The state and city have asked us to hunker down in our homes until April 30 to prevent coronavirus infections, which if allowed to explode might overwhelm Hawaii’s intensive care facilities.

I went into self-isolation in mid-March before the official order. I have been staying at home now for 21 days; my hyper-compliancy prompted by concern for my 84-year-old husband’s existing health issues.

But as the days roll on I wonder what statistical marker the city and state will need to tell people it’s okay to come out of their homes?

And what happens when people resume their public lives?  Won’t they again be vulnerable to contracting COVID-19?

Signs reminding people to keep their distance have gone up at the Honolulu airport. But what sign are officials looking for to tell them it’s OK to resume a normal life? Cory Lum/Civil Beat/2020

State Health Director Bruce Anderson, who is also an epidemiologist, said in a telephone interview Friday he expects the people of Hawaii will need to remain in the current stay-at-home mode at least until June.

He says April 30 is when the state expects the number of new cases to peak — not for the danger of infection to be over.

“We still have a lot of questions about when this will end. What I can say is we expect infections to peak at the end of April or the beginning of May,” Anderson says.

And after the peak, he says, “we will not relax the current restrictions until there is a substantial drop in the number of cases over a sustained period of time — at least 14 days.”

He’s unable to say exactly what number or rate of infections would make officials comfortable to give the green light for residents to go back to work and students to return to school.

“When we do relax the restrictions, it will have to be done gradually with careful monitoring. This is going to take a while,” he says.

“There is no question we need a better surveillance program.”

Better Tests Needed

Anderson is particularly hopeful antibody testing will become widely available in a few months to give the state a better handle on who has developed an immunity and can resume work and school.

Until a COVID-19 vaccination is ready —  predicted to be at least a year from now — the blood serum testing tells who has been infected with COVID-19, has recovered and now has antibodies in their blood to protect them from getting re-infected.

It is useful for tracing how far the virus has spread and to get a handle on the number of people who have been infected yet have shown no symptoms.

“This is going to take a while.” — Hawaii health director Bruce Anderson

Italy and Germany are doing antibody tests now while the U.S. is rushing to develop its own widespread serology testing for this virus. Germany is even talking about issuing immunity passports to those testing positive for protective antibodies.

The U.S. Food and Drug Administration last week authorized the first coronavirus antibody test, developed by a company called Cellex Inc.

Alan Katz, a professor of epidemiology at the University of Hawaii Manoa, says with no COVID-19 vaccination available yet, the big question is: What’s the exit strategy; how do we move to the next phase?

His friend and colleague, Dr. Seiji Yamada, says: “I’m not a fan of Donald Rumsfeld, but I’m afraid this falls under the category of ‘known unknowns,'” referring to the former defense secretary’s remark when asked about the lack of evidence linking Iraq to the manufacture of weapons of mass destruction.

Yamada is a professor at the UH’s John A. Burns School of Medicine and a specialist in disaster management training.

For now, Yamada says the state needs to tighten stay-at-home restrictions by allowing fewer categories of workers to be designated as essential and exempt from stay-at-home mandates.

“People here would not tolerate a full Wuhan-style lockdown, but for now we need more people staying at home, fewer people out and about,” he says.

He says if the current physical distancing mandate fails to slow the spread of the coronavirus, more aggressive restrictions should be considered such as curfews and passes to be out on the streets.

He also thinks the state needs to increase its current level of testing and ramp up contact tracing to interview everyone who has been in touch with infected individuals and isolate them for 14 days like South Korea did with great success.

As part of more robust testing, he says, tests should be given to anybody who has continuing interaction with the public, such as cashiers at grocery stores, restaurant workers handing customers takeout orders, fast food clerks and baristas, to name a few.

Michael Yoshida has his nose swabbed for the COVID-19 test after riding his bike to the drive through test site set-up at the Kaka'ako Waterfront Park in Honolulu, Sunday, March 29, 2020 in Honolulu, HI. (Ronen Zilberman photo Civil Beat)
Michael Yoshida has his nose swabbed for COVID-19 after riding his bike to the drive-thru test site at Kakaako Waterfront Park recently. Ronen Zilberman/Civil Beat/2020

COVID-19 is a stealth disease, infecting some people who get through the contagion with no symptoms at all while they remain in the community infecting others. More testing would reveal the asymptomatic infected.

In his own medical practice, Yamada says, he is lowering his threshold for testing and giving more swab tests to patients than he has in the past.

To date, more than 13,000 tests for infection have been done in Hawaii, mostly by private laboratories. Anderson says Hawaii is third in the nation for testing, behind only New York and Washington states.

Epidemiologist Alan Katz is also a proponent of more testing while at the same time making sure there is an ample supply of personal protective equipment for health workers doing the testing.

Katz points out that as an island state in the middle of the Pacific Ocean, Hawaii has a distinct advantage in fighting the disease. It can almost completely close itself off to nonresidents in a way mainland states cannot.

“If social distancing has been instituted here early enough,” Yamada says, “and the border lockdown to nonresidents is kept in place for long enough, maybe, just maybe Hawaii may have a chance of avoiding the worst of the virus.”

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