How to Control Hawaii’s Coronavirus Epidemic and Bring Back the Economy: The Next Steps

by Sumner La Croix and Tim Brown, UHERO, April 9, 2020   

EXECUTIVE SUMMARY

Increased antigen and antibody testing, comprehensive historical contact tracing, mandated mask use, and isolation of exposed and infected individuals are the most vital measures that the state can take to control the coronavirus epidemic. And, once the threat of COVID-19 subsides and stay-at-home orders are lifted, Hawaii’s non-tourism economy can be gradually opened with appropriate safeguards in place. Tourism, which accounts for 23 percent of Hawaii gross domestic product, could take a bit longer to restart.

Hawaii has already taken two of four big steps in implementing an effective coronavirus control plan: 1) restricting travel between the state and overseas destinations, and among each of the Hawaiian islands and quarantining all arrivals for 14 days; 2) issuing government orders for all residents and visitors to stay at home and for residents to practice social distancing measures and use fabric face masks when in public places.

The third step in an effective coronavirus control plan is the most challenging and already partly underway. State government and private health organizations must expand the availability of testing in each of the four counties; routinely test all individuals with respiratory symptoms or fevers for coronavirus; proactively trace all close contacts of those found infected with coronavirus; enforce isolation and arrange for/provide care to ill and exposed people until the disease has run its course; and expand programs of sentinel testing to monitor the state of the disease in the general population, among health care workers, and other groups routinely exposed to large numbers of co-workers and customers.

The fourth step is for the state, with extreme caution, to gradually relax stay-at-home and social distancing recommendations and orders, and allow some economic activities that involve groups clustered in a location, for example, a workplace, to resume. Restrictions should only be relaxed or lifted if there is a strong monitoring system in place that can rapidly detect a resurgence in the epidemic, and take effective measures to control an outbreak.

RESTARTING THE NON-TOURISM SECTOR

Once the governor’s stay-at-home order is relaxed and businesses and schools reopen, they will need to reorganize their activities to facilitate social distancing, at least until an effective treatment or vaccine is developed. One temporary measure might be to find employees with positive coronavirus antibody tests (indicating that they have already recovered from an infection) to take jobs that require close contact with other workers or customers. A report co-authored by Scott Gottlieb, former commissioner of the U.S. Food and Drug Administration, suggests that people with positive antibody tests could “return to work, serve in high-risk roles such as those at the front lines of the healthcare system, and serve in roles that support community functioning for people who are still physically distancing.” Another report suggests that antibody-positive people could staff and manage retail stores and restaurants. It is anticipated that almost all businesses will reorganize operations, at least to some extent to protect workers and customers.

RESTARTING THE TOURISM ECONOMY

The tourism economy will take longer to restart than the non-tourism economy. This is because tourism from overseas will only resume when either (1) a vaccine is developed; or (2) the coronavirus epidemic is brought completely under control in areas sending tourists to Hawaii; or (3) rapid, same-day antigen tests become available to pre-screen potential visitors at their doctor’s office, an urgent care facility or home airport within a day before leaving for Hawaii. A pessimistic forecast for the resumption of substantial tourism flows from overseas would be 12-18 months, the minimum time period likely to be required for vaccine development, testing and production and for widespread vaccination of the Hawaii population to occur.

If 12-18 months is the pessimistic forecast for tourism to restart, what is the most optimistic forecast?  Tourism could resume quickly if two necessary conditions are met: (1) Potential tourists perceive Hawaii to be a safe place to visit and (2) Hawaii residents can be assured tourists are free of the coronavirus.

Unfortunately, reopening the state’s tourism industry depends on two factors mostly outside our control: the speed with which a vaccine can be developed, produced and distributed; and the speed with which rapid-response antigen and antibody tests can be deployed at foreign and domestic airports sending visitors to Hawaii. What’s important for Hawaii citizens and policymakers today is that we focus on the measures that are under our control—travel quarantines, social distancing, testing, contact tracing and isolation of exposed contacts. Implementation of these measures is entirely feasible with the cooperation of the public, businesses and non-profit organizations, and our state and county governments.

PDF: Full Report (14 pgs) 

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