As Hawaii waits to reopen its largest industry, economists and medical experts increasingly view testing passengers before they board planes to Hawaii as a key to safely bringing visitors back to the state and resurrecting the state’s economy.

Even with a fraction of the visitors it had before the COVID-19 crisis shut down the tourism industry, Hawaii could expect several hundred cases of the virus to be brought into the state each month by travelers, the University of Hawaii Economic Research Organization reported in a paper released Tuesday.

But the numbers could be significantly reduced if visitors were tested at their point of departure before coming to Hawaii, UHERO reports in a paper titled, “Prevention of Travel-related Reintroduction of COVID-19 Infection in the State of Hawaii.”

How to reopen tourism has emerged as one of the most critical issues facing Hawaii as it deals with COVID-19. A 14-day quarantine for arriving passengers imposed by Gov. David Ige on March 21 largely quashed the disease’s spread in Hawaii.

But it also has shut down an industry that provides about one in six jobs. Hotels are bleeding cash and small businesses tied to tourism are being devastated. As of April, UHERO estimated Hawaii had lost some 220,000 jobs, about 30% of the labor force. More than half were the direct results of the halt in tourism, UHERO said.

Although UHERO predicted Hawaii could regain a lot of those jobs relatively quickly, that assumed the state would reopen to tourists in July. The concern is that it could be much harder to recover lost jobs if the state delays its reopening.

The report issued Tuesday argues that testing passengers before they come to Hawaii can allow the state to reopen safely. The authors, who include an economist and two infectious disease experts, call for a two-step process: a temperature screen to determine if a passenger has a fever associated with COVID-19, plus an actual COVID-19 test.

Adding the second test, the report says, “removes 80-90 percent of infectious passengers from flights to Hawaii.”

Testing passengers before they arrive could let Hawaii reopen safely – and relatively soon, says Lt. Gov. Josh Green.

“I think absolutely we should do it,” said Green, a medical doctor who has been deeply involved in the state’s response to the virus.

Green said he has been in talks with the drug store giant CVS Pharmacy to set up a system where people flying to Hawaii could be tested at 1,200 sites nationwide. He said the system could be in place as early as July 15; however, he stressed that it was Ige’s decision when to reopen.

Ige’s spokeswoman Jodi Leong referred questions to Department of Health spokeswoman Janice Okubo, who did not respond to a request for comment.

The UHERO report assumes when Hawaii does open up to tourists, it will have a fraction of the 30,000 daily passenger arrivals, including tourists and returning residents, it had before the crisis. But even one fifth of the former number, or 6,000 visitors a day, could pose risks because infection rates from Hawaii’s main travel markets are much higher than in Hawaii, the report says.

The report was written by Tim Brown, who studies infectious disease and epidemiology as a senior fellow with the East-West Center; Sumner La Croix, professor emeritus of economics at the University of Hawaii, and F. DeWolfe Miller, an epidemiologist and professor of tropical medicine at UH’s John A. Burns School of Medicine.

“If Hawaii reopens to tourism, even at 20 percent of previous levels, hundreds of people with active COVID-19 infections can be expected to enter each month,” the report’s authors conclude. “This will make it hard, if not impossible, to maintain our success against this epidemic and may push us past the tipping point.”

With No Testing, Cases Could Soar

With 6,000 daily arrivals being merely screened for temperature and symptoms, the authors predict, 750 additional active infections could come into Hawaii each month among visitors and returning residents. Adding the second COVID-19 test reduces additional active infections each month to roughly 150 people.

The testing would essentially be voluntary; however, only those who agree to be tested and test negative could forgo the 14-day quarantine.

“In sum,” the report says, “travelers are required to either test there or be quarantined here.”

Although some infected visitors would inevitably slip through cracks, the authors say the risk of those people spreading the disease could be greatly reduced with active testing, contact tracing and isolation programs combined with continued social distancing and the wearing of masks.

“Testing travelers coming to our Islands is essential to keeping us an attractive COVID-safe destination for tourists and to achieving a strong Hawaii economy,” the report says.

Green said several details still need to be worked out. For instance, he said, one question is who would pay for the tests, which cost at least $120 each. Although the visitors could be asked to foot the bill, it would be in the state’s interest to at least help. The state could use federal recovery act money, he said, and it would save the state money being used for unemployment claims if workers could get back on payrolls.

“Does it pencil out?” he said. “Of course it does, in a very big way.”

Still, he said, most details are in place. Testing passengers will serve two goals, he said: making Hawaii safe for residents, workers and tourists, and restoring jobs.

“We don’t want a large surge in cases,” he said. “But we want a large surge in employment.”