Experts Consider More Travel Tests To Contain COVID-19 In Hawaii | News, sports, jobs

Last month, people sat on Waikiki Beach in Honolulu. Hawaii officials are under pressure to increase COVID-19 testing for travelers. AP file photo

The Associated Press

HONOLULU – Hawaii officials are under pressure to increase COVID-19 tests for travelers as the islands grapple with record spikes in new infections, hospitalizations and deaths. The calls come as federal guidelines change to require negative virus tests from both vaccinated and unvaccinated people who come to the United States

Despite evidence that more COVID-19 tests would help reduce the spread of disease, especially in an isolated destination like Hawaii, leaders have opposed the implementation of a two-test policy for incoming travelers.

Earlier this summer, the state lifted all testing requirements for vaccinated people.

And even with a single pre-flight test for unvaccinated travelers, infected passengers can easily slip through the cracks, experts say.

Due to the incubation and latency periods of COVID-19, using just one test to prevent its spread among tens of thousands of daily visitors is comparable to using a chain link fence to keep mosquitos away, said Dr. Darragh O’Carroll, an emergency and disaster physician in Honolulu.

“There are many holes” said O’Carroll. “The science has been pretty conclusive as of probably June 2020 that a single test system was no more than 30 to 40 percent effective at capturing a population of infected people.”

New federal regulations, announced on Monday, require all foreign travelers flying to the U.S. to provide proof of vaccination and a negative COVID-19 test prior to boarding. Unvaccinated American citizens must be tested within one day of returning to the United States and upon arrival at home.

O’Carroll and a number of his colleagues have urged state leaders to do the same, he said.

“Nobody really seemed to be listening” he said. “No matter what we said and how conclusive the science looked.”

After months of mandatory quarantines, business closings, and virtually no tourists, Hawaii had one of the lowest infection rates in the country. Then, in October 2020, the state allowed travelers to skip the quarantine with a single pre-flight test.

Infection rates rose but remained low compared to other states. Some of this has been attributed to a severely crippled tourism industry and a lack of participation in leisure travel. And some believe visitors will see no incentive to test upon arrival if they are quarantined outside their home.

But with the number of trips this summer, the infection rates also increased.

In July, Hawaii lifted its quarantine and testing requirements for vaccinated travelers. A month later, the state was in the middle of a record wave of delta variant cases that filled hospitals and more people died than ever in the pandemic.

Prior to July, Hawaii reported a seven-day average of 46 daily cases. By the first week of September that number had risen to nearly 900. Since then, the number of cases has slowly declined, but experts say it is unclear whether this will stay that way.

Much of this was spread through the community through the delta variant introduced through travel.

Scientists say implementing additional testing measures could help.

A study published in March in the medical journal The Lancet Infectious Diseases showed that a single pre-flight test reduced the risk to an overall population by only 36 percent. But a two-test system combined with a short quarantine period captures a much higher rate of over 70 percent of infected travelers, according to the study.

Lee Altenberg, an associate full professor in the Department of Mathematics at the University of Hawaii, wrote that the paper “Is one of the few studies available to inform policy makers in Hawaii.”

But, he said, the research was misunderstood as evidence that Hawaii’s single-test system was very effective at preventing the spread. State officials said the study showed that their single-test system would capture 88 percent of all infected travelers.

“The public got the wrong impression of how much protection we get from Safe Travels’ pretest program, and you can’t make good guidelines if you don’t have accurate information.” said Altenberg.

“We have to take our travel logs absolutely seriously” Altenberg added. “And if we suffer from the false impression that (Safe Travels) prevents 90 percent of infections, we will not take these protocols seriously.”

Altenberg submitted contributions to the Lancet study last week.

The study’s authors said the 88 percent number represents the percentage of contagious people who would be discovered on the day of travel, not the overall risk reduction for a target population.

The difference between “infected” and “contagious” is important, said one of the co-authors of the study.

“There are obviously people who … will develop an infection, but are not yet contagious.” said Dr. Nathan Lo, Faculty member, Infectious Diseases at the University of California, San Francisco. “And these people are not necessarily discovered.”

Governor David Ige didn’t respond to an interview request, but the state announced on Monday that 1 million free rapid tests will be made available for routine testing by Oahu residents.

Lt. Gov. Josh Green told The Associated Press that decisions about testing ultimately rests with the governor, but noted that Hawaii’s only testing guideline, more than other states in the US, is to keep the islands safe.

“If the mayors want to do additional tests, I absolutely support that”, Green said. “Offering voluntary take-away antigen tests on arrival for vaccinated and unvaccinated travelers could provide additional protection given the highly infectious nature of the Delta variant.”

Green said only Alaska had introduced a similar system in the US states. Alaska is also grappling with record increases in new infections and hospital admissions.

“We did more than everyone else, we did a better job than everyone else” Green said.

Dr. Mathew Kiang, an epidemiologist and professor at Stanford University, was the lead author of the Lancet study. He worries about the lack of routine travel tests and so-called breakthrough infections in vaccinated people. Experts say the syringes help reduce the severity of the disease, but people who get infected could pass it on to others.

“There are a lot that we are not yet entirely sure of about … breakthrough infections, especially when it comes to asymptomatic spread.” said Kiang. but “We know Delta is one of many worrying variants and will evolve over time.”

Kiang said additional tests “enables you to attract more visitors and stimulate the economy.”