As of Friday, Hawaii has experienced fewer than 650 confirmed COVID-19 cases, with a mortality rate less than 0.03. We know that every death represents a tragic loss to someone’s ohana, friends and community. We extend our deepest and heartfelt sympathy to those who have lost loved ones.

Hawaii’s low mortality rate has been due, in part, to the collective sacrifice of our citizens by diligently adhering to the necessary restrictions issued by the governor and mayors. This compliance and aloha by the people of Hawaii have enabled our health care system to maintain the physical and human resources necessary to provide exceptional care to those stricken with the virus.

In addition, our entire congressional delegation championed federal legislation to help support our economy. For all these efforts, the Hawaii Medical Association expresses its gratitude to the citizens and the elected local, state and federal leaders of Hawaii.

Unfortunately, our collective fight and sacrifice is not yet over. With the state unemployment rate approaching 40%, Hawaii’s leadership will continue to address the resulting severe economic hardship faced by so many in Hawaii by instituting guidelines to safely allow economic activity to increase. We express support for the governor, lieutenant governor, mayors, Cabinet officials and Maj. Gen. Kenneth Hara as they address the many details of moving the economy forward while at the same time protecting the health and welfare of Hawaii’s citizens.

As the balance between economic and health concerns is addressed, HMA suggests several policy options that we believe are fundamental in order to prevent a surge on COVID-19 infection, which could again threaten our health care delivery system; and to support and maintain the health needs of our community during this economic downturn.

Preventing a surge. As visitors return and businesses reopen, physical distancing will be a challenge. Until a vaccine is found and broadly utilized, we strongly encourage:

>> An ongoing masking policy for all citizens as well as visitors to our islands.

>> A robust surveillance system to monitor community prevalence.

>> Robust and thorough contact tracing.

>> Exploring testing of, or continuation of, a 14-day quarantine for arriving visitors while implementing practical and realistic methods and locations for immediate isolation and quarantine of those testing positive or arriving with symptoms of the virus.

Maintaining the health and welfare of Hawaii’s people. As businesses have shuttered and jobs have been lost, many of our citizens have lost or will soon lose their health insurance. Many employers have generously extended health care benefits for an additional month or more, even after employee separation. In the coming months many unemployed workers will lose their health care insurance, which is the only lifeline for those with chronic diseases. To protect those impacted, we strongly advocate for an assertive and robust QUEST enrollment program. To facilitate implementation, we suggest expanding current enrollment locations to include health clinics, drug stores and grocery stores.

The above suggestions will inevitably require commitment, flexibility and modification based upon medical advances, e.g., availability of a validated FDA-approved serology test and a large number of personnel to implement. While the challenge is difficult, we believe these concepts are a fundamental framework for Hawaii to recover and progress economically, while at the same time, protect the health and welfare of our citizens.

The physician members of the Hawaii Medical Association remain eternally grateful to our citizens for entrusting their health care to us. We are committed to protecting the people of Hawaii. There is no doubt that the road will continue to be “long and winding,” but we remain committed to walk the walk with the people of Hawaii.

Angela Pratt, M.D., is president-elect of the Hawaii Medical Association; Jerry Van Meter, M.D., is immediate past president; and Christopher Flanders, D.O., is executive director.