Mayor Kirk Caldwell on Friday criticized the state Department of Health for not doing enough to protect against the spread of COVID-19 and for rejecting the city’s offer to assist in the effort.
But Health Director Bruce Anderson and State Epidemiologist Sarah Park said the mayor’s offer was unrealistic and unnecessary. They said the state is ramping up its efforts and is prepared if more people do contract the virus.
The disagreement occurred on the same day the state announced that for the first time in eight weeks, no new positive cases of COVID-19 were reported in the previous 24 hours. As of Friday there have been 629 confirmed cases and 17 deaths.
Caldwell, at a press conference, said he supports the concerns raised by approximately 80 medical professionals and other stakeholders who sent a letter to Gov. David Ige this week pleading with him to persuade the Department of Health to provide more testing, contact tracing and isolating and quarantine policies — and to accept more help doing so.
“It is clear to all of us, at this point, that despite the fact that Honolulu has tried to do testing, contact tracing and isolation, the responsibility lies squarely in the lap of the Department of Health leadership,” Caldwell said. “And we’ve done about as much as we possibly can.”
The mayor said the state’s failure to expand testing and contract tracing is most concerning as the city prepares to allow most retail businesses to reopen Friday, providing they meet guidelines, and possibly restaurants later this month or early next month.
“We know as we open up our community on the island of Oahu, there is going to be a spread of the virus and we’re going to see more cases,” Caldwell said. “And we need to be ready for when that occurs.”
The mayor said that despite his strong concerns, he is not reconsidering whether to allow retailers to reopen next week.
“I think there’s greater risk because we don’t know everything we could know, but I think we’ll continue to take a measured, phased approach to opening up,” Caldwell said.
When city officials told DOH they intended to move forward with plans to do more testing, they were told that “if we do this, it could be illegal testing folks who do not have symptoms,” Caldwell said, adding the agency did not elaborate.
“We’re going to push forward on this,” he said. “We believe that testing, contact tracing and isolation are critical components of putting the public’s health and safety first and foremost as we begin to open up our economy.”
Caldwell said the city is working with Hawaii’s two private testing laboratories. “Our goal is to test all close contacts of anyone who tested positive, both asymptomatic and pre-symptomatic. Our goal is to test all close contacts of close contacts and not wait for someone to get sick to come in and ask to get tested.”
Anderson, reached Friday afternoon, said neither he nor Park had seen the letter that Caldwell referenced.
The 46-page letter by the health professionals said there needs to be “more agile, better resourced public health leadership at the state level. We need leaders who will respond rapidly and effectively to outbreaks. They must be empowered to extinguish brush fires quickly and prevent the exponential growth in new cases.”
Additionally, “DOH should do representative sampling of populations throughout the state to get a feel for prevalence of the virus in the community as the epidemic progresses,” the letter said. “This could be active surveillance instead of merely relying on passive samples submitted through (the) influenza screening system.”
Anderson said the state, through its sentinel surveillance program, is in the process of testing high-risk communities and appreciates what help the city will provide. Through private medical providers and community health centers, the program is giving the state a gauge of what is happening with the new coronavirus.
The state did object to the city’s earlier plan to spend $2 million to use a mainland firm to provide more testing at community health centers because it believes the city’s money could be better spent at local testing laboratories. Caldwell has since agreed to use Hawaii’s two testing laboratories, and the state has no problem with that, Anderson said.
Park said a health care provider who believes a patient may have COVID-19 can swab that person and then have the sample tested at the state or private lab.
Anderson said the state is already testing close contacts “as needed” and plans to do more testing in high-risk populations such as those at care homes, hospitals and prisons.
“We’re doing what we need to do and we expect to do more,” he said.
The state is working with the University of Hawaii to train 200 to 500 people who already have some sort of medical background to help with testing and contact tracing, Park said.
New technology allows investigators to monitor at least four times as many people through a survey, she said.
“We have 23 in-house epidemiologist specialists … to do contact tracing,” Anderson said. DOH could add approximately 70 people through its program with UH. “With that resource, we could potentially track up to 1,000 cases a day.”
Park said the tests represent a “point in time” analysis and it would be unrealistic for any state to test everyone. “We are ensuring that testing is done in a meaningful way,” she said. “We cannot be constantly testing every single person every single day. We do not have the capability to do that. No one does anywhere.”
The state did not tell city officials it couldn’t test people without symptoms, just that they couldn’t test those who don’t want to be tested, Anderson said.
Lt. Gov. Josh Green, who has had his own disagreements with the Ige administration over its handling of the outbreak, said he concurs with Caldwell.
“The mayor and I are in agreement on this one and I’m glad he is,” said Green, a medical doctor. “I definitely agree that the more testing we do, the better equipped we’ll be to continue to keep this virus at bay.”