Now that Hawaii’s people have “crushed the curve” with early emergency lockdown, all eyes are on the return to normal. Lockdown, while effective, comes at tremendous cost — not only financially — but also to health, mental health and our social fabric. With vaccine development still in the distant future, now is the time for long-term planning.
The central question specific to Hawaii is how to reopen trans-Pacific travel while keeping our population safe. In May 2019, 36,000 travelers arrived each day providing jobs for many local families. But travelers now carry the most significant risk for COVID-19 influx. Must we choose between health and economic prosperity?
Hawaii is unique in that, analogously to island nations like Iceland, Taiwan and New Zealand, the sources of COVID-19 infections are localized to airports (and incoming ships). These island nations successfully controlled the pandemic, some avoiding lockdown altogether in large part by controlling inbound travel.
Assume Hawaii eradicates the virus and we return to normal while the infection rate on the mainland is about 1%. After reopening trans-Pacific travel, fewer inbound travelers than usual, say, 10,000 arrive bringing 100 infected people. Typically, COVID-19 infections double every two days via community transmission. Assuming no additional control measures, after a few weeks, there could be up to 30,000 infections.
Although these back-of-the-envelope estimates are rough, the exponential nature of the pandemic is unrelenting. If the influx of infected is cut in half, we gain just two days of reprieve. If social distancing makes community transmission half as fast, it would take just twice the time to reach unsustainable levels. Nevertheless, it is most efficient to control infections near the source: testing incoming visitors, and those in contact with them. How close to normal we can get will depend on the efficiency of screening inbound travelers, and subsequent contact tracing.
Currently, all incoming passengers to Hawaii must quarantine for 14 days. We propose an exemption from quarantine, with a fresh negative COVID-19 test prior to arrival via a test certified by the state. Testing is now widely available; most travellers would test prior to embarking to avoid quarantine. The remainder can test upon arrival at their own expense and quarantine until testing negative. The White House recently confirmed that federal regulations allow such requirements.
Arriving passengers should provide cell phone contact information on their mandatory travel declarations for follow-up if positives are detected or quarantine required. In a tourist economy, travel industry (and Waikiki) workers are front-line workers, and should be tested regularly.
Travel bubble agreements with Australia, New Zealand, Korea or Japan would allow a good test of our monitoring systems while we continue to scale and fine-tune. Greater economic recovery, however, will require more freedom to travel.
No monitoring strategy can catch 100% of infections. Our community must continue to help with social distancing; wearing masks and avoiding large gatherings. We have to acknowledge that we have much to learn in this unprecedented situation. However, we can keep all eyes on the daily data stream and react dynamically.
Our goal is to find as many positive cases as possible, contact trace, test those subsequent contacts (both symptomatic and asymptomatic), and isolate the positives so that we can enjoy as much “normal” as possible. It will not be easy, but it can be done.
In the end, it’s not either health or prosperity. Keeping island people healthy is not only the right thing to do, in a global pandemic, it is the fastest way to economic recovery. A relatively virus-free paradise is what locals need and what visitors want. Because we have to be responsive to a dynamic situation, this is the point where good data and modeling to forecast the impact of policy decisions is important.
Many of us in the academic, data science and public health community are eager to help. Hawaii’s people have made many sacrifices; now it’s time for government leaders to lead the way to the next phase of Hawaii’s recovery.
For more information, visit: sites.google.com/hawaii.edu/hipam/home?authuser=0
István Szapudi and Marguerite Butler are faculty at the University of Hawaii-Manoa and members in the Hawai‘i Pandemic Applied Modeling Work Group (HiPAM), a volunteer think thank to help confront the challenges of COVID-19 via the use of data and models. The views expressed here are their own.