County’s continue to question state surveillance testing calling results ‘misleading’

Coronavirus

HONOLULU (KHON2) — Honolulu and Kauai are questioning the state’s surveillance testing data, saying the test results being provided to the public are ‘misleading.’

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As of Nov. 17, in the surveillance program, the state said there have been 24 confirmed positives out of 17,146 tests conducted or 1.4 per 1,000 (total, since the program’s launch on Oct. 19).

But several county mayor’s have been frustrated with the state’s results and have asked for a county by county breakdown of the numbers.

On Thursday, the state gave an update of preliminary numbers and broke it down by county.

Lt. Governor Dr. Josh Green and Dr. Dewolfe Miller, who is leading the study, said 27 people have tested positive out of more than 17,000 people.

According to the state, testing on Oahu has shown three out of 616 people had tested positive, 0 of 331 tested positive on Kauai, one out of 392 tested positive on Maui and 23 out of 15,931 tested positive on Hawaii island.

“When you’re looking at 273,000 people screened, and you do a study, and you get this kind of data, and you see that we have the lowest rate in the country. I would refer to that as a success,” said Lt. Governor Green on the numbers.  

When trans-pacific travel reopened, Hawaii Island Mayor Harry Kim mandated all travelers flying in Kona taken an antigen test upon arrival.

However, many questioned when the travelers were pre-tested, noting it takes more than three days for the virus to incubate, and many travelers could be tested just hours before they arrive into the state.

Honolulu Mayor Kirk Caldwell said he was promised by the state there would be a robust surveillance testing program in place to see how many positive cases were coming in.

“What they told us in a written memo, is that they would test 10% of all arrivals four days after arriving on the island,” he said during a press conference on Thursday. “And that the 10% would be selected at the airport, here at Daniel K Inouye International Airport and the other airports.”

“We’ve been waiting since for the results of that surveillance test, we’ve relied on the promises made, and took a risk. And that risk now is greater because of the number of cases on the continent, and the raging wildfire of COVID-19 and the positivity rate of over 10% compared to ours which is below 3%,” Caldwell continued.

He said he does not disagree with the methodology or science behind the testing program, but questions the high numbers the state is putting into their results from Hawaii island.  

When the first round of surveillance testing data was released from the state three weeks ago, Hawaii County had about 12,000 tests done, but the other counties didn’t know how many had been done on their island.

“That is not a random pre-selected group of people at every airport where people are coming in from the continent,” Caldwell continued. “And that is a test done immediately upon arrival in Hawaii, and we know that people coming from the continent got tested at the airport at LAX and SFO and the flight takes about five hours.”

He said travelers who were pre-tested in California the day of travel and arrived in Kona five or six hours later, and were re-tested isn’t a good represented sample because it takes several days for the virus to incubate.

“Five hours later and you arrive and get a second test, that is not a four day later, surveillance test,” he said. “You’re going to be negative because it takes four to seven days to start shedding. That’s not surveillance of anything, and it’s misleading.”

Caldwell said he hopes the rate remains low, but wants the state to provide the data that was promised from the beginning.  

“Health and safety are the most important thing as mayor, and I know I’m not the most popular guy I did the stay-at-home, work-from-home orders twice because it was about health and safety. Our tier system is holding a hard line, because it’s about health and safety,” he continued.

“We need to get scientific results about the positivity rate, particularly as we see a higher level of positivity on the continent. Every day they should be saying we’ve tested 10%. Four days later and here’s what we see, yesterday and tomorrow, just like we give you our numbers every day, on a seven-day average, we should know is the positivity rate going up or down,” Caldwell added.

 Caldwell said he would like to have the data so he knows whether more action is needed to help prevent more cases from entering the state.

“If necessary, we put in place a voluntary second test four days later. For us, we go to the government say we don’t want to shut down our visitor industry again, but maybe we need a mandatory second test,” he said during the press conference. “If we see a higher level of positivity and we start infecting those who work in a visitor industry, we need to know that. We just want the information to protect the public health and safety of the one-million residents of this island. I think it’s a fair thing to ask.”

One health expert on Kauai also disagrees with the data being promoted by the state.

He said Kauai data indicates 15 cases are coming in positive per 1,000 travelers.

“I think the concerning thing right now is that certain surveillance data is indicating a much riskier, a much worse scenario, a much higher prevalence amongst travelers, then, what is being promoted,” said Dr. Kapono Chong-Hanssen, Kauai Community Health Medical Director.

He said the Big Island data is being misrepresented.

“Because they’re testing everybody on arrival who had participated in the pre-travel testing, that’s where a huge amount of these test numbers is coming from, to sort of show that there is a low prevalence of infectiousness amongst travelers,” he explained.

“That testing is really not reliable, to me, it’s misleading and dilutes the purpose of the surveillance study, because those travelers already had a negative study or a negative test within 72 hours of that second test on-arrival, and it’s possibly the same-day if they had gone to one of the places where you can get the rapid molecular test before travel,” Dr. Chong-Hanssen continued.

“It’s really not comparable,” he said.

Since re-opening, Kauai has seen a large spike in case numbers due to travel, and Dr. Chong-Hanssen said community spread is now being linked to workers within the travel industry.

“We want the rest of the state to understand that this might be happening in your community to, but it’s just harder to detect,” he said.

“It’s our duty to speak out when we see something that looks like ‘hey, this could be really bad, this could be a lot more risk than what we’re being told,’” he continued.

He said it’s important for people to acknowledge that travel does have risk to it, and the risk should be quantified with good data.

“It’s concerning to me that there seems to be a willingness to ignore that or not continue to try to evaluate whether our travel protocols are safe enough in this evolving pandemic,” he explained. “The thought comes into my mind, is it worth the risk for two months to allow more disease into our community and allow more potential for community spread?”

He compared the cases to matches and a fire.

“If you keep throwing the matches, eventually, some of them are going to catch fire,” he explained. When you have a smoldering fire, kind of like Oahu does, it’s really hard to tell if a match was thrown in there, but on Kauai, you know, we can count the matches.” He said Kauai was able to monitor where their new cases were coming from because they went from having no cases for weeks and months prior to re-opening.

“We’re concerned on Kauai because now we have this steady stream of infections that are mostly related to travel. So those matches are going and you have Thanksgiving where it’s sort of like, okay, you piled up the wood and some straw, and we hope that it doesn’t catch fire, but it’s kind of a setup for something to catch right now, just based on the timing and the trends that we’re seeing on our island,” he continued.

The epidemiologist running the study said the preliminary numbers are in fact preliminary, and he will continue to get data and report on the data he receives until the study ends.

“I would say that, given the data we have that is preliminary, that the results are showing that is very low. I don’t know how else to put it,” he said on Thursday.

Dr. Miller, who has been an epidemiologist for years, and is not paid by anyone in the state, or by federal funds, said he is doing the study as an independent scientist.

“I have lots of partners that I’m working with from the private sector and the public sector, and I can call it as I see it and I would appreciate it if they understand that,” he continued.

He said the data coming from Big Island is enough for a study

“I don’t know that there’s any difference whether we did the test on one island or the other,” he said.

He also said not all counties have decided to participate in their program.

“We would like to have all the counties participating in cooperating with program, yes, but when people are complaining about, they’re being excluded, and they’re not cooperating, that’s kind of hard to take,” Dr. Miller continued.

Dr. Miller said it doesn’t matter if 10% of travelers are tested, the data from any number of samples is what’s important.

“It doesn’t matter what percentage it is, the absolute number is what’s important, in terms of statistical precision,” he said.

He said more focus should be on screening before taking a pre-test as well.

He said more travelers should focus on passing the screening before taking the pre-test.

He said on the Safe Travels App there are a list of questions that ask if a traveler has had symptoms in the last 14 days, or had any contact or exposure to someone with Covid, and if you’ve worn your mask in public.

“This is the biggest problem with implementing the program, which is just implementing what we’re supposed to be implementing anyway, here in Hawaii, which is the masking and the social distancing, the physical distancing, avoiding crowds and parties and celebrations and I don’t know what’s going to happen with thanksgiving,” Dr Miller said.

“So the actual issue of a sample size, which I can calculate for you, for any particular thing with a little handy dandy formulas that we have, are really kind of irrelevant in this situation where we’re getting already such large numbers of data, I wish people would bear in mind that we have some, some data on hand right now to consider and to think about,” he continued.

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