27 Jun (Updated) A Plan for Safely Re-Opening Hawai’i: Kaua’i as a Model
Kaua’i as a Model: Report v1.3
The Honorable David Y. Ige
Governor, State of Hawai’i
The Honorable Derek S.K. Kawakami
Mayor, County of Kaua’i
John P. Alderete and Kaua’i COVID-19 Discussion Group
Kaua’i COVID-19 Discussion Group
Information contained herein is based on sources considered reliable but is neither all-inclusive nor guaranteed. Information and analyses reflect best judgment at the time and are subject to change.
The primary objective of this study is to provide information and recommendations to decision makers on the design and implementation of a plan for screening and quarantining of incoming travelers for the novel coronavirus. The overriding goal is to keep the community safe as we reopen the County of Kauaʻi and the State of Hawaii. The intention is to minimize both the risk of a COVID-19 outbreak on Kauai and the duration of quarantine needed to keep the island safe. The report was initiated on 12 May 2020, completed initially on 18 June 2020, and revised on 24 August 20201
Due to the informal nature of the Kauaʻi COVID-19 Discussion Group, these recommendations are made without the benefit of organized input from key stakeholders such as the hotels, the visitor industry, the airlines, the State Airports system, the Hawaii State Department of Health (DOH), the police and National Guard. If such a group is not already convened, it is hoped that one will be created soon and that these science-based recommendations will be useful in planning, and implementing a system of testing, quarantine and tracing. Given the economic urgency to reopen, and the desire to do so safely, putting a well-designed protective system in place is likely the state’s most important priority for economic recovery.
The Kaua’i COVID-19 Discussion Group has the following recommendations for state and county leadership on how to reopen Kaua’i safely to incoming travelers:
RECOMMENDATION: That thermal screening prior to boarding be advocated by state and county officials as a national minimum safety protocol for airlines and cruise ships.
Direct Virus Testing
We stress that a strictly enforced 14-day quarantine imposed on all arrivals is the safest and most effective option for preventing COVID-19 spread on Kaua’i. In contrast, a plan that lifts quarantine for arrivals who document a single negative test result obtained within 72 hours prior to arrival is unsafe because it will allow at least one third of those capable of spreading the disease to enter the community. A far superior alternative, based on biostatistical modeling described herein, employs a 2-test screening strategy combined with a shortened quarantine period, with the first test being obtained within 72 hours of arrival.
RECOMMENDATION: That highly sensitive testing for infection with SARS-Cov-2, performed on two separate occasions, at least 6 days apart, with the the first test obtained with 72 hours prior to boarding, be offered to all incoming travelers as an alternative to the mandatory 14-day quarantine, potentially reducing the quarantine time to 7 or fewer days.
We emphasize that the performance of two tests separated by at least 6 days greatly increases the ability to identify arriving passengers capable of spreading the infection and is far more effective than strategies based on a single test. According to our statistical model, and supported by data and experts in public health, testing only once without quarantine means that fully one-third of infected passengers will be 1 Revisions to the previous version emphasize the importance of obtaining the first screening test for SARS-Cov-2 prior to arrival as part of a 2-test screening strategy. Also stressed is that we view a well-enforced 14-day quarantine as the gold standard, and as such this approach is more effective than the 2-test strategy proposed herein. These revisions were informed in part by input from physicians from across the state who have joined the Kauai COVID Discussion Group and are the front-line workers in the fight against COVID-19.
COVID-19 Discussion Group iv allowed to enter our communities undetected (32 for every 10,000 arrivals). At a rate of 1,000 visitors per day and assuming an infection rate of 1% among arrivals, almost 100 positive cases per month will enter Kauaʻi unrestrained. Adding a second test after 6 days of quarantine cuts the number by 7-fold to <5 per 10,000, providing an exponential leap in safety.
We emphasize further that we view the proposed testing program as an interim step, rather than a long term solution to the challenges confronting the island. Other options will likely become available in the short- to mid-term that may supplant the approach recommended herein. Importantly, however, the data gained by implementing this program is likely to be valuable for future decision-making. Specifically, the quantitative data on the prevalence of transmissible SARS-Cov-2 among arriving travelers will be generated by proposed testing program, information that is fundamental to future decision-making regarding how best to keep the island safe.
A final point is that the model introduced herein is “flexible” in the sense that it can be applied to predict the risk associated with different testing and quarantine options. Thus, while the power of this model is illustrated by predicting the risk associated leaving quarantine after 7 days when viral testing is performed on Days 1 and 6 after arrival, it can also be used to assess the risk associated with testing on earlier or later days. Thus, we view the model as a flexible ‘risk assessment tool’ for future decision making. We anticipate that this approach will be viewed favorably by most incoming travelers when compared to a mandatory 14-day quarantine.
RECOMMENDATION: That, to increase the effectiveness and integrity of the existing quarantine system, all incoming travelers be quarantined in designated hotels except for those visitors and residents who consent to wear tracking bracelets. Companies that specialize in the implementation of effective quarantine programs have been identified with the potential to address this need. The proposed personalized quarantine facilities should be approved by the Department of Health
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Kauai COVID Discussion Group 2020 Report v1.3 (updated version)