The decision will be made by more than 200 people, including representatives from the state Health Department, Civil Defense and each county.

"We'll probably make that decision" this morning, said Toby Clairmont, director of emergency services for the Healthcare Association of Hawaii. "There's a 99 percent chance that's what we're going to do."

For the past 11 days, the more than 100 Hawai'i hospitals, nursing homes, assisted living facilities, home care and hospice providers, and air and ground ambulance providers have been planning their response to the possibility that swine flu would reach the Islands.

Yesterday, the U.S. Centers for Disease Control and Prevention confirmed a married, Army couple and an unrelated school-age child had swine flu. All three have recovered, officials said.

As a result, the Healthcare Association's plans likely will move from "Level 0" to "Level 1" this morning, Clairmont said.

The biggest human effect is likely to be felt at facilities that care for the elderly, where family visits are especially cherished.

"It's a fairly emotional issue when a nursing home starts to restrict visitation," Clairmont said. "But we're trying to protect the kupuna. Those are closed communities. Unless somebody brings something in, that population theoretically should not get sick."

STILL MONITORING

State health officials continue to monitor 30 to 40 potential new cases per day, pending further testing.

"It wouldn't surprise us if there are more cases, that is true," state health director Dr. Chiyome Fukino said yesterday. "Right now, we have no probables waiting in the wings."

The Healthcare Association of Hawaii hopes its procedures reduce the spread of swine flu. But if the number of cases should grow to affect every Hawai'i hospital, then the group would move to "Level 2."

"At Level 2, that means we are swamped — no more ventilators, no more beds, no more staff," Clairmont said. "All hospitals are heavily affected. That means patients will experience a different standard of care. Only the sickest of the sick will get in. We begin to suspend services. Elective procedures are rescheduled."

At "Level 3," Hawai'i is suffering from a "catastrophic pandemic," Clairmont said. "There are deaths and we're outgunned on every front."

There is no vaccine against swine flu, known formally as H1N1 influenza A.

Despite warnings from state health officials, people in Hawai'i continue to empty pharmacy shelves of the prescription, anti-viral treatment medication known as Tamiflu in apparent attempts at stockpiling.

Some people in Hawai'i are even getting doctors on the Mainland to phone in prescriptions to Hawai'i pharmacies, Clairmont said.

"It is true that a Mainland physician can call in a non-controlled substance and it can be filled," Fukino said. "There certainly has been an increase in local demand (for Tamiflu), kind of like a run on the bank. That's what we're dealing with."

Hawai'i's Longs Drug stores are seeing "increased activity" of Tamiflu sales, said Mike DeAngelis, a spokesman for Longs' parent company, CVS Pharmacy. "The supply fluctuates day to day, store to store."

Sales of hand sanitizer and face masks have also run out at some Longs stores.

"We're trying to replenish our stores as quickly as possible to meet that demand," DeAngelis said.

Walgreens stores in Hawai'i all received Tamiflu shipments on Friday and expect another shipment within the next 10 days, spokesman Nathan Hokama said. Walgreens' three full-service stores on O'ahu also received new shipments of hand sanitizer and anti-bacterial wipes on Monday, Hokama said.

3 IN ISLES RECOVERED

The male Army soldier developed symptoms after returning from a trip to Texas, the Army said in a statement. His wife, a civilian, also developed symptoms.

The school-age child came down with swine flu after traveling to California, Fukino said. Both Texas and California are among states with confirmed cases of swine flu.

All three of the confirmed swine flu patients have since recovered, Health Department spokeswoman Janice Okubo said.

At a press conference yesterday, Gov. Linda Lingle said, "the people are already recovered. There are no new probable cases at this time. We'll continue to be vigilant."