Even as more Hawaii residents become fully immunized against COVID-19, health officials and doctors expect rapid testing to play a growing role in COVID-19 detection as people seek a way to safely return to schools and businesses amid the ongoing pandemic.

Dr. Sarah Kemble, acting state epidemiologist, said the importance of rapid testing lies in its same-day, same-hour results, especially as new variants emerge.

“That’s huge because you can actually respond to that in real time,” she said.

Medical technicians from Premiere Medical Group Hawaii work with COVID-19 rapid test machines at the Kakaako Waterfront Park.
Some airports, like the one in Kahului on Maui, use rapid testing to screen arriving passengers. Cory Lum/Civil Beat/2020

Antigen tests, also called rapid tests, pick up on coronavirus-specific molecules that prompt a body’s immune response, although their accuracy varies depending on how far illness has progressed.

Rapid testing is emerging as a popular choice for on the spot results to provide a safety net for events since many people aren’t vaccinated and more contagious variants of the coronavirus keep fears of outbreaks alive. It’s also quick and cheap, giving it far-reaching potential to assist in bringing back sports competitions, conferences, school gatherings and other events.

Iolani School began using rapid tests regularly about three months ago. Five certified nurses at the Oahu private school have tested hundreds of students per week as part of the athletic program’s protocol, including competing team players from other schools.

“It’s very valuable to give you kind of the degree of safety you need to move beyond what we’ve been doing,” said Timothy Cottrell, the head of school.

Even as more students get COVID-19 shots, rapid testing allows the school to resume rites of passage like senior prom and graduation, he added. Approximately 96% of the school’s senior class is fully vaccinated — just in time for commencement on Saturday.

“That makes it comfortable for us to say, ‘You can receive a diploma without a mask on,’” Cottrell said.

Other institutions such as the University of Hawaii are considering the use of more frequent rapid testing.

University officials are developing plans about how to approach testing, especially for those who are vaccine-exempt, spokesman Dan Meisenzahl said.

Large companies, including Hawaiian Electric, are also considering adopting rapid testing, although the utility is still “exploring future use,” according to spokeswoman Shannon Tangonan.

Rapid testing’s counterpart, or PCR testing, uses a lab technique called polymerase chain reaction to detect the virus’ genetic material.

PCR testing often takes longer and costs more but remains the medical standard, since it yields results with the most certainty. Both types of tests have advantages and disadvantages.

Increasingly Relevant

An average of 5,000 molecular-based tests are conducted daily in the islands, according to the state Department of Health, but that doesn’t include rapid test results. The state only includes PCR tests in its confirmed coronavirus case count. However, in anticipation of an increase in rapid testing, health officials recently began including probable COVID-19 infections to the data.

Dr. Elizabeth Char, director of the health department, noted that COVID-19 testing is shifting toward individualized kits.

“It’s going to be more dispersed, with testing in your doctor’s office or even you test yourself at home,” she said last week during the Honolulu Star-Advertiser’s “Spotlight” program.

Hawaii COVID-19 testing rates have been relatively steady this year, even as cases decline. Courtesy: Department of Health

Rapid tests vary in cost, ranging from $5 to $50, according to the Centers for Disease Control and Prevention. Some PCR tests can be done quickly, but rapid tests still remain the most consistently cheap option.

Several over-the-counter and home-testing rapid kits have received emergency use authorization from the U.S. Food and Drug Administration, although most require a prescription.

One shortfall is that rapid tests make it more difficult to track down whether the COVID-19 infection was spurred by a more contagious variant of the virus, Kemble said. “You’d need to get a second sample to tell if that was a variant strain,” she said.

Patrick Sullivan, founder and CEO of Oceanit, a Hawaii-based company that is developing its own rapid COVID-19 test, says the expediency of rapid testing is still useful to track transmission as the virus evolves and mutates into new variants.

“It’s kind of a race — how fast can people get vaccinated and how fast can the virus evolve? Because of that, you need to have something that is simple, convenient, and affordable,” he said.

The molecular PCR COVID-19 test is still required by the Hawaii State Safe Travels program for people arriving from out-of-state who wish to bypass quarantine — even if they’re fully vaccinated, although officials are looking at expanding a vaccine quarantine exemption.

Doctors of Waikiki was contracted to screen arrivals at Maui’s Kahului airport. Courtesy/Doctors of Waikiki/2021

Some islands also require an extra rapid test upon arrival.

When Maui COVID-19 case rates ticked up this spring, a Doctors of Waikiki team was hired by local county officials to conduct rapid test traveler screening at the island’s Kahului airport.

The team’s rapid tests flagged only three possible COVID-19 cases among the 60,000 people who arrived in Kahului from the mainland since May 4.

Three positives may not seem like much, but Dr. Alan Wu, the medical director and co-founder of Doctors of Waikiki, said those travelers were not alone.

Wu also said he believes the mere presence of rapid testing at the airport causes trans-Pacific travelers to be more careful to avoid exposure to the virus during the three-day window after taking the requisite pre-travel test.

“My whole goal is to prevent the variants,” he said. “We set up at post-arrival, and just having us there makes people think twice. A lot of things can happen in 72 hours.”

Meanwhile, Hawaii County officials are going in the opposite direction by ending their rapid test screening program at Big Island airports.

That’s because most of those who are traveling to the Big Island have been fully vaccinated, said Cyrus Johnasen, the mayor’s spokesman.

“With a steady uptick in fully vaccinated trans-Pacific travelers arriving at our airports, continued post-arrival testing no longer seems necessary for our island’s health and safety,” he said.

Big Demand

Going forward, rapid testing is likely to be most common at large public events such as sports competitions and conferences and other situations when it is not clear who is immunized and who is not.

Dr. Scott Miscovich’s Premier Medical Group Hawaii became an outbreak-response team when the pandemic began and has since obtained certification to conduct rapid testing in 21 other states, backed by 2,000 employees. Prior to the pandemic, the Hawaii company employed 170 people in the islands.

Most of Premier’s local clientele are private schools, hotels and movie sets. Elsewhere in the U.S., demand is great among professional sports teams, he’s found, having worked with the likes of the Southeastern Conference, an American college athletic conference and professional teams like the Los Angeles Lakers.

Hawaii has some catching up to do in terms of bringing back larger events via rapid testing, he said. Some organizers exempt vaccinated individuals from rapid antigen tests required for entry. Others require everyone to get an antigen test whether or not they were vaccinated, he said, just to be extra cautious.

“We are not using it enough. This is the testing that now should be broadly recommended for use for returning to group events indoors,” he said. “I’ve been trying to respond to the pandemic and people keep finding us and calling.”

Miscovich urged the CDC to provide more guidance for the general public about the merits of different tests since it currently is mainly directed to health care providers who offer prescriptions for rapid test kits.

“There’s no regulation. What should be happening is every health department should be setting up the guidelines and saying, ‘These are the only tests that are approved for surveillance, these other tests should not be used for asymptomatic people,’” he said.

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