With Hawaii poised to reopen to tourists in less than a month – and schools set to restart even sooner – a testing strategy espoused by a Harvard University epidemiologist is being hailed by local academics, economists and medical experts as the best path forward for the state as COVID-19 cases surge.

“Inexpensive, high-frequency, self-administered testing – as we wait for therapeutics and a vaccine – is the only way forward,” said Alexander Culley, a microbiologist and visiting professor at the University of Hawaii who studies viruses in the ocean and develops techniques to detect them.

The plan being promoted by Culley and others calls for using relatively inexpensive, saliva-based “paper tests” that people can take themselves at home – daily to every few days – regardless of whether they have symptoms. People who test positive would know to stay home and to take a more sensitive test, called a PCR test, that generally has to be done by a lab or doctor.

Medical personel seal COVID-19 swab samples into test tubes from the drive through test site at the Kaka'ako Waterfront Park, in Honolulu, HI, Sunday, March 29, 2020. (Ronen Zilberman photo Civil Beat)
Medical personnel sealed COVID-19 swabbed samples into test tubes from a drive-through test site at the Kakaako Waterfront Park. New rapid saliva tests would be used in addition to swabs. Ronen Zilberman/Civil Beat/2020

Culley acknowledged the paper tests can’t detect small amounts of the virus the way the PCR tests can. But he said the tests can generally detect large amounts of virus that are present when a person is contagious.

“The most important question is, ‘When are people infectious, and can we detect them when they’re infectious?’” said Culley, who is a professor at Laval University in Quebec.

Dr. Scott Miscovich, a Hawaii physician who has led efforts to do more testing here, agreed. He said it is generally not in dispute that people tend to shed the virus only when their bodies are carrying enough to be picked up by the paper tests.

“If we go to an every-other-day, at home test, we can wipe this off the planet, not just the State of Hawaii,” he said.

To be sure, the idea of conducting widespread home testing using paper tests has far to go before it’s adopted in Hawaii. The paper tests haven’t been approved by the federal FDA. And even if they were, Hawaii health officials would have to go along with the plan.

Janice Okubo, a spokeswoman for the Hawaii Department of Health, didn’t respond to a request for comment on Wednesday.

Still, the idea is clearly gaining traction. Sumner La Croix, a University of Hawaii economist whose work helped guide the state’s plan for reopening the local economy, is scheduled to present the new testing scheme on Thursday to the Hawaii Economic Association.

La Croix acknowledged the paper tests are not as effective as the PCR tests, but he echoed Culley and Miscovich, saying the ease of use and relatively low cost could allow for testing that’s frequent and ubiquitous enough to stop the spread of the virus.

With Cases Surging Most Residents Oppose Reopening

Hawaii reported a record 173 new cases of the virus on Wednesday, marking the continuation of a troubling trend of exponential growth in recent weeks. The seven-day moving average on Wednesday was 129 cases, which marked a seven-fold increase over July 5, when the seven-day moving average was 18 new cases per day. The July average was also a significant increase over the previous month: on June 5, the seven-day average was fewer then 2.5 new cases per day.

With numbers surging, many Hawaii residents are worried about Hawaii’s plans to open schools by Aug. 17 and to ease a 14-day quarantine for visitors on Sept. 1. According to a Civil Beat poll released Wednesday, 54% of voters said they weren’t satisfied with state plans to reopen public schools, and 56% said they weren’t satisfied with the plan for tourism.

The issue for policymakers, therefore, isn’t simply about getting the virus under control but also getting the public to feel safe enough to buy in. For La Croix and Carl Bonham, the executive director of the University of Hawaii Economic Research Organization, widespread paper testing – a concept that is getting traction around the nation – is the way to go.

“It’s not quite as accurate as the other tests,” La Croix said. “But being able to do a lot more testing would isolate a lot more people, get them out of the population. That’s a surefire way to basically control the whole epidemic.”

Paper tests are hardly the only solution. Earlier this week the Honolulu Star-Advertiser reported that the Honolulu technology company Oceanit Laboratories is developing a fast, saliva-based test that gives results in three to 10 minutes. The company’s chief executive, Patrick Sullivan, said the test should prompt a resurgence of visitors to Hawaii.

Edward Desmond, administrator of the Hawaii Department of Health’s laboratories, told the paper he was hopeful about Oceanit’s test.

Meanwhile, S&G Labs Hawaii on Hawaii Island is gearing up its testing capability to be able to conduct about 1,000 PCR tests daily with a turn-around time of one to three days, said Dr. Lynn Welch, the company’s chief executive.

Welch agreed it’s key to restore tourism to revive Hawaii’s economy, and she said her lab has the capacity to serve the islands. She said S&G labs chose to do the PCR tests rather than less reliable “antigen” tests because the PCR tests are the gold standard.

“Somebody might come up with an antigen test that blows our socks off,” she said. “Is that going to be before we have a vaccine? Who knows?”

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