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Click on the icons below to learn more about the hazards detailed in the 2020 Maui HMP.
Public health risks, such as those presented by infectious diseases, vector-borne illnesses, water-borne illnesses, and chronic diseases, are present within every community. They include commonly occurring illnesses like the common cold and influenza, as well as less common inflictions such as bacteria-caused Escherichia coli (“E. coli”) and mosquito-transmitted Zika virus.
The degree to which communities are susceptible to or actively experiencing public health issues can impact a community’s vulnerability to natural hazards, as well as its ability to respond to disasters. For instance, an infectious disease outbreak may complicate evacuations or/and mass sheltering required due to a natural hazard. Similarly, high incidents of chronic diseases may decrease mobility within a community, and natural disasters may reduce access to vital healthcare services needed by the ill.
History reveals that in the absence of information about a public threat, treatments, and vaccines, infectious diseases can be extremely deadly. For example, the 14th-century bubonic plague killed about 50 million people in Europe at a time well before modern medicine or an understanding of contagion existed. The plague did not submit for nearly 10 years, even then, continued to reemerge every decade or so for nearly 400 years.235 The plague was largely managed through trial and error and ultimately controlled through quarantine measures, the first use of it in history. Tuberculous is considered the world’s deadliest infection disease today despite available vaccines and treatments. Although it is nearly eliminated from the U.S., certain locations around the world see high infection rates and have limited capacity to manage the disease.
While major outbreaks are uncommon, public health emergencies can become stand-alone disasters that compound the threat of other natural hazards and exceed local and state capacity. There is precedent for federal assistance due to public health emergencies including West Nile Virus (2000), a mosquito-borne disease, for which a federal emergency declaration was made in New York and New Jersey,236 and the COVID-19 pandemic, which resulted in a major disaster declaration in all states, territories, and the District of Columbia.
Maui County has experienced several acute and ongoing health risks and faces the threat of several others. While not a comprehensive list of potential health risks, the following provides a brief overview of health risks faced by Maui County. It is not intended to be a complete list of potential public health threats.
Vector-borne Diseases: A vector-borne disease is a disease transmitted to humans from living organisms or animals.
Angiostrongyliasis (Rat Lungworm Disease)
Rat Lungworm Disease is caused by a parasitic nematode, also known as a roundworm parasite. In humans, rat lungworm affects the brain and spinal cord, impacting the brain and nervous system. Infected rats can pass larvae of the roundworm in their feces to intermediate hosts, such as slugs, snails, and freshwater crustaceans. Humans can become infected by: 1) eating raw or undercooked snails, slugs, freshwater shrimp, land crabs, frogs, or crayfish. 2) accidently eating produce with slugs, snails, or slime. 3) drinking improperly filtered catchment water with slugs or snails.
Symptoms of rat lungworm include severe headache, stiff neck, tingling skin, low-grade fever, and nausea or vomiting.
Chikungunya
According to the CDC, the Chikungunya virus is spread by mosquitos. The most common symptoms of infection are fever and joint pain, but it may also cause headache, muscle pain, joint swelling, or rash. Currently, there is no vaccine to prevent or medicine to treat chikungunya virus infection.
Dengue
Dengue fever is transmitted to humans by Aedes aegypti and Aedes albopictus mosquitoes. Symptoms include headache, body aches, fever, and rash. In several cases, blood clotting problems can occur.
Symptoms typically last one to two weeks. About half of cases present no symptoms. Prevention actions include avoiding mosquito bites (repellant and covering skin), and well as reducing mosquitos by emptying standing water.
Hansen’s Disease (Leprosy)
Hansen’s disease (also known as leprosy) is an infection caused by slow-growing bacteria called Mycobacterium leprae. Leprosy was once feared as a highly contagious and devastating disease, but now we know it doesn’t spread easily and treatment is very effective. With early diagnosis and treatment, the disease can be cured. Further, to transmit the disease, a person must be in close contact with someone with untreated Hansen’s disease for many months or even years. People with Hansen’s disease can continue to work and lead an active life during and after treatment. Hansen’s disease can affect the nerves, skin, eyes, and lining of the nose (nasal mucosa). However, if left untreated, the nerve damage can result in crippling of hands and feet, paralysis, and blindness.
Leptospirosis
Leptospirosis can be contracted when a person has contact with water, soil, or urine from an infected animal. Multiple types of animals may be infected including dogs, horses, pigs, wildlife and rodents. Symptoms generally include a combination of fever, diarrhea, muscle aches, vomiting, red eyes, and jaundice. Without treatment, Leptospirosis can lead to kidney damage, meningitis (inflammation of the membrane around the brain and spinal cord), liver failure, respiratory distress, and even death.
According to the CDC, people should avoid floodwater as water may contain infected animal urine. The following factors increase risk to Leptospirosis: 1) Drinking from potentially contaminated water sources, including floodwater, streams, rivers, or unsafe tap water. 2) Bathing or wading in floodwater or contaminated fresh water, especially when putting your head under water or if you have an open wound or scratch. 3) Eating food that has been exposed to contaminated water or potentially urinated on by rodents.
Zika Virus
Zika virus is spread by aedes mosquitoes. While the State of Hawai’i does not currently have any cases of Zika virus, Aedes albopictus mosquitoes are found on Maui, so the virus has the potential to spread to the county by mosquito. Zika virus is also considered an infectious disease, as it can be sexually transmitted. Symptoms of Zika infection can include a fever, joint pain, rash, headache, and conjunctivitis (“pink eye”). Only about 20% of people with Zika infection have symptoms. When symptoms occur, they can last several days to a week. Human fetuses are susceptible to severe birth defects if the mother is infected with Zika virus. Preventing the spread of Zika into new areas like Maui includes the following: 1) Education of residents or visitors who are diagnosed with Zika on Maui to avoid mosquito bites and to use condoms or abstain from sex for up to 6 months. 2) Education of the general public about mosquito borne and sexual transmission of Zika virus, and the importance of repellent and covering skin (long pants, long sleeves, and socks) to avoid mosquito bites. 3) Reducing mosquito breeding by emptying standing water and other methods.
Infectious Disease: Infectious diseases are caused by pathogens that can be spread, directly or indirectly, from person to person. Such diseases may be seasonal (seasonal influenza) or result, in the case of new diseases, in a global pandemic.
Coronavirus (COVID-19)
COVID-19 is a highly contagious, viral upper-respiratory illness that was first detected in China in late 2019. The virus quickly spread throughout the world and has resulted in a global pandemic ongoing at the time of this plan. As of May 7, 2020, there were just under 3.7 million cases of COVID-19 globally, resulting in over a quarter million deaths. COVID-19 symptoms include cough, difficulty breathing, fever, muscle pain, and loss of taste or smell. Severe cases may result in death, especially in individuals over the age of 65 or with underlying medical conditions, such as diabetes, lung disease, asthma, obesity, or those who are immunocompromised. COVID-19 spreads from person to person through respiratory droplets in the air or on surfaces.
To prevent the continued spread of the virus, many communities around the world have used stay-at- home orders, in which residents must remain home except to utilize essential services, such as grocery stores and health care services. Many schools have closed, and workers have switched to teleworking. Business closures have caused major economic losses in many countries.
Hepatitis B
Hepatitis B is an infectious liver disease caused by the hepatitis B virus. Hepatitis B infections can be acute (short-term illness occurring with six months of contraction) or chronic (long-term illness in which serious health problems can develop). About 90% of infants infected with Hepatitis B will develop a chronic infection, compared to only about 5% of adults. Symptoms can include fever, fatigue, loss of appetite, nausea, vomiting, joint pain, and jaundice. Hepatitis B is transmitted from person to person through bodily fluids. There is no cure for Hepatitis B, but a vaccination is available to prevent against the virus.243
Measles
Measles is a highly contagious respiratory disease caused by the Rubeola virus. Symptoms include high fever, rash and cough. The virus is spread through the air, primarily from coughing and sneezing. It can result in numerous complications including pneumonia and encephalitis (swelling of the brain) that can lead to seizures, deafness, brain damage or death. Approximately 1 in 5 people who contract measles will be hospitalized. Young children under the age of 5, pregnant women and those with compromised immune systems are most at risk to complications.
Prior to a vaccination, an estimated 3 to 4 million Americans were infected each year. A vaccine was developed in 1963, and most kids are vaccinated by the age of 15. The measles vaccine is usually combined with mumps and rubella, and commonly referred to as the “MMR,” or combined with mumps, rubella and varicella (“MMRV”). Measles was declared eliminated (absence of continuous disease transmission for greater than 12 months) from the United States in 2000. However, in recent years the rate of vaccinations has dropped leading to a reemergence of the disease. According to the CDC, since 2010, cases reported have ranged between 55 cases in 2012 to 1,282 cases in 2019. In Hawai’i, concerns over low vaccination rates in children increase the risk of a measles outbreak. Measles vaccination rates need to be at 93% to 95% of the population to prevent measles from spreading, but in Hawai’i, only 91.5% of kindergartners have received the measles vaccine.
Tuberculosis
Tuberculosis (TB) is a bacterial infection that usually attacks the lungs but can also affect other parts of the body such as the spine, kidneys, or brain. Symptoms include a cough, fever, and weight loss. There are two types of tuberculosis – latent TB infection (LTBI), in which no symptoms are presented, and TB disease. TB disease can be infectious and is spread from person to person through droplets in the air, whereas LTBI is not infectious. Most cases of TB disease are treatable and curable but can be fatal if not properly treated. In some cases, TB infections are resistant to drugs, which is referred to as drug- resistant TB.246 A vaccine exists but is rarely administered in the U.S., given a low rate of incidence. The national incidence rate was 2.8 cases per 100,000 persons (1.3% decrease from 2017), which has been declining since tracking started in the 1930s. However, rate of incidence is declining at a lower rate in recent years.
Non-Communicable Diseases (NCDs): NCDs are diseases that are not transmissible directly from one person to another such as autoimmune diseases, diabetes, chronic kidney disease, Alzheimer's disease, cataracts, and others. Other public health risks faced by Maui County include chronic diseases, such as diabetes, hypertension, and asthma. Substance abuse is also an issue in Maui County, including excessive drinking and abuse of opioids, methamphetamines, and other drugs.
The entirety of Maui County is considered to be uniformly exposed to health risks.
The following presents a summary of previous occurrences of the health risks described above in Maui County:
Angiostrongyliasis/Rat Lungworm Disease: Maui County had no cases in 2019, and has reported one case so far in 2020 (only case in the state)
COVID-19: As of May 17, 2020, 116 cases of COVID-19 have been reported in Maui County, and with six deaths.2The COVID-19 pandemic has the potential to continue to some degree over the next several years, or until a vaccine is developed. Maui has high incidence of respiratory illnesses, such as asthma, bronchitis, and emphysema, as well as high incidence of diabetes.249 These comorbidities make individuals more susceptible to COVID-19 and can also increase the likelihood of death for COVID-19 patients.
Dengue: Maui County experienced an outbreak of dengue 15 years ago. There was also an outbreak on the Big Island in 2015-2016. According to state records, Maui County has experienced less than five cases of dengue per year in recent years.
Hansen’s Disease (Leprosy): From the 1860s through the 1960s, leprosy patients in Hawai’i were forcibly removed from their homes and exiled to Kalaupāpā, an isolated peninsula on the Island of Molokaʻi. It is estimated the Kalaupāpā leprosy colony housed up to 8,000 patients, almost all of which are believed to have been Native Hawaiians. Although the quarantine was lifted in 1969, some patients voluntarily stayed on the colony. As of November 2019, 12 patients, aged 78 to 95 years, remained at Kalaupāpā.
Hepatitis B: Maui County is described as having a high incidence of Hepatitis B cases.
Tuberculosis: Maui County has the highest rate of TB in the nation.
Zika virus: Locally acquired cases of Zika virus have not been reported in Maui County, or in the State of Hawai’i.
Substance Abuse: Maui County has the highest substance abuse rate in the State of Hawai’i.
As the severity of health risks is difficult to determine given the varying impacts associated with different health risks. COVID-19 has possibly had the largest overall impact on Maui County in recent history when considering number of cases, deaths, and societal impacts.
Probability of Future Events
Probability of health risks within Maui County is variable. Many public health risks occur seasonally and are ongoing, such as the common cold and influenza. Major outbreaks, such as the current COVID-19 pandemic or the dengue outbreak in the early 2000s, are less common. Based on the information available regarding historic or current events, this hazard was assigned a probability of likely (10% to 90% annual chance) for all community planning areas.
All current and future populations in Maui County are considered at risk to health risks. Health risks can include outbreaks of infectious illnesses, as well as rises or high incidences of chronic diseases or substance abuse. Maui County is a vacation destination for visitors around the world, making it susceptible to contagious diseases brought to the county from other parts of the world.
Buildings and Infrastructure: Buildings and infrastructure are not typically impacted by health risks but may need to be sterilized or decontaminated in some cases. During outbreaks, critical facilities such as hospitals and healthcare facilities may be overwhelmed.
Health and Safety: Health risks directly impact life safety through deaths or injuries stemming from disease outbreaks or substance abuse (e.g., overdoses). Health risks are unlikely to result in an evacuation, but may result in quarantining, stay-at-home orders, or social distancing measures. Warnings may be issued by Maui Emergency Management or the Hawai’i Department of Health regarding measures needed to combat health risks.
Infectious diseases, such as COVID-19, create added complexity to emergency response including evacuation, sheltering and managing events from typically crowded Emergency Operations Centers (EOC). Public health emergencies may strain capacity of emergency personnel time and budgets to manage multiple disasters.
Public Health Impacts: Health risks have direct impacts on public health through the spread of infectious diseases or rise in substance abuse. Health risks often require action from local, state and federal public health agencies to curb the spread of disease, prevent substance abuse, or treat affected individuals. Major outbreaks may overwhelm local healthcare capabilities.
Impacts to Vulnerable Populations: Based on available hazard information, health risks could affect all populations within Maui County. Populations exhibiting constraints related to household composition, socioeconomic status, access to information, housing characteristics and access to lifelines are susceptible to negative consequences as a result of health risks. Community Planning Areas that may require special considerations or support to meet the needs of vulnerable populations are described below.
Economic Impacts: Health risks can have devasting economic impacts. Localized disease outbreaks may impact tourism, both through direct business interruptions and through the perceived danger of visiting the county. Or, in the case of a global pandemic such as COVID-19, mandatory closures and stay at home orders cause business interruptions, school closures, lost tourism and lay-offs. Further, the county may lose revenues from sales and hospitality taxes, while at the same time having to increase spending and divert resources to managing the spread of disease.
Climate Change Impacts: Climate change may have negative impacts or health risks. According to the Fourth National Climate Assessment, an increase in the incidence of vector-borne diseases such as malaria and dengue in the Pacific Islands has been linked to climate variability and is expected to increase in the future as a result of climate change.
