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Hawaii residents Julie Folk and her husband haven’t seen their four grandchildren since they left Honolulu in early March. Each time they rescheduled their flights, quarantine orders were extended.

“We feel like we’re stuck here and we can’t come home,” Folk said by phone from Colorado, where she and her husband typically spend a few months a year.

Residents like Folk and hopeful visitors eagerly await more details about a state plan that would lift quarantine rules for them if they provide proof of a negative COVID-19 test. The option is slated to become available Aug. 1, and many people are .

Logistical details of the plan are being worked out, Lt. Gov. Josh Green said Tuesday, including whether or not to require tests be conducted within three or five days of departure.

But the same standard — proof of a negative molecular-based test — will be held for returning residents and tourists alike to avoid the . If test results do not come back before departure, the travelers will be expected to quarantine until they receive a negative result, he said.

Despite the surges in cases in several states such as California and Texas, Green remained optimistic that an array of testing partners, along with improved turnaround times of tests will make the feat possible.

“We’re in deep discussions with national pharmacy agencies and labs to get everyone willing to participate on board,” he said. “We’re working through the details to get as much availability as possible. The level of detail is quite extraordinary, actually.”

The recent $90 million for Hawaii airports will also help assist other “layers” of screening, including temperature checks, thermal screening and an electronic records keeping system for health questionnaires.

That, coupled with enhanced testing capacity, more contact tracers and public cooperation with physical distancing and mask-wearing will help put up a COVID-19 shield, Green said.

Alaska As A Model

Alaska is the only other state to have implemented a pre-travel testing program. Alaska health officials told Civil Beat that the program is just three weeks old, but provided data from the second week of its implementation.

During those seven days, about 12,000 passengers were screened in Alaska. About one-third of travelers opted to get a test prior to arrival in Alaska.

Approximately 4,900 others opted to be tested at the airport. That testing resulted in airport officials identifying 13 COVID-19 cases.

Then there were those who selected to self-quarantine, about 2,000 of them. The remaining travelers “either left Alaska for less than 24 hours, were critical infrastructure, or already recovered from COVID,” Alaska’s port of entry coordinator Tessa Walker Linderman told Civil Beat.

Hawaii Gov. David Ige said the state doesn’t plan to test travelers at Hawaii airports — there are simply too many of them. The state’s testing capacity of several thousand tests per day would cover only a fraction of the number of people who typically traverse through island airports.

Seeing those captured by Alaska airport officials, Green says it is his hope that the new Hawaii policy will reduce a large percentage of positive cases that would come to Hawaii, as much as 70%.

The islands’ geographical location gives the state a unique advantage to secure its travel border, he said, citing other examples across the globe. Iceland charges $115 for .�� and have also implemented similar policies, Green said.

“Believe me, California would do it too if it were possible to police their border,” he said. “We’re the only state in addition to Alaska that has the ability to ask people to test, no other state could do that.”

National Movement

There is some national movement to shift testing capabilities to retailers, as federal support for about a dozen COVID-19 testing sites is The U.S. Department of Health and Human Services it was extending a partnership with national pharmacy and grocery retail chains to continue testing through the end of August.

Companies such as CVS, Rite-Aid and Walgreens in some states receive a flat-fee federal reimbursement for each test they provide.

“Providing retailers an option for reimbursement for COVID-19 testing outside of this contract will be essential for the private sector to take over COVID-19 testing once this contract concludes,” said Deputy Surgeon General Rear Adm. Erica Schwartz

Green said those are some of the same companies Hawaii is looking to partner with. CVS, for example, has about 1,400 locations across the country.

This testing is currently not meant for travelers, but patients with suspect symptoms. Those interested must fill out an online questionnaire and indicate if they have symptoms. Online, CVS’ Minute Clinic lists Hawaii as one of the states in which it offers COVID-19 testing.

The cost of the test — especially for travelers who may not be able to get insurance coverage for a test administered outside of medical purposes — could range from $70 to $160.

“Whether or not people pay outside of their insurance, that will be up to them,” Green said. “It depends if they want to take a vacation or not.”

Testing of thousands of Hawaii-bound travelers could become fairly lucrative for the retailers. Before the pandemic, as many as 30,000 visitors or more arrived in Hawaii each day. This May, about 9,000 visitors came — about

Folk said she is willing to take a test before flying home; she just can’t find a place that will offer her one. Nor does she believe it will be effective in preventing the virus’ transmission.

When she asked a local doctor, they said tests were only given to people with symptoms or believed themselves exposed. Representatives at several CVS stores she called said they did

Folk is wary there won’t be any testing options for her — someone without symptoms or suspected exposure — anytime soon.

“If I lie and say I have symptoms? It’s like calling in sick when you’re not — that’s not right,” she said.

“I don’t know how they’re going to test people. Maybe they want Hawaii to feel safe, but I don’t think they are capable of doing that, not because they’re bad people, but because there’s no way for them to do it. It’s a virus.”

The Testing Debate

At a state briefing Monday, some that people wouldn’t be able to get tested and would visit the islands anyway.

Tests will likely be difficult for people in states where outbreaks are worsening, according to Department of Health Director Bruce Anderson. The molecular-based testing is meant for diagnosing active infections and may not detect the virus in its early stage of development, he said.

That’s primarily the reason behind a discussion about whether or not pre-travel tests will be an effective way to stave off the introduction of disease to Hawaii.

Dr. Sarah Park, Hawaii state epidemiologist, told lawmakers earlier this month that she would not trust that negative test results indicate a lack of infection.

Public buy-in to physical distancing, hand washing and mask wearing is crucial in preventing the spread of COVID-19, she said.

“The 14-day quarantine has done an enormous amount to place Hawaii where we are now and being seen as a safe place,” Park said.

But despite those rules, incidence of the disease picked up slightly throughout June after a lull in May.

“It isn’t about what we do for travelers coming home to Hawaii or visiting Hawaii,” Park said. “Our community needs to understand that whatever measures are put in place at the border, so to speak, really what it comes down to is can we maintain safe practices. Because if we don’t, it doesn’t matter.”

The testing standards within Hawaii will remain the same, she noted. When the outbreak began, the Hawaii Department of Health under federal guidance would test only symptomatic patients due to limited supply, she said. It has since expanded its testing criteria to include the close contacts of confirmed cases, whether or not they have symptoms.

“If this in any way compromises the work we need to do to protect our community, I will not stay silent and I will require the labs do the disease surveillance and test people in vulnerable populations such as long term facilities first before any traveler,” she said.

Folk is skeptical herself that a test before boarding would identify a possible infection. The “worst colds” she’s ever caught were often after she flew on an airplane, she said.

“I’d be willing to take their test, but a test is a snapshot in time,” Folk said. “I could have been exposed and it doesn’t show up in a test, or I get exposed on the airplane. The test is ridiculous really for that reason because it won’t protect anybody.”