Leslie “Les” K. Chock is the Director of Regional Infection Control at Kaiser Permanente and a professor of microbiology at Leeward Community College where he has taught for over 25 years. He was born in Hilo, Hawaiʻi and currently resides in ʻAiea on the island of Oahu. He received his BA in biology and MA in microbiology at UH Mānoa. He carries an extensive background in infectious disease serving as a member of the Hawaii Disaster Medical Assistance Team. During the pandemic, Les has utilized his background in infection control to protect staff and patients at Kaiser.
Interview Details
- Narrator: Leslie “Les” Chock (LC)
- Interviewer: Stephen Pono Hicks (PH)
- Recording Date: 11/04/2021
- Format: Zoom video
- Location: Honolulu, Hawaiʻi
- Key Words: epidemiology, public health, PPE, pandemic response, disaster response
PH: All right, well, hello. Good afternoon, Professor Chock, thank you for agreeing to this follow up interview to discuss your experience during the time of COVID-19 and specifically, the Delta variant. This is a second part of an interview that we conducted back in July 6th of 2021. So maybe just to start things off, can you just tell me how you’ve been since we last spoke?
LC: Well, I’ve been good, but during the Delta Surge, we got extremely busy and I’m sure we’ll get into the details further in a little while. But yeah, so now it’s settling down. But during the summer, during I’d say the month of August and September, I was quite busy and so were all the hospitals.
PH: Okay, thank you. And yeah, I forgot to mention today is November 4th, 2021 for the record, and it’s now 4:30 p.m. So yeah, I guess getting back to the Delta variant, could you maybe just describe for the listeners what is the Delta variant?
LC: OK. So viruses mutate all the time and the COVID virus does mutate. So what happens is either the WHO or the CDC tends to label the mutations like, Alpha, Beta, Delta. They give them a name. So the delta is one form of variant, and the Delta seems to have been, I’m not sure, maybe identified in the spring. And perhaps it was.. Perhaps results from many cases in India. So, you know, we had a kind of pulse on it that this new strain was coming. We didn’t know how serious it would be because there were other strains like, Alpha, Beta or South American strain or South African strain that didn’t really take off. But we were keeping a pulse on it. And then fortunately, we have a lot of testing and identification capabilities. So in other countries, in Europe, in the U.K., they started to say, “OK, Delta is starting to take over.” And then as it arrived in the United States, we hear reports, OK, Delta now makes up 10% of the cases, and then now Delta makes up 20% of the cases. And here in Hawaiʻi, we also had OK, Delta is starting to increase. And then finally, during the summer, that surge actually arrives. So we had advance warning that a new variant was coming and it was increasing. We didn’t know how infectious it would be, but we did have some warning. So that was a good thing.
PH: So it was able to be determined with the COVID PCR tests, not only whether they were positive or negative, but also whether they were the Delta strain?
LC: Yes, so the health department had that capability. I don’t know if they tested all positive COVID cases, but I do know they did surveillance for the Delta variant and then they would publish those results. So we saw the number increasing as Delta slowly took over to be the predominant strain.
PH: OK. Could you talk about what changes or measures were taken to prepare for the Delta variant and for yourself as an epidemiologist?
LC: OK, so I work at a hospital, and then we thought things were getting better. So in our last interview in July, actually, the numbers had gone down a bit and we had vaccination, so we thought things were much better. But as we saw this increase in Delta, we started to prepare for it and all hospitals did. And then I think we were pretty surprised at the speed at which it surged. So it climbed very quickly and then it lasted for about two months, and now it’s on the decline. But I was quite surprised at how quickly it spread. So I can tell you, back in July, we had closed most of our COVID units. I don’t know if we had any of our COVID units open. You know, I’ve got to go check, but we had reduced the number of our COVID units and then slowly we started to fill the unit and then we opened up the second one again and we opened up the third one. And during the actual middle of the surge, which is around end of August and September, those three units were actually full. And then we made preparations to open up a fourth and fifth unit, and actually we did get them ready, but fortunately, we never had to put patients to it. So I’d say at my institution, we probably reached maybe 95-96% full capacity. We almost had to go to the additional units. I know some of the other hospitals, like you probably saw on TV, like I think Queen’s West, they had to go on divert. They were full. So the state of Hawaiʻi came very close to reaching almost full capacity.
PH: Yeah. And with your hospital, was that the highest capacity that you had reached with COVID patients?
LC: Yes. So during the Delta Surge, we actually had more inpatients with COVID than we did in the previous surge, which was in the summer of 2020. We actually surpassed that by maybe an additional 30%. So we actually got quite full.
PH: How would you say your response and overall preparedness for the Delta Surge compared to your response to previous surges? Do you feel like you’re becoming more prepared?
LC: Yes. So that’s a good question, Pono. I think preparedness also comes from experience. So the fact that we had already done the previous two surges, I think, prepared us. So in order to turn the units back into COVID units, we already knew what to do because they had done that. So we were able to quickly convert some of the units, maybe within a day or so or maybe one or two days back into COVID units because everybody knew what to do. So we just had to reconfigure the unit. So that was a blessing. Otherwise, I think we would have been in bad shape. But I think since we had gone through it, we kind of knew what to do.
PH: And in terms of supplies, did you ever come as close to a shortage during the Delta variant or did you feel more prepared?
LC: We were more prepared. We had proper PPE. One thing that the entire state of Hawaiʻi almost ran out of and it probably made the news was that we almost ran out of oxygen. So the health department, along with the Health Care Association of Hawaiʻi with the governor, they kind of coordinated and I think with [inaudible] and a bunch of other places, they actually brought in extra oxygen from the mainland, and our hospital had an oxygen generator that we installed, so did some other hospitals. So all the hospitals got together. They had emergency meetings to say, “you know, we might run out of oxygen, so we need to prepare.” Fortunately, we didn’t have to go to that, but we did prepare. Some other places you may have seen in the world, like in India, where they actually ran out of oxygen. So early on, they kept the pulse on that and they were able to prepare.
PH: You talked about that discussion between hospitals coming together and planning. Would there have been a plan if, say, there was a shortage at one hospital to distribute supplies between hospitals on the island?
LC: Yes. So we’re fortunate in Hawaiʻi because Hawaiʻi is a small state and we all know everybody, right. So we have something called the Health Care Association of Hawaiʻi that kind of coordinates the response and it kind of keeps track of what’s going on in the different hospitals. And we had calls with them. I can’t remember if it was once a week or twice a week with all the hospitals, and they’d have a pulse on what’s your patient census, how are your supplies, how are you doing? And they would have the ability to try and shift things around because we all work together. So that plan worked the way it’s supposed to.
PH: OK. And then fortunately, your hospital never exceeded capacity. But is there a plan for what would be done if you were to exceed capacity?
LC: Yes. So all hospitals have a surge plan. You may have seen it like Queen’s and then also at Kaiser, we put up emergency tents in case we need to do overflow. We also had plans to say, OK, you know, fortunately, we didn’t have to use it. But you know, could we turn the auditorium into a patient care area? Other hospitals, my colleagues in Southern California, actually had to do some of that. Some of the hospitals in L.A. actually had to put beds in places in the hallways, etc. Hawaiʻi, we never got to do that. But every hospital has a surge plan on what to do. Fortunately, we never got to that point.
PH: In our first interview, you talked about some of the similarities between COVID-19 and then the 1918 Spanish flu. I guess now that we’ve experienced the Delta Surge, are there any differences that you might note between these two pandemics, maybe just between COVID and common strains of the flu?
LC: Sure. You know, the pandemic flu in my microbiology class, we talk about pandemics and we talk about the great Spanish flu pandemic of 1918 to 1919. It’s important to note that back then, the Spanish flu killed about 50 million people. 50 million. Now, at this point, COVID has killed 5 million and not to downplay the 5 million deaths because that’s a tragedy, but 5 million versus 50 million. This COVID pandemic is not the big one. And you know, there will be other pandemics and there will probably be pandemics more severe than COVID. So this is sort of like a wake up call that we need to always prepare for something as drastic as the Spanish flu or something way more virulent.
PH: Yeah, that makes sense. Another comment you made in a previous interview was just emphasizing the importance of public health and supporting the public health workforce. Do you feel like we’re moving more in the right direction in terms of recognizing the importance of that field and allocating resources towards maybe expanding it?
LC: Yeah, I think that’s been well identified during this current pandemic that the gap was.. Over the past few years, public health has not gotten the attention that it should have. It’s been solely neglected. So I think it’s been recognized. I’m encouraged that many.. It seems like there’s more interest in people going into public health. People are going for their master’s in public health. I’m just hopeful that we can sustain that support. If people get a degree in public health, I hope we actually have positions for them to work in public health. Public health is very important because again, I sort of dabble in both fields. But it doesn’t get all the attention. You know, it’s not very fancy. It’s basic health, right. So sometimes after a few years, interest may wane and it may go back to unfortunately being underfunded. So hopefully we will get more funding and hopefully we can sustain that.
PH: What do you see for us.. This is sort of a general broad question, but could you describe what you think the future holds and maybe what direction we should be moving in as we exit this surge and just where we are right now in the pandemic?
LC: So I think in my previous interview, we mentioned that it’s hard to predict what a pandemic will do. The virus does what it wants and anyone who makes predictions about a pandemic is going to be proven wrong. So Dr. Michael Osterholm at the University of Minnesota likes to liken it to like a wildfire. So as long as there’s wood or brush to burn, then the wildfire will sweep through and then any place that hasn’t been touched by it, if another round comes through, then it will also be caught up in the wildfire. So this summer’s surge, I’d say 90% of the patients were unvaccinated. So vaccination doesn’t actually prevent spread of the disease, but vaccination was very good at reducing the amount of hospitalization. So I’d say 90% of our inpatients this surge were unvaccinated. So yeah, it’s going to continue to sweep through the population until I think everyone has been exposed. And then I don’t think the pandemic will actually end. Again, hard to make predictions. But if you look, like the Spanish flu, it will just continue to go to a low number. And maybe we’ll have COVID all year round or maybe every wintertime we’ll have a COVID season. So that might be the future. But this is definitely not the big pandemic that everybody needs to prepare for because we were fairly lucky. And again, modern health did a good job. To get a vaccine within less than a year, that was quite remarkable. And yeah, that wouldn’t have happened in the past.
PH: Yeah, I guess, obviously there is a lot of uncertainty with this pandemic, but whether it stays or goes, are there any permanent changes that we could take from this experience or maybe just changing in the ways that we think about pandemics and overall public health?
LC: Yeah, I think they’ll be renewed interest in pandemic planning. As I told you, I was involved in pandemic planning maybe 10, 15 years ago and then it kind of seemed to lose attention. So maybe there will be renewed interest in it. And one of the things is that here in Hawaiʻi, we’re very good at working together and that’s the way it should be. So an example, mask wearing has been shown to be effective. And in my class, as I showed in the 1918 flu, people also wore masks and social distancing, and they did basic public health. So I’m thinking as we move forward, you know, in Hawaiʻi, we’re very good at wearing masks. During flu season in the hospitals, some of us wore masks, not everyone, but we would have a lot of people who came from Southeast Asia, Japan, Korea and, you know, on the plane they’d wearing masks because in their culture, they already were used to wearing masks during flu season. So I’m thinking here in Hawaiʻi, maybe mask wearing will be something that, we wouldn’t do it all the time, but perhaps that every year during the during the winter, everyone will say, “OK, you won’t need to be mandated, and everyone will start to wear a mask, like they do in Southeast Asia. I know on the mainland it’s very different, but here in Hawaiʻi, it wasn’t that unusual to see someone wearing a mask in Waikiki or on the plane. So maybe we’ve gotten used to it. And we won’t have to do a mandate because everybody knows this is what we should do. So I think it’s a positive sign.
PH: Yeah, that would be nice. Well, thank you, Professor Chock. Is there anything else that you want to leave with?
LC: No, I would say that, you know, infectious disease is just a microorganism. It’s a virus and micro-organisms always mutate and we just happen to be the host. So this is not the end or the last pandemic. We’ll have more. So again, basic medicine, basic public health and as we talked about before, basic health equity to make sure that people get the basic services, get the medical care they need, that goes a long way to preventing bad outcomes for our population. So here in Hawaiʻi we’re an island, and we all need to work together. So I think that was a strong point for us that everybody works together, and I think we’ve done fairly well.
PH: All right, well, thank you, Professor Chock. I appreciate you sharing your experiences and insights today.
LC: Yeah, you’re welcome.