Lt. Gov. Josh Green and other community physicians are calling on state health officials to do more extensive testing for coronavirus, as Hawaii gears up for the peak of the outbreak in the islands.
Expanding testing to all intimate contacts of coronavirus patients, whether they have symptoms or not, will stymie community transmission, Green said.
“It’s no secret that I believe we have needed much more extensive testing of COVID-positive contacts. This is how countries in Asia stopped the spread,” Green said, adding that private physicians and hospitals have stepped up to fill the testing void left by the state Department of Health, which has taken a position against extensive testing.
“In health care, information is critical. We should be fully assessing any COVID spread in Hawaii. Many people across our state are worried, and tests would help both characterize the full epidemic and contribute to peace of mind.”
The change in policy would help to catch many asymptomatic cases, which is “how we will change behaviors,” he said.
“The moment you test positive, everyone gets very serious about it. People don’t take the disease as seriously until they know they’re positive,” Green said. “If you test positive, then you know to separate yourself from your kupuna.”
The Health Department has argued that only people with symptoms should be tested, though new evidence shows asymptomatic carriers can pass along the virus.
“There is recent evidence of pre-symptomatic transmission, but we are not relaxing our testing requirements,” Health Director Bruce Anderson said Monday in a news release. “Only those people who are symptomatic should be tested to avoid overtaxing private clinical labs,” he said, adding that there is a national shortage of testing kits and personal protective equipment to “protect health care workers who collect the specimens and lab workers who run the tests.”
Screening clinics have been full of people wanting to get tested for COVID-19. Health officials have called many of them the “worried well” — people without symptoms who feel they may have been exposed but don’t meet the criteria.
State officials have touted Hawaii as having among the highest number of COVID-19 tests in the nation, but community physicians — doing the bulk of testing in the islands — say the state still isn’t doing enough to prevent a massive outbreak on the horizon. Of the nearly 15,000 tests conducted statewide, the DOH has conducted more than 400.
“Every other civilized country in the world has proven that testing is the only way we’re going to get ahead of this. That’s how aggressive it is,” said Dr. Scott Miscovich, who has conducted 40% of private tests for COVID-19. “It’s just ridiculous what they’re saying. It is just so medieval. They’re like the only people on the planet that are saying don’t test. They’ve only done 400 tests. That’s incomprehensible, undeniable gross negligence.”
What’s more, medical supply chains are still providing PPE and necessary equipment for Hawaii laboratories, he said.
“Using the excuse that we will put a strain on personal protective gear is another position that is also false. The shortages don’t exist. The amount of personal protective gear now available to be purchased on the world market that could be available and delivered within the next 10 days is unlimited,” Miscovich said.
Dr. DeWolfe Miller, a University of Hawaii professor, infectious disease epidemiologist and fellow in the American College of Epidemiology, agrees that widespread testing is critical to stopping the epidemic.
“Social distancing and masking are all interventions. The tool to really stop an epidemic is testing. It tells us who’s infected and who isn’t and whether we don’t need to be using these interventions,” he said. “We could actually have this state back in business and online before anybody else in the country if we can actually use our testing.”
Even more critical is testing of all health care workers, who can be asymptomatic carriers and spread the virus to colleagues and patients, he said.
State Epidemiologist Sarah Park told a March 25 Senate committee on COVID-19 that testing should be judicious to “maximize the people we know are likely to be the positives instead of just a shotgun approach to just testing everyone.” DOH has said that tests should be reserved for critically ill patients. Broad testing would require significant resources that the state currently doesn’t have, she said.
“If we’re in a low prevalent state … the likelihood of finding a lot of false positives is very high. Every positive we get we’re aggressively pursuing. That’s manpower that’s being directed for every single one. Everyone we find that is a false positive, that’s effort that’s wasted,” she said, adding that some clinicians “are very worried with the way some unscrupulous testing has occurred. It’s going to be at a cost to our health care workers’ ability to care for patients.”
In addition, medical advice for people with viral infections, including COVID-19, is the same, with the exception of those vulnerable to severe infection and health care workers and first responders who are in short supply, she said.
“People with mild symptoms can stay home and recuperate,” Park said. “If all of us really adhere to that, that’s one very effective way to mitigate the disease. If we all social-distance … that is another way to effectively mitigate the disease without testing.”
The state’s tally of coronavirus cases has risen to 410, up 23 from Monday, the bulk of cases on Oahu. A total of 113 patients have recovered since the start of the outbreak, with health officials on Tuesday reporting 24 new recoveries. The state’s COVID-19 death toll stands at five.
State laboratories, which can run up to 1,500 tests per day, are currently testing about 1,000.
Green said the state should “max out our daily capacity every single day to make sure that asymptomatic carriers are tested if they are intimate contacts of positive people. If they kissed them, we should test them.”
“This is meant to prevent us from a surge of critically ill patients,” he said. “This is the way we prevent having hundreds of patients on ventilators. Right now, working on the honor system (for self-quarantining), we all know is incomplete. (This is the) only way to guarantee we flatten this curve and not become New York with mass casualties.”