On Saturday, Hawaii reported 21 newly confirmed COVID-19 infections in the state. On Sunday, there were 13 new cases. On Monday, there were five.
The number could swing back upward Tuesday. But experts say daily case counts from Hawaii’s Department of Health suggest that Hawaii is succeeding in flattening the curve and preventing the coronavirus from overwhelming the state’s health care system.
“You’re doing a good job. I’m impressed by Hawaii,” says Ali Mokdad, an epidemiologist and professor of health metrics sciences at the University of Washington. Mokdad is part of a team that has been modeling the trajectory of the new coronavirus both nationally and globally.
There are a lot of caveats. Data on confirmed COVID-19 cases is limited by who gets tested, and testing results may be delayed. Every day, new figures get posted and any models predicting the spread of the disease are highly imprecise. Case counts also vary widely by county, growing faster in Maui County than in Kauai or Hawaii counties.
But when it comes to statewide trends, Hawaii is doing relatively well, according to Dominik Wodarz and Natalia Komarova, professors at the University of California at Irvine.
Wodarz, a professor at the Department of Population Health and Disease Prevention, and Komarova, professor of applied mathematics, are part of a team in the university’s public health division analyzing the virus’ spread. They co-authored a paper about the trajectory of COVID-19 internationally, and have studied the disease in 10 California counties.
Wodarz and Komarova said the virus’ spread in Hawaii is comparable to Orange County, and both places are doing better per capita compared with Los Angeles, San Diego, San Bernardino and Riverside counties.
Initially in Hawaii, cases were doubling every three days but now, they double every six or seven days, says Komarova.
“The epidemic is flattening out,” she says.
Mokdad from the University of Washington says that the nation is seeing two kinds of epidemics — one for states like Hawaii and California that implemented social distancing measures early, and another for states like Georgia and Florida where the crisis may not peak until June.
Seattle is seeing a slowdown in COVID-19 cases and San Francisco is now being held up as a national model. It’s been nine days since Hawaii last saw more than 25 confirmed cases in one day. Monday’s case count is the lowest single-day COVID-19 report in Hawaii since March 25.
Wodarz cautions that he and Komarova’s analysis is based only on daily reported cases by the Hawaii Department of Health and that lower-income communities may have a harder time obtaining testing. The situation looked much different last week and could look drastically different next week.
Both he and Komarova credit effective social distancing measures for slowing down the epidemic in Hawaii and caution against lifting them.
The numbers are “good and they’re encouraging for Hawaii but they don’t tell you that it’s time to relax,” Wodarz says.
Hawaii’s progress is reflected in the University of Washington’s model projecting COVID-19’s death toll in the state. As of Monday, Hawaii is expected to see 82 deaths by August 4, far fewer than the nearly 400 deaths previously anticipated. Researchers are no longer predicting a shortage of hospital beds or intensive care unit beds in Hawaii.
Mokdad said the downward revisions are part of a broader tempering of projections nationally with the addition of new data on mortality and information about the virus’ progress in Italy, Spain and parts of the U.S.A. including Seattle.
“The peak is earlier than we expected,” Mokdad says, noting that the total number of deaths expected nationally has fallen by more than 10,000. “The epidemic in this part of the world is not the same experience that we’ve seen in China.”
Mokdad also credits Hawaii’s social distancing efforts for pushing the estimated total deaths from an average of 12 at the virus’ peak down to four.
“You guys made the right decision at the right time and that’s why you have less deaths,” Mokdad says.
“The peak is earlier than we expected. The epidemic in this part of the world is not the same experience that we’ve seen in China.” — Ali Mokdad, University of Washington
“Going back to normal has to be in stages,” he cautions, noting that re-invigorating the tourism industry could be risky given that some states are months behind Hawaii in containing the pandemic.
The University of Washington’s projections assume that social distancing policies are in place through May, including a stay-at-home order and closure of schools and non-essential services. Hawaii also has a 14-day quarantine for all arriving travelers but largely relies on self-enforcement.
However, the UW model is uncertain in part because the number of deaths reported each day varies considerably. Researchers don’t have much data to work with because Hawaii has had relatively few deaths, a fact that Mokdad says is “good for Hawaii, bad for our model.”
Any model of COVID-19 in Hawaii is hampered by limited data, says Tim Brown, an infectious disease modeler and senior fellow at the East-West Center.
“The data here is sparse enough that any model is not likely to be particularly solid or realistic here,” says Brown, who specializes in HIV/AIDS and has been observing the progress of the coronavirus in Hawaii.
But Brown agrees that the epidemic on Oahu appears to be slowing down, noting that cases in Maui County appear to be trending upward.
“Whether that will hold up we will see,” he says.
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