We all rejoice at the decreasing number of new COVID-19 cases in Hawaii and the gradual lifting of restrictions. Mahalo to our leaders and to all of us, the people and businesses of Hawaii, for flattening the curve and protecting the whole.

It will all be for naught, however, if we let down our guard too soon. The risk is real: the virus could reinfect and spread in our state again.

The curve is not flattening nationally. A report to the Trump administration predicts 200,000 new cases daily and doubling of the daily death toll to 3,000 by June.

Hawaii’s chance for a sustained recovery depends on putting in place a science-based screening and quarantine system to prevent incoming travelers — namely, visitors and returning residents — from reinfecting the state. We also need a system of detection — testing and contact tracing — to immediately contain any reinfection when it happens.

This article envisions a well-designed and rigorously enforced screening and quarantine system that is needed now. Visitor numbers are already increasing as will resident travel. Cruise ships are wanting to come back sometime this year.

Making travel to, or back to Hawaii — including the island of Kauai, above — impeccably safe is the key to successful and sustained recovery.

Flickr: Marc Tarlock

At minimum, fever testing should be the first screen. Bravo to the state of Hawaii for being the first state to institute fever screening at airports.

However, fever screening should be done before visitors step onto Hawaiian soil. To allow a symptomatic contagious human being to enter an enclosed airplane or ship where he or she will be with hundreds of others for hours or weeks makes no sense.

As is currently done all over Asia, airlines and cruise ships in America should fever screen their boarding passengers. If they don’t, the federal government should require it.

(When an accurate rapid response diagnostic test is widely available that should become the screening test.)

Because fever screening will not detect all infected passengers, all arriving travelers to Hawaii should be tested at the airport with the best available diagnostic test. Hopefully the state has stockpiled enough test kits for an ever-increasing number of incoming travelers. Those visitors testing positive will be isolated immediately in a designated hotel or hospital.

False Negatives

To prevent false negatives from wandering around and putting our communities at risk, the rest of the guests will not be allowed to rent cars and will be shuttled to a designated quarantine hotel where management and workers are trained in protocols approved by the state Department of Health. Police or the National Guard will provide 24/7 support for hotel security. The quarantined visitors will pay the daily hotel rate, not the taxpayer.

A visitor may choose to stay at another hotel of his or her choice (approved by the DOH for hosting quarantined guests) but he or she must agree to wear a tracking bracelet or anklet. Our enforcement personnel currently have their hands full with just a trickle of visitors. It will become impossible — and extremely expensive — to enforce the quarantine as visitor numbers grow unless we use smart technology as well as good system design.

Because a substantial percentage of past infections were caused by residents returning to Hawaii, the policy of home quarantining and isolation of returning residents needs to be re-examined. If other householders were infected in the past, quarantining and isolation henceforth should be done outside of the home.

There are several ways the 14-day quarantine could be reduced significantly. Three diagnostic tests administered 24 hours apart, if all negative, would dramatically reduce the probability of a false negative.

If COVID-19 experts and the DOH agree a person could then be released, that is a three-day quarantine. But Hawaii must have sufficient testing capacity. If accurate saliva tests or the Abbot rapid test become widely available, testing will become easier and hopefully cheaper.

Kauai residents shudder when cruise ships are mentioned because those ships can become viral hotspots that could quickly overwhelm Kauai’s health care system and threaten our community’s health. Cruise ship passengers and crew should be administered diagnostic tests at the port of origin. All those testing positive would not be allowed to embark.

Hawaii must have sufficient testing capacity.

To protect against false negatives, the cruise ship would cruise the ocean for 14 days without stopping at any port. If no positive cases appear for 14 days, the passengers and crew would be allowed to disembark in Hawaii.

Emerging innovations could simplify many processes. For example, studies show the virus can be detected in sewage. If daily sampling of the ship’s sewage could show no virus for the number of days specified by experts as safe, the ship could be allowed to dock sooner than 14 days.

Making travel to, or back to Hawaii impeccably safe is the key to successful and sustained recovery. It will allow businesses to open safely and people to go back to work. It is the most important thing our leaders can secure for us now.

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