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LIHUE, Kauai—An ad hoc committee of prominent doctors and community leaders here has urged a radical re-conception of visitor quarantine procedures now in use in Hawaii and proposed a system of two tests separated by six days of confinement to a quarantine hotel.

In this new system, presented as an interim step to help lead the way to broader reopening to tourism, visitors could opt to take a COVID-19 test immediately after they arrive, then be confined in a designated quarantine hotel, then take a second test. If the second test is negative, visitors could move on to other accommodations.

The test-quarantine-test system could replace the existing system based on 14 days of inconsistently monitored quarantine. The current system does not require any testing and Ige has drawn criticism for not moving more rapidly to establish a testing protocol. The governor’s office did not respond on Monday to requests for comment.

The alternative testing proposal is the main element of a report produced by the Kauai COVID-19 Discussion Group, formed in March by health professionals concerned that existing and proposed testing and quarantine safeguards are insufficient to keep the pandemic from taking a far greater toll. Civil Beat obtained a copy of the report, which has not been released.

The new two-test requirements would extend to local residents returning to the islands, as well. Currently residents are free to go through the 14-day quarantine at their homes. Under the proposal, they would also be housed in designated quarantine hotels between the first and second tests. Under some circumstances, people in quarantine could be monitored by wearing tracking bracelets.

Agreeing to the new system would be voluntary, but a visitor who would not participate would be required to serve a full 14-day quarantine.

“We emphasize that performance of two tests separated by six 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,” the group concluded.

The group said that a system requiring one test could still miss 32 infected people out of every 10,000 visitor arrivals. Two tests separated by six days in quarantine would cut that rate to just five of every 10,000, the group said.

The group’s report includes a section titled “Kauai’s Golden Window of Opportunity.” Kauai had gone two months without recording a new COVID case until last week, when a family cluster near Kalaheo caused the island’s total to rise from 21 to 29.

In a group interview via Zoom on Monday, members of the discussion group emphasized that adopting a different testing philosophy would create an opportunity to alter the nature of tourism on Kauai and in the state generally.

“I see this as kind of an interesting crossroads,” said Dr. Lee Evslin, a pediatrician. “We could get another kind of tourist.”

Dr. Michael Schwartz, a University of Washington expert and part-time Kauai resident who has worked with the discussion group, noted that Kauai and Hawaii are in a different place than many tourist destinations.

“Hawaii has the unique ability to prevent the disease by limiting it at the entry point,” he said.

The report also advocated nationwide adoption of a mandatory temperature screening program.

Lt. Gov. Josh Green said he had not seen the report before Civil Beat emailed him a copy Monday. He said he has been working for weeks “trying to build consensus on what we need and what can be practically implemented. Many of the recommendations in this proposal may be part of the plan once the governor approves it. Much of what is recommended there is not possible.”

The discussion group’s report is titled “A Plan for Safely Re-Opening Hawaii: Kauai as a Model.” The group includes several prominent doctors, including Evslin, Schwartz, Dr. Monty Downs, an emergency medicine specialist, Dr. Heidi Hillesland, an infectious disease specialist, and Dr. Paul Esaki, a family practitioner. The group also includes JoAnn Yukimura, a former mayor and Kauai County Council member, Jill Lowry, director of the Anaina Hou Community Park on the North Shore, and John Alderete, of the Kauai chapter of the Surfrider Foundation.

“Many of the recommendations in this proposal may be part of the plan once the governor approves it. Much of what is recommended there is not possible.” — Lt. Gov. Josh Green

Key to the group’s argument is the contention that even if Hawaii requires a single COVID-19 test, many infected people could slip through undetected. The report estimated that, on average, 100 new cases could remain undiscovered per month on Kauai if only a one-test procedure is adopted.

The report and recommendations were produced entirely internally without requesting input from the visitor industry, the Department of Health, airlines, the state airport system or police agencies. The report said the omissions were deliberate, caused by “the informal nature” of the discussion group.

“Unfortunately, this ‘golden window’ is bound to be short-lived unless an effective strategy can be developed to protect against the infection returning as more travelers arrive on the island,” the report argued. “This proposal is not advocating a reopening of the visitor economy currently. It is proposing improvements to the current system of screening and quarantining incoming travelers in order to keep the community safe right now, as well as to prepare for reopening.”

It also remained unknown whether the two-test procedure would persuade tourists to come to Hawaii, where the average length of stay on Kauai in 2018, according to the Hawaii Tourism Authority, was 7.48 days.

Evslin said operating procedures at quarantine hotels could be modified so visitors could relax on the ground and possibly enjoy a designated section of a beach.

“People would know it’s not the end of the world,” he said.

But Yukimura said making the quarantine enjoyable is a secondary concern.

“The purpose of the quarantine is not to give visitors a resort experience,” she said. “It is to keep the community and other visitors safe.

“As to whether they will come, they are coming and have been coming.”