With Hawaii’s new Covid-19 case numbers declining and more than 80% of those eligible for vaccinations now fully vaccinated, the pandemic has entered a new phase, executives of three of the state’s largest medical organizations say.

And how Hawaii deals with this next phase, the executives said, could have an effect on the state for years to come.

The pandemic is far from over, Dr. Jill Hoggard Green, president and chief executive of The Queen’s Health Systems, Dr. Mark Mugiishi, chief executive of Hawaii Medical Service Association and Ray Vara, president and chief executive of Hawaii Pacific Health, all agreed during Monday’s meeting of the House Select Committee on COVID-19 Economic and Financial Preparedness.

But, they said, it is time for the state to start thinking past the immediate crisis while continuing to stay safe.

“Covid’s not over,” Vara said in an interview. “But the question is how well do we learn to co-exist with it.”

Green pointed to social and economic factors that she called “social determinants of health,” including food and housing, and said the state must redouble efforts to address the needs of lower-income communities to avoid long-term problems.

Vara put it simply: “Poverty is the greatest enemy of health.”

Covid-19 Has Deepened Economic Woes

This focus is a dramatic change from the height of the pandemic, before vaccines had been approved, when the House Covid Committee’s focus was simply getting the virus under control.

But much has changed since then concerning the virus’ spread. Meanwhile, major problems facing Hawaii’s communities have worsened.

For context, Mugiishi pointed to the Aloha United Way’s oft-cited report on economically distressed working families in Hawaii. Known as Asset-Limited, Income-Constrained, Employed – or ALICE – the term generally describes households where people are employed but barely making it, with no safety net for emergencies and income that falls short of paying for necessities.

Before the pandemic, families at the ALICE level or below represented 42% of households, including 9% in poverty. Since the pandemic, the situation has gotten worse. Mugiishi noted that now almost 60% of households are at or below the ALICE, the Aloha United Way reports.

In addition, Mugiishi said, 50% of the state’s children receive government subsidized health care.

This plays out in big health disparities. For example, Vara shared a map showing that life expectancy in West Oahu and Waimanalo is a decade shorter than in Hawaii Kai. Green said Hawaii should make it a goal to cut those gaps by half in 10 years, something she said is widely thought to take a generation.

The risk of being too careful and not safely opening the economy, Vara said, is that economic disparities will only get wider, pushing the most vulnerable people into holes they can’t get out of even with public assistance. At this point in the life of the pandemic, with so many people vaccinated, Vara argued, that’s a critical risk greater than the medical one caused by Covid-19.

“The story at this time is there’s a greater risk in front of us,” he said, “which is that we put this community from a social perspective in harm’s way that will take us decades to get out of.”

Carl Bonham, executive director of the University of Hawaii Economic Research Organization, put the situation on the individual level: “Not having a job is a pretty serious problem when you need to feed your family.”

Bonham was hardly the only non-medical type at the virtual committee meeting and media briefing that followed. Also on hand were political, business and community leaders like committee co-chairs Scott Saiki, speaker of Hawaii’s House of Representatives, and Peter Ho, chairman, president and chief executive of Bank of Hawaii.

“Covid is not pau,” said Naalehu Anthony, a filmmaker and Covid-19 committee member who founded the organization COVIDPau to communicate pandemic issues to disenfranchised communities. “But we also need to find ways to move forward as a community.”

Bonham said people who choose to get vaccinated, and thereby protect the community’s health, should be rewarded with even more privileges that allow them to get their lives back to normal. Proof of vaccination is now required to get into places like restaurants, theaters and gyms, as well as large events.

“It needs to be easier and easier to live your life if you’re vaccinated,” he said.

Vara said the science is clear that the worst cases – which stress the hospitals and thus prompt government officials to enact social and economic restrictions – are among the unvaccinated.

“It’s time for it to be socially acceptable for you, if you are vaccinated, to have greater freedoms than if you are not,” he said. “If you’ve taken that step there should be additional freedoms that are allotted to you.”

During the House committee meeting, Honolulu Mayor Rick Blangiardi declined to say what if any additional privileges might be granted to vaccinated people. But Blangiardi made clear he agreed with the overarching theme.

“We’re going to have to live with this disease for a long time,” he said. “We all know that.”

Gov. David Ige on Monday also expressed a vision about living with the virus. During the Honolulu Star-Advertiser’s “Spotlight Hawaii” program he said Covid-19 will one day be like the flu and require yearly shots to fend off the most recent, contagious variant.

Ige said Hawaii is in a good position to implement boosters because the state already has a robust IT system used for its Safe Travels program, which allows travelers to sidestep a 10-day quarantine upon arrival in Hawaii by showing proof of vaccination or a negative test.

Ige also expects state finances to recover more quickly moving forward.

“We are well ahead of schedule of what we anticipated the economic rebound would be,” Ige said.

More than 7 million travelers have used the state’s Safe Travels program since it launched October 2020, he said.

In August, in an announcement that made global headlines, Ige urged travelers to stay away from Hawaii while Covid cases were surging. But that was only meant to be temporary, until mid-October for domestic travelers.

Ige has said international travelers should be encouraged to return for the holidays but that state officials and tourism industry executives are working on details.

“We do want to make sure that when we invite people back, that we have space and we have restaurants and we have other activities for them to do,” Ige said.

Civil Beat reporter Blaze Lovell contributed to this report.