The Latest: 2 Deaths, 120 Cases; Lt. Gov. Recommends Counties Follow Big Island Testing Lead

Nov 26, 2020

Where we stand

The state Department of Health reported two deaths and 120 new COVID-19 cases today. Because of the department's two-day delay in posting new numbers, the counts represent cases from Tuesday. Some counties are reporting more timely numbers that may differ from the state's counts.

Oahu had 92 new cases, Maui 14, Hawaii County 11 new cases, Kauai 3,  and Lanai and Molokai none. There were no new cases diagnosed out of state.

The latest state counts bring the Oahu total to 15,101, Hawaii County, 1,569, Maui 517, Kauai 105, Lanai 106 and Molokai 17. The number of out-of-state cases total 203.

Since the pandemic began, the state has seen 17,618 cases. The death toll rose to 237.

Green: Counties should follow example of Big Island on second tests

Data released yesterday from the state's surveillance testing shows a small increase in the number of travelers testing positive after arrival. The numbers also show that returning residents have a "very strong risk for COVID-19" compared to visitors.

The latest surveillance program results promoted Lt. Gov. Josh Green to recommend that all counties follow the lead of the Big Island, which has been conducting an antigen test after arrival and a subsequent PCR (polymerase chain reaction) test to confirm a positive case.

"To the extent mayors can follow a similar policy and operationalize post-testing, I recommend that course of action for extra assurance and an added layer of safety to the Safe Travels pre-travel testing program," he said in a news release.

"Plus, as the initial data indicates, strategic post-testing for returning residents could also prove beneficial in slowing the spread of COVID-19," he added.

The state has been evaluating how well the Safe Travels pre-flight testing program has been doing in detecting positive cases by conducting a voluntary second test after arrival.

As of Tuesday, the surveillance program found 45 positive cases out of 20,253 tested since the surveillance program began on Oct. 19. That amounts to 2.2 cases per 1,000 tested. 

The program is ending the data collection phase of the program and shifting to assessing the data.

Dr. DeWolfe Miller, an epidemiologist from the University of Hawaii John A. Burns School of Medicine, is leading the study. Miller and his team will produce a report that aims to help state leaders in making decisions about the Safe Travels program.

In preliminary findings, Miller said screening before the pre-travel test would improve the sensitivity of the test.

The screening 14 days prior to the PCR pre-test would include ensuring that the passenger had been free of any COVID symptoms, such as a fever, had not taken fever-reducing medication, did not feel ill, had no difficulty breathing, was not in quarantine, had not traveled, and had no potential exposure to the virus.

Also, the passenger should not have attended social gatherings and should have been wearing a mask at all times outside his or her home.

Miller noted COVID cases are increasing on the U.S. mainland, which may impact previous results.

He also said the results from the Big Island's post-arrival testing were included in the surveillance data. Preliminary analysis of the program, which had large no-show numbers, may have created an upward bias in the case rate estimates, he said.

Miller further said preliminary data show returning residents have a very strong risk for infection compared to visitors.

Community spread has accounted for most of the COVID cases in Hawaii, but travel-related cases have been increasing since the state allowed passengers to skip the quarantine with a negative test under the Safe Travels program.

The Hawaii Tribune-Herald reported today that Big Island Mayor Harry Kim wants a re-evaluation done of the Safe Travels program as Kauai seeks to exit from it temporarily.

Kim said he thought from the beginning that the single pre-flight test of Safe Travels was insufficient to prevent spread of the virus.

He said the Big Island is the only county that mandates a second test after arrival, which he said is the only way to ensure travelers aren't asymptomatic during the first pre-travel test.

The mayor said he would want an evaluation of the effectiveness of the Big Island program as well.

Kim said there are several "gaps" in Safe Travels, including one that allows as many as a quarter of passengers to bypass a test and the quarantine if they are exempt for reasons such as essential work.

He said he strongly urged the governor to do away with the exemptions and require all travelers to take a test.

City misses chance to ease restrictions, cites Waiawa cases

Mayor Kirk Caldwell believes Honolulu can advance into the next phase of its reopening before Christmas, but the city will remain in its current tier for at least another week and a half.

As of yesterday, the seven-day average for new cases on Oahu was 78, with a positivity rate of 2.5 percent.

To ease more restrictions, Oahu will need two-week averages below 50 cases  along with a positivity rate of 2.5 percent.

Caldwell says the city is on the cusp of lifting restrictions.

"What is impacting us right now is the number of cases coming out of Waiawa Correctional Facility -- you know, somewhere between 40 and 50 and 60 cases in the past couple of days.

"If we don’t add those into our case count, Oahu’s down at 45 cases – which would get us below the 50 that we need to be. So, if we didn’t have the infection rate coming out of the prison, we’d be on our way to Tier 3."

Under the city’s reopening plan, Tier 3 would allow gatherings of up to 10 people and ease more restrictions for gyms, restaurants and retail merchants.

The state Department of Public Safety said yesterday that the number of positive cases at the Waiawa Correctional Facility remained at 149 with one in the hospital. The number of staff testing positive stands at 10.

--HPR's Casey Harlow

Caldwell: let those who don't have results in hand to get airport mobile lab test

Mayor Kirk Caldwell has asked Gov. David Ige to amend the Safe Travel rules once again so those who don't have their COVID-19 test results when they arrive can get a second test at the city's airport mobile lab.

The lab turns results out in about three hours, and could be offered to those who didn't receive their pre-flight test, who lost their results or whose results were delayed or rejected. Caldwell said the city would pay for their test, which normally costs $125.

In return, the passengers would need to agree to quarantine until they get the results in about three hours and, if they test positive, to download a contact tracing app. The positive cases would be reported to the state Department of Health.

A second group who are now exempted from the pre-flight test and the quarantine because of essential work and other reasons would also need to get tested under the mayor's proposal. Caldwell says this group accounts for as many as a third of the arriving passengers.

A third group are those who elected not to get a pre-travel test, did not get one because of an emergency, or did not plan their trip well and failed to get a test; they could also get one at the mobile lab. They would need to pay for it themselves and would also need to agree to quarantine until they get re-tested in about four days. The two tests would cost $250.

One the reasons Caldwell said he is setting the change is to release more people from quarantine, which has been burdening the Honolulu Police Department. HPD has been doing spot tests on people who are supposed to be in quarantine, but the numbers have been growing since the reopening to trans-Pacific travel.

Caldwell said he would still like to see the surveillance testing program, which he called "misleading at best, fradulent at worst," to continue beyond its end of November cut off date.

The mayor has been feuding with Lt. Gov. Josh Green -- both of whom are likely gubernatorial candidates in 2022 -- over the efficacy of the surveillance program that Green heads.

Caldwell said the methology is solid, but the data includes results from the Big Island's post-arrival test program. That program tests passengers immediately after they disembark rather than four days later when they could be shedding the virus.

Asked if he could see a time when he might want to pull out of the Safe Travels program as Kauai Mayor Derek Kawakami has asked to do temporarily, Caldwell said Kawakami's county is different from Oahu.

He said he understands why Kawakami might want to take that step because of the limited ICU capacity on the Garden Island. Oahu, in contrast, has a large hospital capacity, Caldwell said.

Kawakami said yesterday he knows his request to return to a 14-day quarantine regardless of test results comes as a shock to many, but he pointed to a "unprecedented surge" in new infections since the reopening to trans-Pacific travel.

He said from March to October 14, the day before the reopening, Kauai had 61 confirmed cases of COVID. Since the start of the pre-travel testing program, the island has seen 62 cases. 

"That means our case count has doubled in just the past five weeks," he said. Kauai needs a pause to get control of the virus, he said.

If Gov. David Ige grants the request, the rule change would take effect no sooner than Dec. 1.