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The impact of epidemics on Native Hawaiian and Pacific peoples during the Kingdom of Hawaii provides a historical perspective from which to learn and draw guidance about abating the current pandemic of coronavirus SARS-CoV-2 (which causes COVID-19 disease).

Historically, a holistic response to widespread disease incorporated aloha at its foundation, knowing that the responsibility to control and eradicate disease rested with all.

Hawaii’s dependence on global tourism and imports of food and energy puts us all at great economic and health risk, while socioeconomic, racial, and pre-existing health disparities make some communities more vulnerable than others.

As we now look to reopening schools, our local communities should not have to choose between education, economics, health, and wellbeing in isolation. Instead, businesses, government and health care agencies, community-based organizations, scientists, educators, and families need to connect, design, and implement innovative strategies to safely reopen schools.

Rather than potentially becoming sites of community spread, schools could turn the tide of the growing pandemic through a collective, holistic effort.

Evidence of the disconnect between the current national policy and community concern is present in the reluctance of local school communities to reopen our schools. Over 4,000 testimonials submitted to the Board of Education challenged the state to consider the concerns of teachers, students, families, and their communities-at-large.

Modifications Required

Uncertainty involved in reopening reflects awareness that SARS-CoV-2 affects people of any age group in ways that still are not completely understood. Additionally, essential workers like grocery clerks, health care providers, and those in multigenerational households are faced with disparities in infectivity and risk.

We must navigate our way forward by sharing information collected by communities and research laboratories to build a knowledge base to better inform the public.

We can turn to 19th-century Hawaiian and English language newspapers as a model of a forum for community members, policymakers, and health professionals for actively sharing information during and between epidemics.

We believe a sustainable structure designed around a robust testing and monitoring system combined with the establishment of a community platform (i.e., website) that honors and incorporates community knowledge needs to be in place.

As people live in one community and work, shop, and play in others, there is an urgent need to increase access to widespread testing; to shorten the time to receive results; to create a robust contact tracing infrastructure; to involve communities as partners in messaging the COVID-19 response in expanding outreach; and to implement strategies that account for the screening of asymptomatic cases.

Without these modifications, we lack the ability to control or suppress the spread and are wholly unprepared to reopen schools and tourism.

Schools can be a source of resilience if we prepare students and provide outreach to families by teaching, modeling and promoting mask wearing, cleaning, social distancing, and examining patterns of behavior underlying the spikes in local cases. Schools can partner with scientists to collect data that better inform policy.

A record daily high of 73 cases on Saturday sustains an alarming upward trend we foresaw after the stay-at-home order eased. When faced with this uptick, our communities ask important questions like, “is the mutated, more contagious viral strain behind the spikes in cases around the world, already present in Hawaii?”

Researching to find an answer should be among our responses, as this more contagious strain may change the dynamics and context of the actions we take moving forward.

With the push to reopen schools and travel, proactive community advocacy for expanding COVID-19 testing is no longer an option; it is a necessity. We need to actively address the gaps in our current diagnostic approach by directly examining community spread, by having access to more complete state data, and considering strategies like modifying testing criteria, pooled testing or antibody-based testing.

Innovations of this kind would enhance our testing capacity, outreach and education, speed of results, and ability to catch missed diagnoses through identifying asymptomatic cases. One third or more of COVID-19 cases may be asymptomatic, and students over 10 years of age may spread the virus just as efficiently as adults.

Bringing teachers, students, and staff back to school in early August without safety training, standard guidelines, and readily available testing may put schools at the center of COVID-19 contagion. Reciprocally, asymptomatic spread within our communities will leave everyone in schools vulnerable.

If the number of cases continues to rise under our currently limited testing capacity, it will soon become impossible for contact tracers to identify the clusters of affected individuals in time to contain further spread. The recent uptick in cases portend this outcome.

Asymptomatic spread within our communities will leave everyone in schools vulnerable.

To prevent this outcome, empowering our schools with education, research, data, and transparent communication will be key. Schools can play an active role in reducing the number of COVID-19 cases by equipping teachers, students, and families with knowledge in a safe environment and implementing more effective practices and means for communication to connect with surrounding communities.

As parents, educators and scientists, we hope the knowledge of an impending reopening of schools and travel will lead to an intentional, broad-based, collective effort to incorporate community knowledge and data sharing into effective policies and practices for controlling SARS-CoV-2 transmission, and ultimately, to eliminate the virus locally.

Pupukahi i holomua. Let’s all come together to move forward in the best interest of everyone.