April 3, 2020

COVID-19 Questions with Dr. John Janikowski

Lanai family practice physician Dr. John Janikowski answers some of the most common questions about COVID-19 and explains what residents can do to stay safe. Information on COVID-19 in Hawaii is continuously changing, so please be sure to stay up to date on the most recent guidelines and recommendations by checking reputable sources from federal, state and Maui County websites (links below).

There are no reported cases of COVID-19 on Lanai. Do we still have to follow the state’s recommendations to shelter in place?

Absolutely, please do it for everyone’s safety. Please do your best to check for regular updates from the Centers for Disease Control and Prevention (CDC), Maui County, Hawaii State Department of Health (DOH), and Anything can change, minute by minute.

Can we partake in activities like swimming and hiking as long as we stay away from others?

At this time, staying at home is preferred, so residents should attempt to exercise in their home or in their yards. However, isolation can sometimes have a negative impact on one’s overall health. Therefore, it is OK for you to take a short walk, simple hike, swim in the ocean or participate in exercise, but continue to be in motion and mindful of keeping a six-foot separation from anyone you might come in contact with. Do these activities with your immediate family or alone — not in groups. Notably, there are several physical activities that people can participate in virtually, such as yoga classes online.

I’ve heard that people can be asymptomatic (have no symptoms) and be carriers for COVID-19. If I need to help or take food to my kupuna, how can I make sure that I am protecting them from potential exposure?

When you go to your kupuna’s home, wash your hands immediately and clean all surfaces, containers or packages food is in with a disinfecting wipe. Wash all surfaces and allow to dry. Don’t hug or kiss your family members at this time. If you need to cough or sneeze, cover your mouth and nose with a tissue or your elbow and wash your hands after.

Should I wear a mask to protect myself and others when going outside?

Per Hawaii DOH guidelines, whether you should wear a face mask depends on your situation. If you are sick, wearing a face mask can help prevent others from being infected by the droplets from your cough or sneeze.

There is some recent information suggesting that wearing masks when out in the public, especially if a large percentage of the population is doing so, may be some help in controlling the virus.

The best preventive measures are to wash your hands, especially before and after touching your face, nose or mouth, and limit your contact with sick people. To help prevent the spread of diseases, cover your nose and mouth with your elbow or a tissue when coughing or sneezing and stay home if you are sick.

If I recently traveled to a neighbor island where COVID-19 cases are more prevalent, is there a chance I could have it but not be showing symptoms?

Absolutely. There is currently a mandatory 14-day self-quarantine for those who have traveled interisland or outside Hawaii. Travel should be stopped or limited only to essential travel to avoid this possibility.

Is it okay that I visit close friends or family during this time if I am not sick and they are not sick either?

It is recommended to stay at home and avoid in-person contact if possible, to protect you and your loved ones and avoid any possibility of spreading the illness. Communicate through phone calls, video calls, text or emails if possible. If your loved one doesn’t use or have access to technology and you need to visit them, attempt to stay six feet apart. Everyone should also wash their hands. It is well known that asymptomatic people can still have and be spreading the virus. Even if you or your family are not having symptoms, you could still be contagious.

Who is at higher risk for serious illness from COVID-19?

Individuals with a weaker immune system such as the elderly (over age 65) and/or anyone with chronic illnesses such as diabetes, thyroid or heart conditions, or those who have undergone chemotherapy are at higher risk of developing complications.

What are the first signs and symptoms of COVID-19 and how is it different from a regular cold or flu?

Per the State Department of Health, patients with COVID-19 typically have reported mild to severe respiratory illness, including fever, cough, and shortness of breath, or trouble breathing. Some patients may not report fever, especially the very young, elderly, immunosuppressed, and people taking certain fever-lowering medications. Loss of sense of smell or taste has been reported at times in the early stages of COVID-19.

Who should get tested for COVID-19?

This is going to evolve based on numerous factors, such as test kit availability or laboratory technology staff support availability. Currently, it is recommended that testing be done for symptomatic or suspected cases, particularly those with risk factors and their very close contacts with prolonged exposure.

The CDC also recommends that not everyone needs to be tested for COVID-19 and provides some information that might help in making decisions about seeking care or testing. They note that most people have mild illness and are able to recover at home and there is no treatment specifically approved for this virus. However, testing may be helpful to inform decision-making about who you come in contact with.

Health care provider testing is being considered but we are reviewing needs and resources continuously.

Where can Lanai residents get tested for COVID-19 and what is the test like?

Testing is available by appointment and as ordered by your provider at our clinic, Straub Lanai Family Health Center and at Lanai Community Health Center. Please call the clinic at 808-565-6423 should you have any questions. We have just received a protective testing booth and will be using it with our test set up to better protect our clients and health care workers administering the testing.

The test is performed by a special and very small swab being inserted into the nostril and must remain in place for at least 5 seconds. It goes into the very back of the nose toward the opening to the throat called the nasopharyngeal. It is not pleasant but is quick and doesn’t require any true invasiveness.

If I take the test and am awaiting results, how do I safely protect my ohana from potentially being exposed?

If testing results are pending, we recommend that the individual isolate from others to a single room and avoid sharing a bathroom if possible, to avoid contact with others and prevent spreading the potential illness. Perform good handwashing with soap and water for at least 20 seconds. Try not to panic and be patient.

What is the treatment available for COVID-19? Is treatment for the disease available on Lanai?

Currently, there is no approved standard treatment, only experimental treatment. This can be risky for some individuals, and side effects can be serious in some cases. Supportive care can be provided on Lanai, but in much worse cases, critical care off island could be required — for example needing to be in the ICU on a ventilator.



Keep checking the following reputable sites for the latest resources and information on preventing the spread of COVID-19 in Hawaii:
Centers for Disease Control and Prevention
Hawaii State Department of Health
Maui County


Letter from Dr. Janikowski

Lanai still has no documented COVID-19 cases. Now is the time to be MORE VIGILANT. If we wait until we start having positives, which we anticipate will happen, that will be TOO LATE.

I am imploring everyone on Lanai to step up their game. This request is coming from me not only as a physician living and practicing on Lanai for nearly 11 years, but also from the public health perspective as I have an MPH (Master’s Degree in Public Health) from the University of Michigan.

I realize that a number of community members are already taking appropriate precautions. In order to protect yourself, your family, your friends, and the community at large; everyone needs to:

  1. SOCIAL DISTANCE by maintaining a minimum of 6 feet and do not congregate in groups.
  2. WASH HANDS often and for at least 20 seconds. This simple task could save your life.
  3. AVOID DANGEROUS ACTIVITIES that could result in an ER visit. The ER may be overwhelmed and does not need preventable injuries. The ER may have COVID-19 patients and you don’t need to be exposed.
  4. WEAR A MASK, SCARF or BANDANA when out in public. I see a lot of people already doing this, but we need 80-90% compliance if we want to flatten the curve. I protect you by wearing my mask. Please protect me by wearing yours.
  5. EXERCISE is good for your physical and mental health. In your home or your yard is the best place. If you are walking, running or jogging outside of your yard, it is best to do it alone or with only one other person (while maintaining a 6 foot separation).
  6. SHOP ALONE so only one person from the family is out. Make a list (preferably to include several days to a week’s worth of items). Go in, get the items and check out.
  7. PHARMACY Call to check if your Rx is ready before going to pick it up.
  8. DON’T VISIT FRIENDS or FAMILY. Even if you are all healthy appearing, we know that asymptomatic or pre-symptomatic people can spread the virus. Call, text, email or use other social media instead of face-to-face.
  9. STAY HOME except for essential reasons. Make sure it’s a bona fide essential reason. Going to the store only to buy a candy bar or some ice cream is NOT essential.

The ONLY way we will minimize the number of positive cases is if we all take this seriously. Think of it this way: Would you rather spend a couple weeks with these restrictions or a couple weeks in the hospital on a ventilator?

John Janikowski, DO, MPH

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