Hawaii COVID-19 testing criteria now includes people not showing symptoms who have been in close contact with people who have tested positive, Department of Health officials said Wednesday.

The policy calling for more widespread testing follows a previously held and hotly debated position that Hawaii would follow a more conservative approach and reserve testing only for people showing symptoms, in accordance with federal Centers for Disease Control and Prevention guidelines.

The policy change was announced Wednesday during Gov. David Ige’s daily press conference on COVID-19. Lt. Gov. Josh Green, a medical doctor and member of the state’s virus response team who has advocated for more aggressive testing, said the policy was clarified earlier in the day during a meeting between Green, Gov. David Ige and Bruce Anderson, the director of the Hawaii Department of Health.

“We are testing all close contacts for COVID-19. I think that’s clear,” Anderson confirmed at the press conference.

The announcement came during a day marked at times by confusing discussion of the state’s testing policy.

During a morning hearing of the Hawaii Senate Special Committee on COVID-19, Green reiterated his call for more testing.

“We know a large number of people are asymptomatic carriers,” he said. “And if they’re walking around, they could be spreading.”

When lawmakers expressed support for Green’s position, he suggested they share the opinion with the Health Department.

“I think you should tell them what you want,” he said.

After a lunchtime recess, the hearing resumed, and Anderson told the senators the state already was conducting wider testing.

“We are testing all the close contacts of every case,” he said.

‘Back And Forth’ On Testing

During Ige’s press conference later in the day, when asked when the policy was adopted, Green said state officials had been “going back and forth about this” before clarifying a position on Wednesday. It involves tracing and testing people who came into contact with a sick person and monitoring the contacts as well.

The state’s official shift marks one of several aggressive steps Hawaii has taken to contain the spread of the virus.

In addition to stay-at-home orders, the state has imposed a 14-day quarantine for all new arrivals to the state, including residents flying back home, in an attempt to keep people from importing the virus from elsewhere.

While the policy has proven at times difficult to enforce, it has resulted in a marked decrease in arrivals – to 700 or fewer daily from about 30,000 per day before the announcement.

Meanwhile, on a per capita basis, Hawaii already ranked among the nation’s most aggressive in terms of the numbers of tests conducted. As of Wednesday, Anderson said, some 15,000 tests had been conducted in Hawaii.

In terms of controlling the virus, Ige said, “We are outperfoming virtually every other state in the country.”

The new policy of even broader testing marks a significant change, and a victory for doctors who have been pushing for more expansive criteria.

Among them is Kai Matthes, a Maui doctor who also is part of a local team trying to create a ventilator that can be made quickly.

Matthes lauded the state’s new policy but noted that testing was only one aspect of the state’s response. Also key, he said, was to trace people with whom the infected person had come into contact.

“The combination of testing and contact tracing – that is what’s going to make a difference,” he said.

State Stuck To More Limited CDC Guidelines

In the past, the state health department had said its previous, more limited testing criteria were based on CDC recommendations to not test asymptomatic people or even those with mild symptoms, based on the belief that the symptomatic were far more likely to actively transmit the virus.

Even at that time health department officials said they were aggressively investigating anyone who might have come into contact with an infected person to make sure the contacts isolated themselves.

Doctors who wanted more screening said an expansive testing program could show who has the disease and how it spreads and thus stop it. Research on the virus shows about 80% of cases are mild or asymptomatic.

State officials said part of the reason for the previous, more conservative approach was a relative shortage of test kits and supplies. But that appears to be changing, as private labs obtain more resources and cooperate to serve the public demand.

Faster Testing, Contact Tracing Apps Could Be Next

The bulk of the testing is conducted by  two private labs, Diagnostic Laboratory Services Inc. and Clinical Labs of Hawaii. Piia Aarma, a spokeswoman for Diagnostic Laboratory Services, confirmed that it and Clinical Labs “back each other up for the benefit of the communities we all serve.”

DLS currently has the capacity to perform about 200 tests daily on island with same-day results. Of those, about 90 to 130 tests are being used for hospital patients, Aarma said. The rest are used for tests that require quick turnaround, such as for essential health care workers and first responders.

This capacity will increase when more of the reagents that are needed to conduct tests on the island are obtained, Aarma said, but it’s not clear when that will happen.

Still, the labs can perform many more tests here and send the swabs to the mainland. But the number of tests sent off island is limited by the availability of testing kits, Aarma said.

The availability varies, Aarma said, from a low of about 6,000 kits per day available to both DLS and CLH combined, to as many as 12,000, with an average daily availability of 8,000 to 10,000.

The next step, Matthes said, may be for Hawaii to scale up local testing so it can get results more quickly. Fast contact tracing also may be key, he said, adding that a recent article in the journal Science indicates that cell phone apps can help public health officials conduct faster, more robust contact tracing.

Anderson stressed that Hawaii still has no plans to burn through supplies by testing people who show no symptoms and haven’t been in contact with a sick person.

“We’re never going to be in a situation where we’re testing everyone,” he said.