The novel coronavirus has upended life in Hawaii and been an economic disaster, but Hawaii residents do have some unique advantages as public health officials fight to slow the local spread of the disease.

Even while residents watch and worry as the daily count of infections in Hawaii climbs — it stands at 224 today — University of Hawaii at Manoa epidemiology professor Alan Katz points out that this state has an enormous advantage as an isolated island chain.

The history of the 1918 Spanish Flu pandemic shows that a few isolated areas that imposed tight restrictions on who could come in and who could leave survived with few impacts from that disease, he said.

“We are an island, so we have much, much better control of borders than any land-locked state does because it’s virtually impossible for some place in the middle of the United States to survey all of their boundaries,” Katz said.

The movement of visitors into Hawaii from the rest of the nation has been choked off in a way that is virtually impossible in other states, and Hawaii officials are poised to further restrict traffic between the population centers within Hawaii with an interisland quarantine.

The Hawaii Tourism Authority announced Tuesday the visitor count arriving in Hawaii on Monday plummeted to 121, down from an average of about 30,000 per day a year ago at this time. In all, 681 people arrived Monday on 41 flights, and the vast majority of those were returning residents or flight crew members.

Even within the state, much of Hawaii including the neighbor islands is sparsely populated and rural, which reduces the chances of a major outbreak, Katz said.

“Rural means less densely populated and the key risk for person-to-person transmission is close person-to-person contact,” said Katz. “That’s why social distancing is really the key for mitigation of transmission.”

Even with the travel quarantine in place along with the closures of bars and non-essential businesses and the statewide restrictions on residents’ movements, Katz said Hawaii will inevitably see more cases because the incubation period for COVID-19 is up to 14 days.

But Hawaii has also been increasingly aggressive about testing people for coronavirus. State health officials said Monday they have so far tested 8,936 people for the novel coronavirus, which is far more tests per capita than many other states.

According to coronavirus testing data maintained by the website Vox, Hawaii ranks sixth in the nation for the number of people per capita who have been tested for the disease. That puts Hawaii’s testing effort on par with Massachusetts, which has nearly 5,000 coronavirus cases.

The state’s approach of testing only people who show symptoms is “more focused and more valuable than simply going out and testing everyone who wants to be tested,” according to state Department of Health Director Bruce Anderson.

“We’re actually not far behind (South Korea) in terms of tests per capita,” Anderson told the Senate Special Committee on COVID-19 on Friday.

Hawaii’s 14-day quarantine program to try to block infected people from coming into the state “seems like it’s working,” Anderson said, but added that quarantine will not help to cope with cases that are already in Hawaii.

“I think we’re doing it better than most are,” he said of managing the cases that are already here. “Our numbers are down. We’re able to thoroughly investigate the cases that we know about and identify contacts and of course they’re being quarantined if they’re close contacts. If the numbers get much bigger, we’re going to have a much more difficult time managing that.”

Still, he added that “we all anticipate a time when we’re going to start seeing much more community spread. It’s practically impossible to avoid, and our challenge is to keep the numbers down to a level where we can manage the cases that are occurring and of course tamp down the number of cases as best we can through our contact investigations.”

The number of confirmed coronavirus cases in Hawaii has nearly doubled from 120 to 224 since Anderson made those comments, and Katz urged residents to take health guidelines seriously to avoid a major outbreak..

“The most important thing you can do is maintain social distancing. Stay 6 feet away from each other. That’s going to really dramatically mitigate person-to-person spread of this. If you’re not essential, if you’re supposed to be at home try to stay at home. Don’t aggregate in groups,” Katz said.

And while some people may be ignoring city and state stay-at-home orders, the orders are being enforced in Honolulu. Police Chief Susan Ballad said today her officers have issued about 1,500 warnings since March 23, handed out about 180 citations, and made nine arrests for violating the emergency orders.

Katz said his sense is that “folks in the state of Hawaii are behaving in an incredibly responsible manner.”

“People are basically adhering to the recommendations, the guidelines and the mandates,” he said. “I think that’s unbelievably important…Social distancing at this point — at this critical point in the pandemic — is the way we’re going to mitigate the person-to-person spread.”