What do Hawaii, New Zealand and Australia have in common? They are islands.

What do they also have in common? They are free of rabies.

They are rabies-free because in addition to being isolated islands, with controllable access, they enacted policies to quarantine all animals, in Hawaii’s case for 120 days. We now have better testing and rabies vaccines so we can keep Hawaii rabies-free more simply with quarantine available when needed.

If we can keep rabies out, why can’t we keep COVID-19 out? We can, and New Zealand and Australia think they can too.

With the expanded availability of quick tests we will soon be able to screen everyone coming into our state. Loopholes around our quarantine rules need to be closed but we have or will soon have the tools to effectively keep new cases of COVID-19 out of our state. No other state will be able to do that.

If we can keep it out, all we have to do is stamp out the existing cases.

Dog at the Animal Quarantine. Halawa Valley. 15 may 2015. photograph Cory Lum/Civil Beat
A dog at the Rabies Quarantine Station in Halawa Valley on Oahu. Hawaii can keep COVID-19 out of the state just as we do with rabies. Cory Lum/Civil Beat

We do not have to settle for “mitigation,” which just decreases the number of new cases without the goal or the hope of achieving the absence of cases. We can and must strive for eradication. If we have the will, and allocate the resources, we can do it.

I believe that ethically we must do it if we can. If we settle for mitigation as it appears the mainland must, there will be a relentless drip of new cases, of new deaths, of fear and uncertainty, and continued challenges to our social and economic framework.

Hawaii is actually doing a pretty good job so far. Oahu is a challenge, but the neighbor islands are in better shape and our internal inter-island quarantine and limited flights are helping. As I write this there are no active cases on the Big Island and one active case on Kauai.

Quicker Testing, More Tracing

What can we do to improve?

We need more and better and quicker testing and it seems that this is on the way.

We need an army of contact tracers to find and test all the contacts of any new cases.

We need to continue our efforts on the neighbor islands and if we can get them free of COVID-19 we need to keep them free. Ideally there will be no mainland flights to the neighbor islands to facilitate testing of all arriving passengers. We also should test all passengers flying inter-island before they get on the plane.

Once the neighbor islands are free of cases and we have the testing and contact tracing forces in place we can plan for opening neighbor island businesses and potentially opening schools in the fall.

We can then work on eradicating COVID-19 on Oahu and making sure we have plugged up all the holes in our quarantine system. After a small cluster of cases emerged in Wuhan with the index case an older man who was thought to have recovered from the virus but somehow relapsed, China is considering testing all individuals in Wuhan and testing many millions of people. We could do that on Oahu.

Oahu is critical. We have so far avoided any outbreaks at long-term care facilities, and we can hopefully maintain that record as we move towards zero active cases. We must continue our social distancing and we must be willing to test and contact trace aggressively if we find any suggestion of a cluster of cases.

We may have to stop letting positive cases self-isolate at home. When Chris Cuomo of CNN in New York did that, he infected his wife and 14-year-old child.

We could isolate all cases in designated COVID-19 hotel/hospitals with close observation and immediate transfer to a COVID-19 hospital. We should reserve some of our hospitals for COVID-care staffed by younger, less vulnerable health care workers and reserve others for trauma, cardiac care, elective surgery and all the myriad of non-COVID-19 medical needs. This is what China did.

We have a great opportunity to reinvent a new paradise.

I will leave it to your imagination how wonderful it would be if our state was free from COVID-19. We would be the pride of the United States. Health care workers would flock to a COVID-free state as would teachers to our reopened schools. Well-screened tourists would be welcome, but with the selling point of a COVID-free state we could diversify our economy and attract clean and well-paying companies from biotech, the Green New Deal, and information technology.

We have a great opportunity to reinvent a new paradise.

We will not have to wait for a vaccine that may never come or suffer the deaths it would take to buy herd immunity. If we kept our improved public health infrastructure we could deal with and conquer a mutated COVID-19 or the next pandemic that is likely to come.

Lastly, we will be a safe harbor for our undersea and surface Navy and all the other armed forces that would benefit from having their bases in a COVID-free state.

Our forces here are the tip of the spear that is needed to control China’s expanding ambitions and the economic boost from a military expansion could help mitigate the diminished tourism dollars and provide a boost to our construction industries.

Let us have the courage and the will to stamp this plague out and keep it out of our new paradise.

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About the Author

  • Richard Creagan

    Richard Creagan, M.D., is a state representative from District 5 on the Big Island. He was board-certified and worked in Emergency Medicine in California and on the Big Island at Kona Hospital, where he was vice chief of staff. He has been a farmer on the Big Island for 30 years and has been chair of the Agriculture Committee for the last four years. Prior to that, he was vice-chair of the Health Committee. Of relevance to Covid-19, Creagan published extensive research on the genetics of human disease at Yale and the University of Connecticut. Later with Yale colleagues, he started a biotech vaccine company in the Bay area where he was planning director and then medical director. He holds patents in vaccinology and viral inactivation. He also worked at the Hawaii Department of Health as an Epidemiological Investigator during the SARS outbreak in 2002-2003.