HONOLULU (KHON2) — Oahu’s reopening plan is a four-tier program that could take until the end of the year to reach the home stretch. Always Investigating analyzed what it takes to move from tier to tier.

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KHON2 asked city officials to clear up where the plan has some flexibility along the way and where things will stay most rigid. Much of it relies on the interplay of testing and positivity rates, which doesn’t always move in tandem.

The Oahu reopening plan centers on two metrics to define each of four tiers: a rolling week-long average of daily new cases and the percent positive of all tests. The order says in order to move ahead, the city must have been in the current tier for at least four weeks, and meet both metrics of the next tier for a couple of weeks.

“If we’re attempting to focus testing in the areas where outbreaks and clusters are occurring, then we would expect the positivity rate to go back up,” explained Dr. Mitchell Rosenfeld, who is working with the city on COVID-19. “If we’re doing more general testing of the population, we would expect the positivity rate to go to go down.”

And there is the rub, where the two metrics might not always sync up. A small test batch of really sick people could give a low headcount and a high positive percent. Or vice versa, an eye-popping case count could actually be just a sliver of a percent in a really big test batch.

“That was actually an issue from early on in terms of how we’re going to be able to relate these two metrics when they seem to contradict one another,” Rosenfeld said.

Take Oahu’s surge testing, which the Department of Health and Human Services told KHON2 as of Sept. 23 yielded just 350 cases out of 58,152 tests — a 0.6% positivity rate. KHON2 asked the city: Can the two “determinative metrics” — headcount and percent positives — become an either-or choice for policymakers?

“As it’s written, it’s both,” said Hiro Toiya, who is the Director of the Honolulu Department of Emergency Management. “But if the situation changes in the future, then of course, we need to adapt to the situation. What we wanted to do was create a system that is durable enough in time but recognizing that there’s so much that we don’t know about this disease, and there’s going to be so much change coming in medicine and technology.”

Do not expect wiggle room within each industry or how rules will flow from tier to tier for the business sectors.

“We’ll continue to work with the whole community to do what we can to safely reopen our economy and more societal activities. But as it stands, there is not an appeals process,” Toiya said. “We don’t do individual exemptions. We try to keep it as structured as we can.”

Always Investigating asked: Why limit the metrics to just case counts and positivity when the majority of cases have not been severe or deadly, and it is the hospitalizations and ICU capacity that was always at the heart of the mantra to “flatten the curve?”

“Hospitalizations and ICU bed use and ventilator use all lag the surge of possible exposure,” Rosenfeld said. “So this is a stat that we’re monitoring on a daily basis and, of course, we’re watching trends. But often, once we’re starting to pick up evidence that there is a cluster or surges occurring, then we’ll even be sure more focused on those resources and making sure they’re available.”

Big changes are coming for testing on Oahu. As soon as next week, the University of Hawaii John A. Burns School of Medicine will start testing at a new city-sponsored lab. It has a 1,200-a-day capacity and will start off with 100,000 ThermoFisher tests. The city paid for it with $3.9 million in federal coronavirus relief funds.

“They’re in conversations with the community health centers, with public housing. with areas of high impact,” explained Honolulu County’s Chief Resilience Officer Josh Stanbro. “They want to do focused testing in areas where it’ll make the most difference and help populations the most that may have the least access to testing.”

Test volume also may pick up along with contact tracing capacity. As close contacts are reached, many will get a COVID test. The state has ramped up to nearly 300 contact tracers. Honolulu is about to add 80 more in a contract with OmniTrak using their call-center staff. Two more similar contracts are also in the works, and phone-service professionals are lining up to help.

“We got a call (on Sept. 24) that Hawaiian Air has offered up a whole bunch of employees,” said Gary Kurokawa, who is the Chief of Staff for Mayor Kirk Caldwell. “I’m looking to see other opportunities with companies that can help provide unemployed employees, like the hotel workers, the front desk workers who are very good at customer service.”

The state agrees that a medical background is not required, but a background check is for all first-contact callers. Their job is to connect with a positive case and hand them over to the Department of Health’s (DOH) specialized medical teams. That handover itself is protected.

“We’ve also invested a significant amount of Homeland Security funds into our cybersecurity infrastructure to add more efficiencies to the contact tracing process, but at the same time, creating additional safeguards into the privacy of people’s information,” Toiya said.

Testing may also pick up in response to another kind of virus surveillance underway: wastewater testing, which the city has been doing since June.

“Over the past two weeks, with the change on leadership at DOH, we’ve been able to make a lot of progress around sharing data, and try to validate the broader wastewater testing that the city has been doing,” Stanbro said. “We started that at a broad population scale, and DOH is most interested in wastewater testing for congregate living, or at the level of the nursing home or at the level of a population that lives in one place. And you can kind of monitor very efficiently and with cost-effectiveness with regular testing for the wastewater just for that area. And then if you pick up something, you can go in with the more expensive individual case testing.”

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