Gaps cited in Hawaii’s pre-travel COVID-19 tests, contact tracing

Testing Hawaii tourists for COVID-19 before they arrive, and tracing contacts of people with the virus, may not be as effective as the general public might think.

Pre-travel tests under a tourism reopening program slated to begin Oct. 15 likely would identify only around 80% of travelers who have the novel coronavirus because of the lag between when a test is administered and when someone contracts the virus or when the virus can be detected by tests, according to Ray Vara, president and CEO of local hospital operator Hawaii Pacific Health.

That means around 20% of any visitors with COVID-19 could arrive in Hawaii without the virus being detected, said Vara, citing research studies on the issue.

Mark Mugiishi, president and CEO of local health insurer Hawaii Medical Service Association, agreed with Vara’s assessment.

Under the state’s plan, visitors who obtain negative COVID-19 test results from an approved provider 72 hours before their plane takes off for Hawaii can avoid a mandatory 14-day quarantine.

Meanwhile, Hawaii contact tracers are gathering meaningful information from under 50% of the people they attempt to reach in connection with confirmed COVID-19 cases, Mugiishi said.

Vara and Mugiishi raised the two issues Monday during a meeting of the state House Select Committee on COVID-19 Economic and Financial Preparedness, of which they are members.

Committee members are concerned about further government-ordered business and industry shutdowns if coronavirus case volumes spike again like they did in August when new cases surged above 200 or 300 on many days compared with May when there were often zero to five new cases a day.

Pressure to avoid returning to lockdowns could be eased if residents don’t unrealistically expect that the pre-travel testing program is going to catch all COVID-19 cases among visitors.

“How do you prepare the public for that?” asked committee member Rep. Bob McDermott (R- Ewa, Ewa Beach, Ewa By Gentry, Iroquois Point). “When we welcome the visitors back, and whatever that number is — 25,000 travelers a week, or 30,000, I don’t know — despite our best efforts we may see an uptick in cases even though we’re pre-testing … we may see a little spike but that’s a cost of doing business as we return to normalcy.”

Committee members, who noted that current new case volume has settled closer to 100 a day in recent weeks, said such a message will be communicated to the public.

“Part of the communication plan to the local residents has to include that component — that in fact, we are going to see upticks and volumes of (coronavirus) activity,” Vara said.

At the same time, there’s a need to increase the response rate to contact tracing.

Mugiishi said the response rate under 50% is likely due to factors that include a lack of understanding and caring about COVID-19 and its spread.

The willingness of taking unsolicited calls from an unknown caller also could be at play, some committee members speculated.

“We do have to communicate with the public that they have to cooperate with the contact tracers,” Mugiishi said.

Poor contact tracing results follow the state Department of Health expanding the number of contact tracers after being accused by elected officials of falsely inflating the number of people doing such work.

Vara said the number of contact tracers is up to 286, which exceeds a current goal by 25%, based on a recent report from Gen. Kenneth Hara, incident commander for Hawaii’s COVID-19 response.

Vara also said that based on Hara’s report the state has slightly exceeded its goal for first-contact callers at 43, and has 14 of 20 desired disease investigators.

“I think we’ve made good strides,” Vara said.

“We have improved capacity, now we need to improve yield,” Mugiishi added.

Improving Hawaii’s contact tracing work will become more important as visitor arrivals grow, Vara said.

It’s also possible that state and county leaders will tweak the pre-travel testing program, possibly before it starts in less then three weeks.

If state officials agree, some neighbor island counties could be permitted to have different testing requirements for avoiding quarantine, such as having to pass a test after arrival.

Some tourism industry officials are concerned that visitors making travel plans now could be surprised by a different requirement when they arrive depending on which island they visit.

“We’ve got travelers that are trying to book their trips,” said Wendy Laros, executive director of the Kona-Kohala Chamber of Commerce. “The 15th is the opening date. It’s an urgent situation.”

Vara and other committee members said it’s not viable at the moment to require an additional a post-arrival test for visitors statewide because of issues over the availability, cost and application of quick-response tests. But they added that this could happen at some point in the future.