Evolving ideas on opening safely

Hawai’i is now not only one of the most beautiful places in the world but also one of the most COVID-free. The big question everyone is grappling with is how to safely reopen our economy with limited tourism.

If we open without proper protocols, we could have a surge in cases and go into another lockdown. Opening correctly calls for improved regulations on arrivals, good contact tracing and testing for all of us, and proper isolation of anybody with the virus. Because we are dealing with a problem none of us has ever dealt with on this scale, there are many diverging opinions on the path forward. Below is my opinion on how we can open safely, based on some of the best practices’ literature emerging from around the world and tailored to our island’s unique qualities.

While I believe the following is rooted in sound public health policy, I am not a lawyer or a constitutional scholar and there may be legal or implementation issues with some of the ideas. My hope is that the following suggestions can help contribute to the public discussion.

• Because our numbers are so good, we should steadily open our local economy as we are doing. If Hawai’i continues to see few or no new cases, we can open and keep open schools, restaurants, and all other businesses while re-allowing inter-island travel without quarantines.

• We should require that all incoming out-of-state passengers be tested for the virus before their flight. Passengers will not be able to board without this clearance. They will also be retested after one week in quarantine.

• Consider allowing passengers from almost COVID-free nations such as New Zealand, Australia, perhaps Japan, and others to be placed in a “safe bubble” category and to not quarantine. This type of arrangement must be constantly evaluated for safety.

• When passengers arrive from non-bubble locations such as the U.S. mainland, they will be quarantined for only one week if it can be shown that testing before arrival and after one week in quarantine can screen contagious people properly.

• Arrivals could go to a special quarantine hotel or self-quarantine in the location of their choice.

• The quarantine hotel will be specially equipped and planned. As these arrivals will have had one negative test by the time they arrive, they are at a lower risk of having and spreading COVID. The hotel could possibly have a designated section of the beach and a large pool available for guests with proper social distancing. Food service would be all room service or takeout to eat on the beach or lawn.

• Because self-quarantining has been so difficult to control, visitors deciding to not use the special hotel and instead self-quarantine (in the location of their choice) would be required to wear a tracking bracelet for one week.

• We should consider requiring all visitors to have a contact-tracing app on their phone (described below) for two weeks.

• Contact tracing is the work done by the DOH to find and alert all people that have had contact with a person testing positive for this coronavirus. The Kaua’i branch of the Department of Health has significantly ramped up their tracing capacity island wide by adding more than 60 additional trained tracers. These efforts could be reinforced with the implementation of an app such as COVID Safe Path which at least three other states and 23 countries are currently evaluating.

• Residents of Hawai’i should be asked to voluntarily use a contact tracing app also. I have already downloaded the COVID Safe Path App to my phone. It tracks me just as the GPS does on my phone but the data may not leave my phone without my permission. If a person is identified as positive for the coronavirus by the DOH, the trail of that person (with no identifying features) would go out on the app if the positive patient agrees to release their information. Your phone would tell you if there had been a contact, where it was, and for how long — but for clear privacy reasons it does not identify who the person was. You would then decide whether to discuss this contact with the DOH and what next steps would be safest for you and your family.

• COVID-19 is most contagious in inside spaces and one of the most common ways to catch it is from other family members in your own house. Therefore, another way to limit the spread and to more closely monitor a sick person for worsening symptoms would be to create isolation centers for people who have the virus. These isolation centers would be free of charge and voluntary, but people would be strongly encouraged to use them if they test positive, especially if they have kupuna in their homes.

• We should continue wearing masks in public spaces, especially indoor public spaces and other places where social distancing is difficult.

• This virus is much less contagious outside. We should encourage the increased use of public outdoor spaces, particularly outside dining opportunities.

If we just gradually open with no new protocols to ensure safety, even with the current 14 day quarantine in place, increasing numbers of returning residents and visitors put us at high risk of being another hot spot for COVID and going back to sheltering in place. Using systems similar to those described above could allow us to ramp up our economy, while ensuring that we keep ourselves and our families safe.

This column represents a sharing of information. No content on this column should ever be used as a substitute for direct medical advice from your doctor or other qualified clinicians.

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Lee A Evslin, MD is a Board Certified Pediatrician and Fellow of The American Academy of Pediatrics. He was a former healthcare administrator on Kaua‘i and periodically writes a column for The Garden Island.