The pandemic continues to not only affect people's health, but their economic security and ability to work, even though many Hawaii residents might be "over it."
In the University of Hawaii Economic Research Organization's second quarterly public health report, released today, researchers found the impact of the pandemic widened in its fall survey results when compared with those from the conducted last spring.
"Overall, as we enter a new phase of the pandemic, Hawaii's populations are becoming more confident that the worst of the pandemic is behind us, driving COVID-19 booster uptake down, " said the report. "However, significant impacts exacerbated by the pandemic, including long COVID, mental health issues, and the prevalence of other comorbidities, may pose significant challenges that warrant monitoring."
Although more than a third of those surveyed perceived the pandemic over for their personal life, the survey found a higher positivity rate among respondents, at 45.5 percent in November compared with about 25 percent in May.
The higher positivity rate—or those that reported testing positive for COVID-19—was to be expected, according to author Ruben Juarez, UHERO's HMSA endowed professor of health economics, since it captured all respondents infected at least once since the start of the pandemic, including the summer.
It's likely to be higher when asymptomatic individuals with COVID-19 are accounted for, he said.
Higher rates continue to be seen among younger adults, the report noted, as well as Native Hawaiian, Pacific Islander and Filipino populations, and among those who are unvaccinated and unboosted.
What was alarming, he said, was the stark picture of long COVID impacts on Hawaii residents surveyed.
Approximately 30 percent of those surveyed said they were suffering from long COVID, a percentage that was the same in November as in May. However, of those who are unemployed, 47 percent reported suffering from long COVID, which was a 5-point increase from May.
Of those suffering from long COVID, more reported severe or very severe symptoms than previously, with the most common ones being brain fog and headaches. The expected length of symptoms also increased by almost a month from the last survey to 4.42 months.
The issues associated with long COVID, such as unemployment, mental illness and access to health care and treatment, will need to be addressed for years to come, said Juarez.
"I think that as we continue seeing these infections, we need to figure out no matter what—how to decrease complications for long COVID, " he said. "The fact that it is having impacts on employment as well as to mental health—that's going to be a problem."
Unfortunately, Juarez said, the economic and racial disparities that existed in May continue to persist in the November results.
One in 3 individuals surveyed still reported suffering from depression, with no change between May and November. Individuals suffering from long COVID or unemployment have higher levels of depression and lower self-esteem.
The latest report also attempted to gauge how people perceived the pandemic in November.
Overall there was more optimism, the survey found, with about 85 percent in November saying the worst of the U.S. pandemic is already behind us compared with 76 percent in May.
There was a shift of perception of COVID-19 as more of a health concern (47 percent in November compared with 60 percent in May ) to more of an inconvenience (39 percent in November compared with 32 percent in May ).
In November, 10 percent said they believed the pandemic was already over, up from 7.4 percent in May.
Signs of COVID-19 fatigue are present, with fewer individuals expressing a willingness to take precautions such as social distancing or masking in public indoor spaces should there be another large wave.
But the economic fallout from the pandemic continues to increase, the report found—with 28.6 percent of those surveyed reporting their savings depleted; 13.6 percent unable to pay bills; and 9 percent without enough food for their household.
Hawaii's booster uptake is lagging even as the impact of COVID-19 on people's health and economic security widens. Only 27 percent of those surveyed received the bivalent booster.
The May report was based on survey responses from a cohort of more than 2, 000 adults from across the state, when Hawaii was in the midst of its fourth wave of COVID-19 cases, according to Juarez.
The latest report was based on a follow-up rapid health survey in November of 1, 627 of the more than 2, 000 initial participants in May. While there was a wave in May, the case counts in November were in a holding pattern, with a daily average of about 150 cases per day, and a positivity rate of 5 percent to 6 percent.
Omicron subvariants BQ.1 and BQ.1.1 were edging out BA.5, but without any apparent impact on hospitalization numbers, which remained at about 65 COVID-19 patients per day.
As with the previous report, which was published in the summer, the November survey found that education remains an important factor for vaccination status.
Those with some college education, a bachelor's degree or advanced degree were more likely to be vaccinated than those with no high school diploma or just a high school diploma. Those who were older than 60 were more likely to have received the bivalent booster than those under 50.
The uptake was also related to trust in different sources of information. Unvaccinated individuals are less likely to trust medical providers or the federal government, and more likely to get their information from social media and faith leaders.
More than half of those surveyed, 52.8 percent, had a great deal of confidence in medical doctors, and 51.1 percent had a great deal of confidence in scientists, as information sources on COVID-19.
Respondents who never tested positive for COVID-19 were more likely to trust official information sources, the report said.
Those surveyed had just about as much confidence in journalists and news media, at 8.3 percent, as they did in religious leaders, at 8.2 percent.
UHERO conducted the surveys in partnership with the Pacific Alliance Against COVID-19. The surveys are supported, in part, by federal coronavirus funding.
Juarez said he expects the next report to focus on the economic impacts and costs of long COVID in Hawaii.
UHERO Public Health Report
The second UHERO Rapid Health Survey was conducted in November 2022, with more than 1, 600 Hawaii adults statewide participating.
Key findings:
—COVID-19 positivity rate increased, to 45.5 percent of respondents in November compared with 24.8 percent in May. Higher rates continue among younger adults, Native Hawaiian, Pacific Islander and Filipino populations.
—Long COVID outcomes remain high, with 3.74 percent reporting severe or very severe symptoms in the fall compared with 1.39 percent in the spring. Among the unemployed, 47 percent reported having long COVID.
—There are more optimistic views of the pandemic, with about 85 percent saying the worst of the U.S. pandemic is already behind us compared with 76 percent in May.
—In the fall, 36 percent said COVID-19 was over for their personal life compared with 22 percent in the spring. In November, 10 percent said they believed the pandemic was already over, up from 7.4 percent in May.
—Signs of COVID-19 fatigue are present in Hawaii's population, and fewer are willing to take precautions if there is another large wave. Only 27 percent of those surveyed received the bivalent booster.
—COVID-19 fallout and effects continue, with 28.6 percent reporting their savings depleted; 13.6 percent unable to pay bills; and 9 percent without enough food for their household.
—Fewer people are willing to take COVID-19 precautions such as social distancing and masking in public indoor spaces if there were to be a future wave.
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