constricted population. So the other thing we talked about on the show last night is dengue is just one thing and there are other emerging diseases that are on our doorstep, and we of. T, there was an outbreak in the Marshall Islands which is pretty close, and a lot of people come from there. They had well over 2,000 cases just this past summer. There were pr. Page 25 -28 December 2, 2015 And they would have been infected, and we had the right mosquitos, right. Fortunately most of them come to Oahu, and aedes aegypti not present on Oahu. Okay, so the other one is the zika virus which is similar to dengue virus. T had a huge outbreak in Brazil, and in 2007-2009 they had an outbreak in Yap of zika virus. Now zika has a huge wave of birth defects in Brazil. Over 700 babies have been born with damaged brains and microcephaly; small heads. So those things are on our control our mosquitos. So you know, we have to get this outbreak done, and we have to get rid of the aedes aegypti mosquito, and then we have to address not just aedes, but albopictus throughout the State, or else, you know, when those two diseases come we are going to be devastated. And I think people now should be tested for dengue, but also for chikungunya and zika virus, because they have the same symptoms, right. And leptospirosis essentially has the same symptoms, so I think everybody should be tested for leptospirosis. The reason we want treatment, we want the results back quicker, like 24 hours or something. It may take 24 hours to do the test, but to get the results back to the doctors and patient, taken a week or more. If those test are negative, then we might treat empirically for leptospirosis, while for leptospirosis. So you know, the Department of Health has been doing a great job, Darryl Oliveira has been a true hero. And the County has been really responsive, you po And Josh and I have said the Governor to be more practical about providing resources. I think, you know, you would ask for emergency declaration. I think, amount of con, you know, eclare an emergencynd then the national press picks that up and says, h, t go ight? So people that is not particularly safe for is pregnant women. Even first time dengue cause miscarriages, and it probably already has caused of, although t, I think they should be warned about it. And CHR. KANUHA: Thank you, Dr. Creagan. Council Members, I want to just specifically if you guys could, Senator has to leave questions right now him. Ms. Wille. MS. WILLE: Yeah, how much additional assistance do you feel that we need here? Page 26 -28 December 2, 2015 MR. GREENome of that question, Director of Health know the exact number of people that they have on a day to day basi told that it does fluctuate some, I do know that the Department of Health was severely under staff from a vector control standpoint. know how many public health workers they have access to through the County to go door to door. I do know that the numbers of concerned individuals that call or write us, far exceeds the number of streets that have been able to be addressed, where people feel they have infections. ery, very difficult as you all know with so many areas that could be affected, and so many very faraway places where people are having symptoms. I would say this though, when I made the statements earlier, two weeks ago, t hoped that we would utilize a much larger force of people, hundreds of individuals, in which case it would of have to come from basically the national guard. And ithat the Governor did okay the use of them to information, like I started. People are not, in some cases, informed. I penetration. But we received for instance a comment yesterday that an individual was up north, up at Hpuna they lived in Nlehu, they were taking a stay vacation. They went to Hpuna, with their wife, this individual. They talked to 11 individual travelers, and only one of them was aware of dengue. Now it takes work on dissemination information, which takes bodies, it takes trained public health workers to go door to door and to give good health information in communities that are affected. It takes, of course, to actually now understanding, do some clinical work. Drawing some blood the EMS team, which are just truly devoted workers. And we give them credit, going to take a lot of man power, if we want to stay completely ahead of this wave. The numbers, day, thank goodness and not 60. Therefore we can kind of cool our jets a little bit. Bs the information. Ia large water area that somebody might want to take care of. It might be extra spraying if they determine ilize these extra resources now. In other words, overkill in the short timeframe rather than trying to deal with them and pick them off one by one which will be impossible. Again, I defer to representatives from Puna and Hilo. It will be impossible if it gets into a dense community, I think you need a lot more people. Page 27 -28 December 2, 2015 MS. WILLE from hearing the two of you is that we need to really change this into a war on the g of it as a war on the dengue cases up to right now. You know, we need to deal with each of the cases and go methodicall want to be doing this for some other vector, or whatever it isthat we need to do this. Lets just do our fire break far enough out, and with respect to not just dengue fever, but right now climate changes adding all different ones. I mean you what can we do when MR. GREENAnd that point has been well made by Dr. Pressler and Dr. Park in other settings, that it is individual; however, I do like the idea of knowing to the best of our ability how many total people have contracted the disease, so we know what the scope of the outbreak looks like on the Big Island in modern times. I will say this, in the acute phase making sure we can eradicate this specific mosquito, is the most important thing that we do. e public health initiative on Fight the Bite, which was very well done, and very well produced and promoted by Department of Health is super relevant. But it also has brought a second level of attention and concern, and that is our ability to deal with public health issues in general in rural settings. The truth is , but how many of you are aware that we have a significant number of Hansen disease cases on the Big Island which is leprosy? There are significant number of cases, because we have individuals that come from all like this infection, but those individuals sometimes can get care. That can be treated, cured unlike many decades past. B capacity in a public health way to be able to find out all the individuals, many of whomabout 50 percent of the Big Island lives somewhere near the poverty line or below, receives Medicaid care. So first yes, we must prevent the spread of this infectious disease, this virus m talking about our colleagues and the global health department, to focus on the rural world communities going forward. To have non-traditional capacity to get there to do testing, to provide some onsite home-based services. Some care in the case of necessary treatments, and to actually do assessments in some of these outbreaks. And I think that would be the biggest lesson that we learn from this outbreak. Page 28 -28 December 2, 2015 MS. WILLE: Okay, I yield for others. CHR. KANUHA: Thank you, Ms. Wille. Mr. Ilagan. MR. ILAGAN: Thank you, Mr. Chair. Senator, I just wanted to ask you because you had your show, and that was very informative of you doing the Q&A with DOH. I was just wondering is there any other questions that either a follow-up after the questioning, or maybe a question that you remembered afterwards that you should of asked? Is there any comments or questions that you wish to say? MR. GREEN: Ilagan is commenting on. The first part, we were lucky enough to have Dr. Sara Park and Ms. Nakasone there, a vector control expert on Oahu, and of course Richard and I were there. And onlly clear to me is, in cases of infectious disease and were here, middle of the Pacific all alone. The World Health Organization is another entity which has great capacity and experience in tropical regions they deal with an incredible amount of infectious disease, and it can sound alarmist when a person like me says please bring The World Health Organization. I who first mentioned them. And I wanted to ask Dr. Park, what would be the harm in bringing additional resources? It was kind of said offhand, the president would have to ask for that individual. Well you know what? We have the capacity as elected officials in an area struck by an infectious disease not to just ask the President, but to ask that question aloud in the time of need for the Big Island, which could affect our people and our economy for a generation to come, should we not avail ourselves to those additional services. So I think bring individuals like that, to share our experiences with them, So that was one thing that really occurred to me, ther On the one hand I want us to go back to the essentials, which is get rid of standing water, definitely wear insect repellant, and definitely call your doctor and the I mean if you stick to that, to beat this provided if we get enough manpower. But there is a real interesting question about these other infectious diseases that Richard has brought up. How worried do we have to be? know yet, even personally, how worried we should be about chikungunya. I w how many cases of lepto. Maybe I should know that, to me. And I think it would be good if, for instance, every health care provider was instructed. And I would really welcome some expert assistance in that way. That was one thing on my mind after our first program. Second program that Richard and I did, we spent more time on the historical aspects. And I think they Page 29 -28 December 2, 2015 MR. ILAGAN: Thank you for sharing that, I also feel that the Big Island is very in each chamber, we have the House and the Senate. And as most residents in the Big Island always voice out that Oahu, the State Legislature is very Oahu-centric. And I just wanted to ask from your point of view, on this outbreak has it been that kind of reaction when you bring this before, lets say other legislators or other departments? other departments that you would also have to interact with. I just wanted to MR. CREAGAN: Well you know, I think the people on Oahu realize to a great extent this is not likely to spread, except in a very tiny way to Oahu, because they . I mean, statewide problem. I economy of the State, it will hurt the Big Island. Now there might be a little ripple effect on the other places, but most of the tourists , you know, m not going to dengue Island, ll go to Kauai, Maui, or Oahu. to think , and affected. MR. GREEN disappointed that it took so there on top of it quickly. I can assure you had this happened on Maui or other areas, there would of have been info briefings in a New York minute. And the Oahu guys, preparing for the session. However, we need to be 24/7 with certain issues, and I think that had I shown up with a container covered of potential mosquitos from the Big Island, opened it they would of you know what. And when I was doing some interviews with the press, it was interesting because the media hadthere was one prospective case I believe on the Big Island. Maybe even one confirmedon Oahu, . One case maybe? Not related. It was unrelated, so be very clear. I, for sure. There was one unrelated case of dengue on Oahu. And the media, pretty good job on Oahu, they were almost obsessed with me to talk about that one case, and we were sitting here on 70 or 80 cases already. One case, if there was an outbreak of 15 to 20 cases in Manoa or some other place on Oahu, I mean my opinion is we would see not just the President mobilized, we would see everybody mobilized. So the Department of Health, ? The Director is here. S, But we would see millions, and Page 30 -28 December 2, 2015 millions of dollars going into a response in my humble opinion, if it broke loose on Oahu. So we are one State. We depend upon one another. And by the way, if God forbid this becomes several thousand cases, if we get an unlucky break and those cases then start popping up around the S massive response. So to be ground zero and to eradicate it health and tourism going forward, g the many, many millions of dollars that would not just be lost, but also have to be devoted on Oahu. So I been frustrated. And we can shout as loud as we want, but it really does take a concerted effort. And you know, I personally need to seeI donic here, but I need to see the Governor go down to South Kona. And I need to see our Governor and the team walking with the , or wherever cases may be. Because I need to see that they understand what you experience as the Council people, which are the local government. So I think that we are now impressing that upon them, we will always have this chip on our shoulders as neighbor islanders we may not get the full response. But ssibility that my five year old or eight year old gets sick, you grateful to have Director with us today and CDC and the team. CHR. KANUHA: Thank you, S:45, and you have to catch a flight back. Just wanted to let you know that we really appreciate you coming situation. Thank you for being a great representative of the community. MR. GREEN: Than honor to come. Thank you. CHR. KANUHA: Sorry. MR. ILAGAN: I know Chair. That was the second time, I was interrupted. CHR. KANUHA: I know. MR. ILAGAN: And all I just wanted to say is thank you, Senator and Representative, for CHR. KANUHAagain, I want to bring back Dr. Pressler and Chief Oliveira up. And then we can definitely continue with you afterwards, because they also have to get going. MR. CREAGANch. Page 31 -28 December 2, 2015 CHR. KANUHA: Perfect. Maybe in 20 minutes or so. So I want to continue with the questioning, and if they had any more information from what you going to give it back apologize for cutting you off. MR. ILAGAN: continue with what I was about to say? Okay, thank you. Where I left off was that effective or that reliable. That was the comment that I heard, and I just wanted to make sure DR. PRESSLER: Yes, I think something like the Asian jen may have a roll in places where dengue is endemic, and so you have hundreds and thousands of cases. So it may be a very useful tool to go out and try to identify those individuals at risk. As I said, we talked to CDC as soon as it was brought to my attention, I shared the information with them. And the response back was that yes, recommend it in lieu of the lab test that we have readily available. MR. ILAGAN very proactive approach on this issue. And aft feel a little bit different in the sense of it being more reactive than proactive. And I just wanted to voice out my reasons of reason why is currently in the community meetings that have been heldand I want to say in that point you are taking a very proactive approach, b g the charge, I believe it should be the Department of Health making these meetings and coordinating these meetings. The other part is that when these meetings have been voiced out, the question is will our areas be sprayed. And from the response I been hearing is that the Department of Health will only spray the areas that more of a reactive approach, instead of actually going to different areas and spraying for mosquitos control. And one suggestion I would say is, the Aqua-Resin that only could be purchased by DOH, a lot of the land owners equipment, let alone be able to purchase the Aqua-Resin and my concern is that these homeowners would just buy off the shelves chemicals, and actually might use it wrong, because they might not look at the label correctly. Page 32 -28 December 2, 2015 I was wondering if the DOH could take a more proactive approach in the sense of having workshops that could certify lets say, landscapers who have equipment is because what I been hearing from DOH is to their area, contact a commercial business that sprays for mosquitos. Well I tried to look for a commercial businesses. And I was wondering if DOH can create these workshops and certify, these landscapers sthe Aqua- actually able to spray for mosquitos in a regulated manner. And so the public has more options to call, and also be more proactive in their approa suggestion. And I just wanted to hear, your thoughts in my comment? DR. PRESSLER: Chief and to Mr. Ueno. First of all, for the Department of Health to take the lead on all of this, I think that it would be inappropriate for the department that is based in Honolulu to think that we have any idea, as you have all pointed out, commander of this unified command is Chief Oliveira, over here working with addressing the vector control and the disease investigation, and the laboratory piece of that. But certainly Chief Oliveira and the teams that he puts together with the Health Care Association, and others that work collaboratively all the time on disasters are the best ones to identify how best to get the word out, and how to address the specific issues here in the community. I appreciate your comments, about how can we help you to help yourselves get rid of the mosquitos. That is going to be a humongous effort. Not everybody wants spraying, and DDT I thought was no longer allowed. But most of your question I address that. MR. ILAGAN: And before the Chief address that concern, I just want to actually thank the Mayors Office, because they have been setting up these meetings, and I see Ilihia, Clarisse, and Karen. Iapologize. But I see that the Mayors Office has actually taken on that role in setting up these meetings, and as you mentioned your headquarters are in Oahu. staffed also, but I just wanted to thank them. Because they have been a very big part in setting up equipment, getting the flyers out there, and helping out with those meetings. DR. PRESSLER: Yes. I applaud the Mayor and his team, and the only reason I part of the unified command. Page 33 -28 December 2, 2015 MR. OLIVEIRA: I just want to again, emphasize as Dr. Pressler team effort. W in that type of a structure, because not any one agency has the resources to stand alone and deal with this. We all need to depend on each other and share our capabilities, expertise, and resources to multiply that workforce or capacity to address this issue. On the issue of the products that can be used, again, through the discussions like with Keith Kawaoka at Department of Health, as I mentioned, my counterpart in the unified command, h Agriculture, and have identified a list of almost 500 different products that could be available to the general public for purchase that would be an effective adulticide. S, again, the value CDC being here is coming up with what are some of the most successful insecticides that they might have seen, experienced with, and can help us make a recommendation on the best product. The other thing, in some preliminary discussions this morning with the CDC team was maybe there should be a stronger effort placed on the larvae sides as a means tremendous value to the CDC being here. W, I think good recommendations come out from their assessments o right and can do more, as well as maybe things we can change, our strategies and tactics. But along the lines of insecticides we hope to provide the community with a list of recommended pesticides, or insecticides that would be very effective for the mitigation of the mosquito. MR. ILAGAN: with the Department of Ag, a is definitely a need to tackle this issue. And Department of Ag has the expertise regarding pesticides. I also wanted to ask you for thinking in the sense of this is really proactive-proactive, is looking into the GM (genetically modified) mosquitos, regarding oxitec mosquitos. use pesticides and insecticides to actually control, and would be environmentally friendly. What your thoughts on that? DR. PRESSLER: May I address that, because I brought that up with the CDC as (Federal Food and Drug Administration) And I know you heard Representative Creagan, talking here, probably w capture of mosquitos and really identify what is the issue here. Is probably the aedes albopictus, is a bigger problem actually then the aedes aegyps the Page 34 -28 December 2, 2015 case this particular GMO mosquito right now, the male sterile mosquito is only the aedes aegypti. But worthy of further research to see what are the opportunities for us to try to, if not eradicate it at least reduce the population of mosquitos on the i rid of them. If we could do something like bring in the sterile male mosquitos for right now, aedes aegypti is a possibility in the future. Not immediately, not today. B hopefully that could be done as well. MR. ILAGAN ing. I just want the public to understand a little bit that, if you have a sterile male and the sterile male mates with the female, and that prevents the population growth to DR. PRESSLER MR. ILAGAN cause anytime you mention those three letter words GMO, t and I appreciate the answers that you have provided. Because Puna has experienced their fair share of disasters, and the last thing we need is an outbreak. I want to help you as much as I can, in my role. By you communicating with us, it helps us to brainstorm some ideas. So I really appreciate you coming down here, and I also appreciate Council Member Chung and the Chair, for organizing this special meeting. So thank you. CHR. KANUHA: Thank you, Mr. Ilagan. Mr. Chung. MR. CHUNG: Thank you, Mr. Chairman. You know, most of my questions have been answered already. But you know, it was brought up by both Representative Creagan and Senator Green, a this question, the resources, short term, do you guys have enough resources, just for the remedial part right now? Not for this proactive thing we were talking about, but how are we on resources? And be as candid as you can, I mean if you guys need more, let him know. MR. UENO: I can speak for the vector control side, the response side, is that re forwarded to us. MR. CHUNG: Okay, and what are those objectives? Page 35 -28 December 2, 2015 MR. UENO referred to the vector control program. Our program is basically responding within 24 hours to 48 hours. MR. CHUNG: Okay, good. MR. UENO: And we do have a lot of support coming in from the Neighbor I meeting those requirements. MR. CHUNG: Chief? MR. OLIVEIRA: And again, one of the values to setting up the structure that we have with those different operations branches, we were able to set measurable objectives for each one of the branches, and then evaluate our performance. And that helps us to identify, if we have logistical needs to complete those objectives. As Aaron pointed out, the vector control with the objectives we set allowed for a time period that was reasonable. As I mentioned, they need to get consent from So that 96-hour window, was identified as a reasonable time period from the notification of the lab to the vector to get the spraying done. very aggressive and able to meet and exceed the expectations there with the resources we have. And building additional capacity to keep up with the demands right now. In addition to the equipment and personnel coming in from the Department of Health from across the State, as I mentioned, the Mayor has authorized the purchase of additional equipment. Public Works, and Parks Departments are buying the equipment. By the end of this week we expect to have on island, I want to say 20 of the spray units, island from Department of Health and a large compliment of personnel are trained in various departments to support the vector control efforts. DR. PRESSLER: Let me just add that the Governor has also asked the Navy to provide some additional resources if we need them. And the Navy is waiting to hear back from the CDC on Friday, whether or not the CDC thinks that the Navy needs to mobilize to bring additional resources to us here. So this is, you know, the White House is aware of this outbreak, the Governor is very concerned about it, and is actively engaged and kSo I just want everyone to appreciate that. MR. CHUNG: So as far as the people on the ground, Page 36 -28 December 2, 2015 MR. OLIVEIRA Council and maybe the public, but every morning we have a 9:00 briefing with Dr. Pressler at. I developments MR. CHUNG: Right. MR. OLIVEIRA: And it helps us to again, get a snapshot in time i doing logistically. MR. CHUNG: How about in terms of getting information out? Now, you know, , Tribune Herald, daily coverage. You know, today I invited Na Leo. Well I arranged for Na Leo to be here; a beat television, right. Is it possible for you guys tois that an untapped resource that we could utilize maybe, and have them get the information out? Could you work with Na Leo as well? MR. OLIVEIRA the local resources on island that people can turn to, and as you know, we still without radio coverage. , stations, so we have to find ways to close the gaps in some of these areas, and it means stepping away from some traditional communication means. and encouraging the community members to come out and participate, because they can get their questions asked and answered. Tha doing that, but any ideas you have, any ideas the community has on how we can ity bulletin boards, I mean saturate the community with accurate information, the less erroneous information gets around, which creates more problems for our residents and business. MR. CHUNG: You know, Chief, I know you guys have to go like 10 minutes ago, but I just have a few more questions if you would indulge me. You know, I talked about diagnosis, prognosis. Where are we right now in terms of the numbers? Are we like leveling off, or how do people read these numbers, or is there anyway of reading these numbers, or do the numbers mean anything? You know, we see an increase, steady increase, but not like exponential or anything like that. Is there anything to be read into these numbers? Page 37 -28 December 2, 2015 DR. PRESSLER: putthe map of actual outbreaks, and the other map that we have on the Department of Health website in addition to that is public, because it takes into consideration a number of different things. But also on that map, curve. And so we may say today we have five new cases, most recent was November 22, I believe. Anyway, that was the most recent. The other three may have been from a month or two months ago, so there old cases already. And the key is that it is four or five more cases each curve, and how many recent cases verses older cases that are being identified. So ry good question. MR. CHUNG: I mean so are you in a position to say, you know, are we okay? DR. PRESSLER: Well we will never be okay, until long as we have a single case MR. CHUNG: Right, of course. DR. PRESSLER: I can tell that Dr. Lyle Peterson has been quoted for saying, this is a small outbreak, not an out of control epidemic. T to be over tomorrow, and he has repeated, message out too, this could go on for months. We need the public to be aware of that and not to be alarmed if, cases, period. And then them biting someone, and someone becoming symptomatic, and then them being bitten by a mosquito. And the life cycle of the mosquito and the MR. CHUNG: Well, let me Segue into another question to you. The Department of Health is a big department, right? DR. PRESSLER: Huge. MR. CHUNG: You have a lot of different divisions, or subdivision. Is everyone within that department working in concert with each other in an expeditious manner, too? DR. PRESSLER: Not only everyone within the department, but within the view. As Department of Education, DAGS (Department of Accounting and General Services), DLNR (Department of Land and Natural Resources) we got it all Page 38 -28 December 2, 2015 And this has been discussedI was in a cabinet meetings this morning before I flew over here, and we talked about dengue. The entire cabinet is aware of this, and it has been emphasized that this is a priority for the State. And everyone is adding whatever resources that they have, nd to try to eradicate this. MR. CHUNG DR. PRESSLER: And the Governor is going to be here shortly to meet with the Mayor. MR. CHUNG: You know, the reason why I asked that question, I was watching one of those public informational meetings, I think it was in Kona somewhere. And someone brought up the idea of lifting a burning ban. You know, because a lot of mosquitos hang around under leaves and things like that. Clean Air Branch? Anybody want to talk about that? DR. PRESSLER Darryl? MR. OLIVEIRA: Right. As you mentioned, at the Kona meeting that suggestion Clean Air Branch and Dr. Presslers team and have identified a process by which we will reinstate Ag cted because of the air quality there, but for the purpose of controlling the environment, or controlling the habitat for the mosquitos. So a similar application process, with a quick turnaround time for the iting for comments from Fire, to allow them to comment on any fire concerns they may have. And again, that has been identified as another mitigation strategy that we hope to employ very quickly, by making that available to the agricultural operators in We MR. CHUNG: Great. So all of the approvals, protocols, all in place already for that. Ready to go pretty soon? MR. OLIVEIRAs comments at this point. Because d Ag permit process. But definitely thanks to Dr. Presslers coordination through her team, the emphasis has been placed on making it as painless and expeditious as possible for the applicant. MR. CHUNG: And you know, a thing or two about Fire Departments, right? Page 39 -28 December 2, 2015 MR. OLIVEIRA: Little bit. MR. CHUNG: So how long is that going to take? MR. OLIVEIRA: Well, . And the concerns that they all have again, we can all appreciate is, we just had hydrological outlook report from the National Weather very soon. When you consider the amount of rain that our island saw in the going to experience severe drought. So we just wanted to make sure that the Fire Department has an opportunity to share their comments and concerns, what role they might be able to play in the review of the applications. But everybody is committed to make this a quick permitting process, without ever compromising public safety. MR. CHUNG Margaret brought up the matter of the migrants, right. Because you know, we glad that she asked it, and you guys answered it. Because you know, those are questions that are out there, and they deserve to be addressed by the public. ? Right at the very outset of this outbreak, I think either the team or the Department of Health, was reluctant to tell people where the incidents of the dengue were occurring, and that really came to the consternation of a lot of residents, you know, because here you tell us DR. PRESSLER: Yeah, and I can address that. MR. CHUNG: Please. DR. PRESSLER: You know, we have requirements as health care providers (Health Insurance Portability and Accountability Act) laws, which we can actually be thrown in jail for violating . So you know, patient identifiable information can be as simple as an addressI mean not even an address. Some other things where share that information publicly, so our team to their credit were following the law. I suggested that under the circumstances the public health issues were superseding re not violating the HIPAA laws as far as I know, but I have encouraged our team to air on the side of making sure that getting out there. And there is no way to identify an individual from the dots that Page 40 -28 December 2, 2015 I told our team on a daily basis giving detailed information to the unified command, information that cannot be released to the public, because it is against the law for us to say this individual at this address. W MR. CHUNG: Yeah, I think we are all aware of the privacy issues involved. moot already, since we do have the map, it came out in the paper, and we really do credit whoever is responsible for that. But they could have done that earlier, too. DR. PRESSLER: Yes. Maybe they were erring on the side of caution, and protecting individuals privacy, and sometimes we need to look at the public health. MR. CHUNG: Yeah. That was really one of the main complaints early on. DR. PRESSLER: Appreciate, thank you. MR, CHUNG: You know, I got other questions, but you know, I just appreciate what all you guys are doing. And thank you so much for coming today, it shows your concern. DR. PRESSLER, these kinds of meetings are extremely helpful to me and to all of us. As we hear comments some very useful and helpful ideas that we can consider, and see what we can do and what we t, and appreciate you calling us together. CHR. KANUHA: Thank you. Mr. Paleka. But I want to again, emphasize that they will be having to leave pretty soon. So if you have really important questions to get it to them, and we can keep it as brief as possible. MR. PALEKA: Good afternoon. Thank you, Dr. Pressler, for attending. Thank you, Darryl, for doing all of our meetings and keeping our public up to date on the current situation. I proper protocols having met and listened to the presentations in Mountain View, and thank you for coming out to Phoa next. In regards to the infected mosquitos and the specimens that you have mentioned, is there a database where you are following confirmed mosquito specimens in different areas, or is that something we could use more? Mr. Ueno. MR. UENO infected mosquitos, so we are not analyzing the mosquitos at this time. MR. PALEKA: Is that not part of the protocol or? Page 41 -28 December 2, 2015 MR. UENO: No. You know, when CDC is here, trying to trap the mosquito first, and trying to identify the mosquitos that are being part of this outbreak. And then possibility of taking those mosquitos back to Puerto Rico for PCR (Polymerase Chain Reaction) analysis. MR. PALEKAwell, from some individuals, that we try to pass on information to you folks that you have mentioned today that you have used, t progress of the vector itself, so I was just wondering. And perhaps we can go a little bit more and I know we have little bit time. But I do want to thank you. I have faith. And Mr. Ueno, we still confident or cautiously optimistic, as the main question that I had before, and it remains. So I have confidence in all of you and what you continue to do, and I just wish you all the best. DR. PRESSLER, until we know that this current outbreak is eradicated. MR. PALEKA: Cool. Alright, well if we can do anything, please let us know anytp you get information out there. But thank you again, very much. CHR. KANUHA: Thank you, Mr. Paleka. Ms. Eoff. MS. EOFF: Thank you, Mr. Chair. I just also wanted to thank all of you for being here today, as well as Representative Creagan and Senator Green. I agree that knowledge is power. And besides the real technical data, people just need to know that they should not get bit by a mosquito, and do everything they can to eradicate them around their homes. This Fight the Bite flyer, where is that available? Is that being placed in markets or everywhere people go? MR. OLIVEIRA: Yes, right now at least two of the large retail supermarkets. The KTA chain as well as the Foodland chain, have been putting them at the registers for bag inserts. You can actually download it off the DOH websites. DR. PRESSLER: And we have our information translated in 10 different languages. MR. OLIVEIRA: We are trying to translate them for the visitor industry, as well as make them available to anybody that asks. A good example was at the Waimea meeting, . We will make those copies and get them there. Page 42 -28 December 2, 2015 MS. EOFF: Because I think we were saying earlier that not everybody goes watch TV. But I think those are very effective. Those capture your attention, they look serious and important, and to read. DR. PRESSLER: And I know Representative Lowen was sending them out to all of her constituents, and we would encourage other Legislators encouraging the schools to send it home with the kids, the churches. H them. MS. EOFFthem into the schools currently through our office too, to send them home in their backpacks is another way. But back to the issue, somebody mentioned before the fine line between panicking everybody. Especially you know, visitors who may decide not to come here. But informing them. I think it was Senator Green said that tourist were not aware out of the ones that were polled. In fact, we stayed at Hilo Hawaiian last night, and on the dresser there was just a piece of paper that looked like a letter from management. look alarming, I mean I may not of even read it. I might of thought it was just one of those thanks for, you know, staying here at our hotel letters. And it occurred to me that it should have been maybe more bullet points. More you know, not to panic the guest, but at least so they would read it. It did give information and some caution, but I hope those flyers could be given to the hotels here, visitor. MR. OLIVEIRA helping to get into the resort community. MS. EOFF: Okay. MR. OLIVEIRA: The rental car agencies, and we heard at the community meeting that the Kona Airport at least, the airport manager was broadcasting our message at the airport. So I think everybody is trying their best to get the information out. We can all continue to identify more and more, what we can do to really saturate the information in the community. MS. EOFF: Oh thank you. That effort right now. Because I think as soon as people realize that, they will be more cautious, you know, put on something to repel mosquitos. And also for our residents to dump their standing water, and do whatever they can around their own homes. So I just want to say thank you. All my other questions were answered, those were very detailed presentations and effective for us. Thank you very much. Page 43 -28 December 2, 2015 CHR. KANUHA: Thank you, Ms. Eoff. Council Members, I know we have so many questions we could be here for a week just asking and answering questions. I really hope that we could do this again in future meetings, bring you guys back. DR. PRESSLER: I always love to come to Hilo. CHR. KANUHA: And definitely getting more information out to the public as possible, , thank you for the communication, I appreciate you guys being here. I know you guys are going to have a meeting afterwards, right? Right after this. So any other final before we just say a big mahalo and a hui hou, until we see each other again. And then we can relay a lot of the questions that the public has, because this was a discussion amongst us. I really wanted to get that out there, as much information as possible from you guys, from our representatives, and senators. As much information out to the public through our livestream, through the video conferencing that we have. So any more questions that the public has? Yes. DR. PRESSLER: Yeah. May I just add that four questions, we will encourage those, and Ilihia in the Mayors Office has been absolutely suburb and being sort communications officer out here from CDC. But we want to have all these questions come to one place. CHR. KANUHA: Okay. DR. PRESSLER: So th back to you, and adding them to our frequently asked questions, so that we can get the information out to everybody. get lost in the shuffle. I try to be responsive, but I might miss some. CHR. KANUHA: Great, thank you. Okay, thank you very much. Council Members, do you want to take a brief recess? I know I want to get to public re still around. STATEMENTS The Chair directed the Council to proceed to the next order of business, FROM THE Statements from the Public on Agenda Items. PUBLIC ON AGENDA ITEMS: The following individuals registered to speak regarding Comm. 595, and came forward when called by the Chair: Michael Hyson. Cory Harden. Page 44 -28 December 2, 2015 Laura Moire MD, rep Lisa Andrews. Rene Siracusa, representing Puna Community Medical Center. Toby Hazel. Richard Abbett. Josephine Keliipio. Geoff Shaw. Stephanie Donoho, representing Kohala Coast Resort Association. CHR. KANUHA: Please let me know. If not I will close public testimony. Council Members, through discussion, if anybody had more discussions about it. We do have But we can continue discussion. A MS. WILLE: Okay. I want to pick up on what Stephanie was speaking about, because you know, I mean one of things I sort of wanted to say when the whole group was here. Well there are areas where there has been no cases found, I mean I look at the resort area, which isokay, if you go from Waikoloa, Mauna Lani, Mauna Kea, , how much we are getting done? Y. But the last two nights where it was said, we , what if all the sudden tomorrow were asking are you resource ready, have good resources? But are we ready if all the n earthquake? S, what do we do, you know, where do we snap our fingers? But at the same time again, you know, , them. at the same time how do we get more information out, especially to residents and , like the mobile van, and really getting that out, wh also, you know, how do we address where we are being so proactive? Page 45 -28 December 2, 2015 I know I got a few calls about the airport messages. You know, things that were being announced at the airport, just from visitors in my district, and fear, and what is it. So I think having that balance, vector control. Boy Scouts, oyou know, they said the Navy. hakuloa. Lets get out there and just really hit, we are the most vulnerable. I mean, I know we talked about Hookena Beach, our beaches are like the area that areAnd I look at even where there are beaches and then you got standing water, or things like Geoff Shaw talked about. You know, where are our public places, and dealing reas where the largest number of tourists are coming in, lets try to really promote that this is a safe place. I mean, I know people right now that have called and said, Europe to come here over the summer. And they would be staying in Waimea, g, and that it certainly will impact us. You know, I also keep thinking about going back to the little red fire ant situation, and just sort of paralleling all of this, and the comments about the State, and what happened with the little red fire ant, which was something I worked on way back when, until this politics stuff. It was just trying to get the State to do something. The County people were saying, , and the State . And you know, look at Scott and say well we jumping on this, and how do we use this as a got how do we really mobilize the State in terms of Department of Health? just going to stop until that noise Relinquish Chair: At this time Chair Kanuha relinquished the chair to Vice Chair Poindexter. ACTING CHR. POINDEXTER: Excuse me. Aloha, one of the sites has their mics on, maybe can we turn that off? Please, thank you. MS. WILLE: And if you could just give me an extra minute here. You know, the Department of Health is talking about how they have resources, but I look at how hard it is for us to get a permit through to go for something like environmental management, a saying the mobilizing. I mean, feel comfortable with the level of the , at feel comfortable with the State Department of resources. Lnd if we were to talk some now, but actually postpone this then, till next time. So if we want to sort of think agenda. Page 46 -28 December 2, 2015 ACTING CHR. POINDEXTER: Thank you, and for the record Valerie Poindexter assuming the chair for Dru Kanuha. And just letting the Council not done, oh, Relinquish Chair: At this time Acting Chair Poindexter relinquished the chair to Chair Kanuha. CHR. KANUHA just had her discussion. Who had the floor next? Ms. Poindexter. MS. POINDEXTER: Okay. I totally agree with what Council Member Wille was stating, m hear Department of Health, and I was at a meeting at the Department of Health last week sometime for work a workshop. And I heard one of the doctors there . I thing or something like that. And I felt offended by that, because you know, Big Island we always feel like the stepchild when it comes to things happening. And , like what Council Member Wille was talking about, the fire ant, you know, until it gets to them. And unfortunately, well not unfortun And sometime panic is good. Y saying that we should make everybody panic. But I think everybody should realize that this could turn into an epidemic, oneis mode. When I looked at what was happening in Hmkua. When the plantations closed down and we were going to go bankrupt and sugar was going to be gone. We thought oh God, we losing our medical, we losing the water. How are we going to . And guess what? Everybody came out, and everybody participated, and we beat it. You know, we ended up getting retrained for jobs, we ended up securing our housing, and we ended up securing medical, we got private water systems up and running and then dedicated it over to the County, because the community came together on it. So I just want to thank Council Member Chung, for bringing this forward for us to be able to share, and maybe me sharing my frustrations with all of that too. keep it that way by them checking, coming to test our mosquitos, for them to come and spray the area, whatever it takes to keep it out. Not wait for it to come into Hd then goops, we better go over there and check it out. And those areas, wet mosquito countries. You know, so anyway, thank you for just Page 47 -28 December 2, 2015 everybody to take this seriously, and not let it get out of control. Thanks, aloha. CHR. KANUHA: Thank you, Ms. Poindexter. Mr. Ilagan. MR. ILAGAN: Thank you, Mr. Chair. I just want to briefly mention, actually several testifiers had mentioned the papaya leaf, or the papaya solution, and that was asked during a meeting. And I remember DOH mentioning, and maybe Representative Creagan, if you might have additional information. Nod your head yes or no. Okay, I just wanted to make sure. DOH pretty much mentioned exactly. T or false. The that we had an opportunity to getting resurfaced during testimony. CHR. KANUHA: Thank you, Mr. Ilagan. Any other discussion, Council Members? Ms. Wille. MS. WILLE: Do we want to postpone this till next time, so that if we want to discuss it further then, or not? CHR. KANUHA: I think a good idea would be, because this is a special meeting of the Council, you know, we could always hold another special meeting of the Council. It does take a little logistics to figure out when we can get you know, lets say Dr. Pressler, or Chief Oliveira here, so that we can you know, instead of just discussing among ourselves and kind of having these questions out in the open, we could have them here kind of answering them. That would be the most helpful not only to us, but to the community as well. MS. WILLE: Yeah. Our next committee meeting is January 7. CHR. KANUHAknow, they MS. WILLE: Okay, I just thought if we got sort of an update at that point okay. CHR. KANUHA: And we got a lot time before that too, to put that on an agenda item. MS. WILLE: Okay, fine. CHR. KANUHA Council. Okay, I just want to again thank you guys for being patient, thank the public. Unless Mr. Creagan, did you have some more education that the public Page 48 -28 December 2, 2015 , you can maybe lead him in a question. MS. EOFF: Okay. Representative Dr. Creagan, some people experience more severe symptoms of the disease and get very sick, and others may have mild symptoms or not even show symptoms. Do you know why that is? Or what people could do maybe to avoid getting a severe case, if they do contact dengue. MR. CREAGAN: I think that there is no way for someone to ameliorate their symptoms except take Tylenol. And in the Philippines they even recommend against Tylenol, because you know, in severe forms of dengue you can impact your liver. impact your liver, so Tylenol is one of the few things you can take to decrease your symptoms. Motrin, ibuprofen, aspirin is all going to impact your platelets, and since your platelets is lower during take those. So you know, basically just kind of t , I guess. The concern is, of course, e symptoms are going around, and potentially are viremic, they have the virus in their blood, and if bitten by a mosquito can still pass it on. A paper came out just three weeks ago in PNAS (Proceedings of the National Academy of Sciences) that said, you know, that two or three cases that are asymptomatic for every symptomatic case. And we still . But in terms of prevention, you know, this Fight the Bite thing, I mean using mosquito repellent works. You know, in the Midwest they have the West Nile proactive about mosquito control. And you know, when hunters go out hunting, on them, and mosquitos. And while things the public health people have passed out, , you know, Fight the Bite flyer. And you know, sells lots of permethrin impregnated clothing, and you know, my wife ordered some just a few days ago, because they had it on sale and free shipping. So I mean, I think in the M West Nile. West Ns one of the other diseases that could Alaska has it. But you know, they keep monitoring birds, remember when birds were flying from the sky and everything whether West Nile was coming in here. So I think this is not a bullet, okay? First time denguevery unlikely anybody is going to die you know, possibly Page 49 -28 December 2, 2015 us, how to change our life style to protect against, you know, risk of the mosquitos and educate ourselves on what we can do. And some things are like permethrin impregnated clothing, you know, long sleeves, you know, when these mosquitos are potentially biting. And you know, when it comes down to it, when tourists without alarming them and shutting them off, right. I mean from Kohala was right, the risk for tourist is very low. But a lot of tourists get it here, and going home and they have it, and they are reporting it. S not as low , okay. And even if they get it, the likelihood their going to have severe consequences is also very low. So we s, s t come here. You know, my one concern is, because first time dengue still can cause miscarriage in about five percent of pregnancies, that should be something to be cautious about. Apart of that the risk to tourists is very, very, low. But we can still learn from this, okay, as a community, how to handle the mosquito problem, the only island that has aedes aegypti left, I think we have to pressure the Health Department to help us, and we will provide I hope, in the Legislature, Josh and myself and everybody else, to help this i to take probably a couple of years to do that. Anyway, but thank you for having us here. I thank everybody that came, because community dialogue, we want some people understand it, people do should. So thank you for having me here, I really enjoyed meeting you. And thank you, Aaron for calling this. It was good to talk to you, I have never talked to you visually before so this is great. Thank you. CHR. KANUHA: Thank you, Representative Creagan. Council Members, did you have any more questions for Representative Creagan? If not again, mahalo for coming and spending your time with us today. MR. CREAGAN: Very enlightening to watch the whole meeting. CHR. KANUHA: Thank you to the public, for being patient with us as well, and , on our island and how to best prevent, or keep each other safe from the spread. So with that I think Page 50 Hawaii County Council-28 December 2, 2015 Vote on Comm. 575: The motion to close file on Comm. 575 was carried by (Filed) the following voice vote: Ayes: Council Members Chung, David, Eoff, Ilagan, Paleka, Poindexter Wille, and Chair Kanuha— 8. Noes: None. Absent: Council Member Onishi— 1. Excused: None. CHR. KANUHA: Motion passes. Can I have a motion to adjourn? ANNOUNCE- The Chair directed the Council to proceed to the next order of business, MENTS: Announcements. (There were none.) ADJOURN- There being no other business, at 4:18 p.m., Ms. David moved to MENT: adjourn the meeting. Seconded by Mr. Paleka and carried by the following voice vote: Ayes: Council Members Chung, David, Eoff, Ilagan, Paleka, Poindexter, Wille and Chair Kanuha— 8. Noes: None. Absent: Council Member Onishi— 1. Excused: None. CHR. KANUHA: We are adjourned. Thank you. Council Approval: MAY 1 7 2017 410IF COUNT• CLERK SM/j a/rk Page 51