A state-commissioned study measuring the Safe Travels pre-arrival testing program’s impact on the spread of COVID-19 in Hawaii found few links to positive cases but also room for improvement.

While nearly 346,000 people arrived in Hawaii between Oct. 16 and Dec. 1, the study period, the state has recorded just 226 known positive coronavirus cases, which is a rate of about 0.61 per 1,000 people, according to the study.

It also tracked the results of post-arrival tests given to nearly 22,000 travelers on a voluntary basis during the study period, with 50 testing positive. Those included 32 of 19,456 people who participated in Hawaii County’s surveillance testing program, and 18 of another 2,500 or so on other islands.

“You just look at the big picture,” said Dr. F. DeWolfe Miller, who authored the study at Lt. Gov. Josh Green’s request. “Where is the big epidemic from all these tourists coming? There isn’t one.”

Hundreds of passengers arrive and wait in a slow moving line with Governor Ige in foreground during press conference. Arriving passengers are screened if they have pre-travel testing required to avoid the 14-day traveler quarantine. Tests are only accepted from trusted testing and travel partners. October 15, 2020
Gov. David Ige opened up the state to trans-Pacific visitors on Oct. 15 through the Safe Travels program, which allows travelers with negative COVID-19 test results from trusted partners to bypass the 14-day quarantine requirement. Cory Lum/Civil Beat

The higher rate can be explained by the participation being voluntary, Miller said. It was challenging to get people to show up. Although 10% of arrivals were selected and “invited” to take part, only 2,500 or so agreed.

It also meant the study and its free testing opportunity was more likely to attract people who were already experiencing symptoms, which creates a bias in the study, he said. The tests were given to travelers on arrival or up to four days afterward, according to the study.

Hawaii’s pre-travel testing program, which allows travelers to bypass a mandatory 14-day quarantine if they have a negative COVID-19 test in hand, began on Oct. 15 in a bid to reopen the state to visitors while maintaining safeguards against the coronavirus.

Critics worry that it may lead to outbreaks as a number of travelers have tested positive after arriving, especially making an impact on Kauai, which has temporarily opted out of Safe Travels.

On the whole, the results showed that Safe Travels works in terms of keeping COVID-19 at bay, Miller said, acknowledging that there are cracks in the system.

“Yes, it is working. Yes, it can be improved upon,” he said Monday in a telephone interview.

One of those cracks, the study suggests, could be the state’s exemptions, which include essential and critical infrastructure workers, transit and military members, that allow people to partially or fully avoid quarantine.

Hundreds of passengers arrive and wait in a line with Governor Ige and Lt. Gorvernor Josh Green in foreground during press conference. Arriving passengers are screened if they have pre-travel testing required to avoid the 14-day traveler quarantine. Tests are only accepted from trusted testing and travel partners. October 15, 2020
About 20% of arriving passengers during the study period were exempt. The state could do a better job screening that category, Miller said. Cory Lum/Civil Beat

Approximately 20% of travelers who arrived were exempt travelers and some of them may have been infected with the respiratory virus, Miller said.

For example, a health care worker who was exempt and traveled from Oahu to Lanai on Oct. 20 was believed to have triggered an outbreak that left dozens of people infected.

“It was all preventable,” Miller said.

An expanded pre-screening process could have stopped that situation — something the study recommends, along with improved traveler education, he added.

There are still many unknowns about how much pre-travel testing can detect COVID-19, said Sumner La Croix, a University of Hawaii economist who previously co-authored a report on pre-arrival testing with Miller and Tim Brown, another UH scholar, but did not help write this report.

The new study, with its small sample size having examined 22,000 or so test results out of 346,000 travelers, doesn’t provide all of the answers, but it suggests tighter screening may be justified, he said.

“Safe Travels Hawaii needs to be flexible enough to bend with the circumstances of the epidemic,” he said.

Read the study: 

Page 1 of FINAL REPORT SAFE TRAVELS DeWolfe Miller

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