To prepare Hawaii for a potential second surge of infection, Honolulu officials have developed a plan to increase the state’s COVID-19 testing capacity, channeling federal funds to the University of Hawaii medical school and community health centers to do it.
The approach will include more targeted community outreach through seven Oahu clinics, as well as bolstering test reserves for first responders and other types of essential workers who are at higher risk of exposure.
“The way that we will be able to safely reopen the economy is to have enough testing capacity to find where the virus is, supportively isolate those folks so that they can get through it and come back,” said Josh Stanbro, Honolulu’s chief resilience officer and executive director of the Office of Climate Change, Sustainability and Resiliency.
“And then, in order to reopen, we believe there’s going to be certain professions that are going to be higher risk and frontline sort of workers that we should be testing more often.”
Strict quarantine rules for incoming Hawaii travelers remain in effect. But certain activities and businesses have recently been allowed to reopen.
As talk continues about how to relax certain policies and re-start the economy after record job losses, expanded testing has repeatedly come up in public conversations as an integral part of returning to life as it once was, especially with the possibility of a second wave of infection always on the horizon.
More contact tracing is also part of those plans. But contact tracing is the official duty of the state Department of Health, which currently has 77 people on staff to do the detective work and recently announced a new training program in partnership with the University of Hawaii.
Collectively, commercial laboratories across the state such as Clinical Labs Hawaii and Diagnostic Laboratories currently have the ability to conduct as many as 3,000 diagnostic tests per day. And a new contact tracer training program will increase the state’s ability to monitor those who have been infected as well as their close contacts.
Mayor Kirk Caldwell said Tuesday the goal is for the university’s laboratory to conduct as many as 100,000 COVID-19 tests by the end of the year.
Half of those will be the molecular diagnostic type of tests, and the remaining half serological, or blood tests that identify antibodies. Antibody tests could measure the disease’s historical footprint — something Stanbro says could inform public policy response.
Because research is still developing about the efficacy of antibody testing, the state health department has not yet endorsed it. But the tests are becoming more frequent across the islands, and have been deployed at Hawaii Pacific Health hospital campuses.
Oahu has seen the majority of COVID-19 cases to date, with 416 infections verified by DOH officials since March. Statewide, about 90% of people diagnosed have recovered.
The city also plans to test wastewater, as well as ramped up diagnostic antibody testing. The web of multiple datasets will give policymakers a broader picture, he said.
“If we start to see all three of those test rates move up and quickly then we know there’s a problem here in the community,” he said. “We want to make sure we have some early warning systems to identify that and dial back if we need to.”
Due to the downward trend in new diagnoses this month across all islands, the state has excess testing capacity, according to Edward Desmond, the administrator of the State Laboratories Division.
Gov. David Ige has said previously that Hawaii laboratories are ready to step up if the state needs it, since laboratories are conducting only a couple hundred tests per day.
But Dr. Sarah Park, the state epidemiologist, has said mass testing would not be very efficient because the tests offer a point-in-time snapshot and may not capture patients who fall ill after getting tested. That’s why the state is sticking with federal guidelines that dictate only symptomatic people be tested.
Commercial labs have conducted the bulk of testing in the state to date, but tests are all based on physician referral.
That’s where there may be gaps that city support could help fill, despite the fact that Honolulu does not have its own health division.
“Most cities do have their own departments of health for a lot of historic reasons and structurally we don’t,” Stanbro said. “We’re just trying to augment the capacity and the skill set of the Department of Health … to see what we can do to assist and get more capacity out there to help people.”
The new surge in funds to the John A. Burns School of Medicine’s nascent Tropical Medicine Clinical Laboratory will allow it to test for the virus, but also allow it to jumpstart its research on diagnosing COVID-19 using saliva samples rather than nasal swabs.
The lab is also going to prioritize testing homeless and uninsured people who may not otherwise get access to COVID-19 testing.
“It will be a dynamic working relationship with the community health care centers and we’ll follow what their needs are,” said Rosie Alegado, the community liaison for the lab which is now called the “Lab for COVID-19 Testing Innovation in Hawaii.”
The influx of funding also covers the cost of some equipment and supplies.
“The lab is a really good fit for these monies because we can bring that expertise in infectious disease as well as public health,” Alegado said.
First, the university will acquire and verify its new equipment is working properly, then it will conduct diagnostic tests of samples from nasal swabs. In its first phase, the laboratory will be able to conduct 250 tests daily and will scale up to have a surge capacity of 1,000 tests per day, according to Alegado.
“Once we can prove to ourselves that we can walk, we can start to fly,” she said.
As long as there isn’t a surge in infections that require a full focus on diagnostic testing, the laboratory will also be able to verify the saliva collection method alongside the traditional nasal swab method, she said.
To date, only one university in the nation — Rutgers University — has received federal authorization to conduct the saliva tests for diagnostics, not just for research.
The second facet of the testing expansion involves the island’s seven community health centers: Kalihi-Palama Health Center, Kokua Kalihi Valley Comprehensive Family Services, Koolauloa Health Center, Wahiawa Center for Community Health, Waianae Coast Comprehensive Health Center, Waikiki Health and Waimanalo Health Center.
Each health center will receive about $179,000 for specimen collection and another $50,000 for infrastructure development such as equipment, supplies, staffing and advertisement. Another $20,000 will help each clinic scale up telemedicine services, according to Mary Oneha, CEO of Waimanalo Health Center.
Waikiki Health CEO Phyllis Dendle said the center has not yet begun to test for COVID-19, but the city funds will allow its clinics to get the supplies they need.
Kalihi-Palama Health Center currently has dedicated resources to be able to test 50 people per day, but could scale up to 100 a day if the need arises, according to its CEO, Emmanuel Kintu.
Waimanalo Health Center is also actively screening patients by appointment — ranging from one or two to as many as seven people a week. Patients are screened over the phone first and samples are taken while they sit in their cars in reserved stalls at the Waimanalo clinic.
The new funds will allow the staff and its partner, Project Vision, to go into the community and screen people where they live throughout the Ko‘olaupoko region, said Oneha.
“Given the low prevalence of the illness in Hawaii, the most important thing for us right now is to increase capacity, and that’s what this plan of the mayor with the health centers does,” added Dr. David Derauf, director of Kokua Kalihi Valley Comprehensive Family Services.
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