Hawaii’s arrival testing debate continues, decision expected this week

HONOLULU (KHON2) — On Oct. 15, anyone who travels to Hawaii will be required to get a negative COVID-19 test 72 hours before arrival.

Several leaders and health officials are now sounding the alarm. They’re saying that more needs to be done or the state will see a surge in cases, and possibly another shut down by the end of the year.

Neighbor island mayors have been discussing the situation for weeks.

On Thursday, Oct. 1, Sen. Donovan Dela Cruz, Sen. Jarrett Keohokalole, Sen. Michelle Kidani, Sen. Donna Mercado Kim, Sen. Sharon Moriwaki and Sen. Kurt Fevella sent a letter to Governor Ige requesting that “traveler arrival testing be implemented at all Hawaii airports receiving direct flights.”

They added, “We are concerned that the 72-hr pre-test and on-arrival temperature screening will not provide adequate vetting of infected travelers and will catch less than 60% of travelers to our islands.”

The letter continues to state: “Dr. Jonathan Dworkin, Queen’s Health System, and Dr. Darragh O’Carroll, Kuakini Medical Center agree that without additional arrival testing we will be putting our residents and visitors at-risk. They believe if we depend solely on a 72-hr pre-test, that even if a resident caught this virus three days prior to the test, it has almost 100% chance of being a false negative.”

The senators state how important it is to re-start the local economy but it “must be balanced with prudent and cautious prevention and mitigation protocols. The current plan will cause a surge of infected residents and visitors by Thanksgiving, which forces us to return to economically and morally bankrupt lockdowns.”

“Our request is to shore up our State’s plan for reopening by keeping a shorter six-day quarantine and releasing the traveler after a second negative test is performed on day six. As an alternative, we ask that the administration work with the Airlines to create a process for separating voluntary pre-tested travelers and non-pre-tested travelers either into separate cabins or onto separate flights. Repeat testing of travelers, or increased separation, will go a long way in ensuring that we minimize the unintentional spread of the virus, and allow us to reopen local businesses on Oahu, reopen our schools gradually, and prevent depletion of our already stretched medical and PPE resources.”

Honolulu Council member Tommy Waters, whose district includes Waikiki, drafted a similar resolution last week.

Lieutenant Governor Dr. Josh Green disagrees and said that the pre-testing program will vet out the majority of sick passengers. He said that he’s even suggested a plan to test 10% of passengers to see how the program works.

“All this energy on a second test is a misdirection and fearmongering,” Lt. Gov. Green said. “Now, I would love to see extra tests get done, and they can be optional. Of course, the more tests the better, but only if we have them.”

Lt. Gov. Green said that the state only has about 4,000 daily tests, which is well below the projected 8,000 to 10,000 daily arrivals. He said that visitors to Hawaii stay on average seven to eight days, and that no person, couple or family will come to Hawaii and spend the majority of their vacation in quarantine.

“If they test positive on the fourth day, what happens? They have to stay here and quarantine for two weeks, with all of their family who are close contacts in a hotel at their own expense. Do you think that they’re going to agree to that?” Lt. Gov. Green said.

He said that the current tests need to be kept for local residents, first responders, contact tracing and any potential outbreak at a school or care home.

“To test someone who already is only one in 1,000 risk, a second time, it really places the priority in a low-risk group instead of protecting our own people,” he said.

He said mayors should enforce masks policies better, which is ultimately the best way to prevent spread and catching COVID-19.

“The White House is getting overrun by COVID. Those guys are getting tested every day. It’s because they didn’t wear masks. So, the real debate should be about masks. The mayors should enforce their mask-wearing policies that will be excellent. They should realize that people who are spending these scary tales about a second and a third test are really just intent on having no one come here ever,” Lt. Gov. Green said. “If people want to not open Hawaii, if that’s what some of the mayors are saying, they should just say it and we’ll have that discussion.”

He continued, “Then we’ll find out what we have to do to support people on very long-term unemployment, without health insurance, we’ve already moved 40,000 people to Medicaid, where it’s very difficult to get health care. We’ll have to figure out a way to educate our children, because those very same individuals who don’t want to open schools. I mean, you’re talking about the total disruption of society for a very long time.”

Green said the state needs to re-open and people need to get back to work.

“If we continue to remain shut, I think you’re going to see massive numbers of people finally saying I can’t even fathom listening to the rules that are out there. Then you’re going to have a lot of spread,” Lt. Gov. Green said.

He said hotels already have a plan in place and if a visitor were to fall ill during vacation, American Medical Response will go directly to their hotel and give them a free test and put them in isolation until they get their test results the next day.

He said that spread would be minimal because all employees at the hotel, restaurants, and across the islands would be wearing masks and following local guidance.

“It’s a fallacy that tourists are the biggest risk,” he said. “The risk is not wearing masks and not adhering to social distancing.”

In Lt. Gov. Green’s press conference last week, he proposed a way to check people with a second test.

“Testing 10% of all the people that that come back, whether it’s our local residents or travelers, we can actually muster those tests right now to get 8,000 people that would be 800 tests a day,” Lt. Gov. Green said. “We would see–is it two out of 100 that were positive four days in? Is it one? Maybe it’s a lot, if it’s a lot of people we’ll adjust the policy, that’s a way to do it.”

One health expert sees the situation differently.

Dr. Darragh O’Carroll, an ER physician in Honolulu, said that more measures are needed or the state could see another lockdown by Thanksgiving.

He said it takes three days, at the earliest, for the body to increase its viral load, and for some, it could take ten to 11 days. “That’s why we have our 14-day quarantine,” he pointed out.

On average, it takes five to six days for someone to develop symptoms. Dr. O’Carroll said 40% of people never do.

He said one in 1,000 travelers coming in positive is a low scenario because one test only catches 40% of infections, not 80% as previously claimed.

“If 8,000 people are coming per day, that’s at least 32 that are slipping by our current plan per day. If you multiply that by 30 that’s 960 that are slipping by,” Dr. O’Carroll said.

He said that the prevalence of the virus is only going to increase. Dr. O’Carroll said states are already seeing an increase in numbers due to the fact colder temperatures lead to more people staying indoors and gathering inside.

“And so that the statistics of one in 1,000, are based off of a lower prevalence of 0.5%, when our national average right now is 0.78%, (Saturday) it was point 0.77%. So, it’s only increasing,” he said.

He said California’s current prevalence rate is just shy of 1%, which is where the majority of travelers will be flying in from.

“If you’re surveying a group of people–that’s what our visiting arrivals will be if you’re trying to do surveillance of these people–that one test is going to catch at best 30 to 40% of people,” he explained. “And so that’s why a lot of people are sounding alarms, not only Councilman Tommy Waters but also our state Senate as well.”

“One test is going to catch, even if it’s perfect, one test is going to catch at best 40% of people,” Dr. O’Carroll said.

He said that he understands the economic consequences of having additional measures in place, but said ultimately, another lockdown would be detrimental to the state.

“But this short-sighted gain is setting us up for a long time, a long-term, disastrous holiday and winter season,” Dr. O’Carroll said.

“It’s not something that’s safe, and it’s a short-sighted economic burst for a long-term economic woe.”

“Without additional testing by Thanksgiving, or sometime in December, we would be in pretty dire straits and looking at shutting down,” he continued. “I understand the need to open up and the economic need but what we need to consider is that our small businesses cannot survive another reopening and shutting down.”

Dr. O’Carroll continued, “Let’s put the safeguards in and if they prove safe enough, then we can back down and then we can analyze but to go through with this plan, where no other state, city, or country has done successfully, it is absolutely wrong thing that we should be doing.”

Lt. Gov. Green said that he recommends doing the pre-arrival testing program and using strategic surveillance to test additional people.

“So that we know that we’re not getting a lot of positives, and if the cases ticked up, then we revisit the whole issue. But if people want to shut down Hawaii again, it’s going to send a chilling effect all across the globe,” he said.