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Public officials said Wednesday that Hawaii has flattened the curve of COVID-19 infection, but reopening the economy to tourists still appears far off.

For almost two weeks, Hawaii health officials have verified fewer than six new cases per day.  Now, the state will begin to assess how to reopen the local economy in phases, Gov. David Ige said.

“The curve has been flattened. But until there is a vaccine or a cure, we are not out of the woods,” he said at a Wednesday press conference.

Honolulu will begin this week to allow certain businesses to operate, and some public parks will reopen.

Still, certain restrictions could be put in place again if more cases are identified.

“Please keep in mind that there is a widespread expectation of a second wave of cases, not just here, but on the mainland and worldwide,” Ige said. “If we start to see a surge, some of the mandates may have to be reinstated.”

An Unclear Path To Reopening Tourism

Several businesses received the green light to resume operations on Thursday, such as pet grooming services, car dealerships and golf courses.

But plans to reopen the tourism industry — which fuels Hawaii’s economy — are still in flux.

“We are going to have to ask a very tough question, which is a bigger question that requires a lot of input — what is the standard to reopen for tourism?  We’re all going to focus on safety but we have to be sane about it too,” Lt. Gov. Josh Green said.

The state’s mandatory 14-day quarantine imposed on all people arriving by plane is still in effect, and is meant to discourage tourists from coming to the islands.

On Tuesday, about 500 visitors and residents arrived on 13 flights, according to the Hawaii COVID-19 Joint Information Center.

“Remember, quarantine means you have to stay in your room, you can’t go to the pool, you can’t get your meals delivered,” Ige said. “There are no services in the room, they don’t make your bed, they don’t provide linens. You’re restricted to the room and you’re not allowed to leave.

“When visitors understand that that’s what it is, and that we’ll enforce it, we’re pretty confident they’ll chose not to be here.”

As many as 30,000 visitors arrived in the islands daily in January and February.

Rapid Testing

More testing and expanded contact tracing is considered one key to reopening businesses and eventually tourism.

Right now, five Hawaii laboratories collectively can conduct as many as 3,000 COVID-19 diagnostic tests per day.

But the current workload — the demand for testing — is only about a third of that. About 400 to 1,000 COVID-19 tests are being processed daily in Hawaii, according to State Laboratories Division Administrator Edward Desmond.

The state’s testing capacity is currently enough to test those who are ill, Green said, with some tests left over. But if visitors returned, Hawaii would not only need to increase its testing capability, but also boost resources at DOH for contact tracing.

“Now the extra surplus can really be used creatively, depending on what our priorities are,” Green said.

The health department currently has a team of 44 people working on contact tracing. The department is still working on a request for additional personnel and only recently acquired laptops and cell phones for its case investigators.

“We have the opportunity to review these tests and see how we’d like to do it,” Green said. “To do mass testing for all 1.4 million people (in Hawaii), that’s not feasible right now and it’s also not even recommended because we haven’t seen the large surges in our intensive care units in our hospitals.”

The State Laboratories Division acquired a dozen molecular rapid test systems in mid-April, and has since distributed them to neighbor islands and major clinical laboratories on Oahu, Desmond said.

The Abbott ID NOW instruments are approved by the FDA to conduct emergency rapid testing, and results can come in the matter of minutes. It takes seven or eight minutes if it’s a positive, and about 15 minutes if it’s a negative, Desmond said.

The State Laboratories Division distributed two Abbott testing kits to each neighbor island county, and two each to Diagnostic Laboratory Services, Clinical Labs Hawaii and Kaiser Permanente.

The tests have been a game changer, especially for neighbor islands, which did not have the ability to test on island until they received the kits, Desmond said. Prior to that, specimens collected were sent to Oahu for processing.

But the rapid-testing machines are only capable of conducting one test at a time. And currently, they’re reserved for high-priority patients, such as those who are critically ill or elderly with underlying conditions, health care providers and first responders.

“I don’t believe that the instrument itself and the test kit is sufficient throughput to really help us with testing visitors coming in,” Ige said, in reference to the rapid tests.

Meanwhile, antibody tests also pose other sorts of opportunities to track the COVID-19 disease, but state officials were wary to say whether or not antibody testing would be put to use for the visitor industry.

Those who have the antibodies that fight the virus may still be infectious, but the tests could be helpful in other ways, such as identifying people who could donate plasma to help in the treatment of other patients.

FDA-approved antibody tests are scheduled to begin at Clinical Labs Hawaii this week.

Antibody tests hold some potential to distinguish one’s immunity to the virus, but most are still in development and many

Nationally, limited supplies and errors in the development of U.S. diagnostic tests have delayed and hampered the nation’s ability to track COVID-19 via testing.

In the meantime, the Department of Health plans to expand its ongoing sentinel surveillance program, or the testing of random samples that come from patients who have respiratory symptoms that are determined to not be caused by the flu.

More doctors will contribute specimens to be tested as part of the surveillance, including some who work at community health centers.

“We’ll have a much better idea of what’s happening out there,” DOH Director Bruce Anderson said. “It’ll give us a pulse of what’s happening in our state and whether or not it’s circulating.”