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Honolulu will allow gatherings of up to five people and reopen some businesses on Thursday as it implements a new plan that will guide the pandemic response going forward, Honolulu Mayor Kirk Caldwell announced on Tuesday.

Starting on Thursday, parks, beaches and trails will be open to groups no larger than five and a permit will be required from the parks department for any “canopy-type structure” in city parks.

Social gatherings — meetings of those who do not live together — will be allowed for up to five people.

Restaurants, retail and spiritual services will be open at 50% capacity, although restaurant groups will be limited to family and household members. The mayor said restaurants will be required to ask people if they are related but acknowledged it would be difficult for people to prove and said it would be an “honor system.”

Indoor malls will be allowed to open. Hair salons, barbershops and nail salons can reopen with modifications. Gyms can open for outdoor activity only. Public and private pools will be able to open.

Attractions including the zoo, aquarium, museums, bowling alleys and botanical gardens will be limited to groups of five and will have their overall capacity limited to 50%. Movie theaters will also be limited to 50% capacity, and food and drinks will not be allowed.

Outdoor attractions like a water park and mini golf will also be limited to groups of five or less but won’t have a capacity cap.

Outdoor sporting activities for up to five people are allowed, but organized team sports will still not be allowed.

Bars, nightclubs and arcades will remain closed. Local short-term vacation rentals will still not be allowed to operate. Helicopter tours will also remain closed.

Remote work for businesses is encouraged to the extent possible, according to the plan.

A New Framework

In general, pandemic-related restrictions in Honolulu will be implemented in a more predictable way from now on based on the island’s COVID-19 case numbers, Caldwell said.

The city released the details of a four-tiered system that outlines restrictions depending on the level of community spread of the coronavirus. The city will rely on two criteria to determine that level: the number of daily cases reported and the positivity rate.

“It’s a more open and transparent type of plan where the residents of this island can know at any given time how we’re doing and whether we’re going in the right direction or the wrong direction,” he said.

“What we do as an island determines whether we go forward or whether we go backward with this matrix.”

Tier 1 represents a high level of community spread that is stressing the limits of the public health system to test, contact trace, and isolate or quarantine. This tier would kick in when the island has a seven-day average of more than 100 cases a day and a seven-day average positivity rate of 5% or higher.

On the other end of the spectrum, Tier 4 represents a low level that is easily handled by the public health and health care systems. Honolulu would be in this tier if cases stay under 20 over a seven-day average and if the positivity rate is less than 1% over the seven-day average.

The plan was developed over many hours of conversation between city and state officials and private stakeholders, Caldwell said.

Data for the two metrics is expected to be published daily by the Hawaii Department of Health and evaluated on a weekly basis for purposes of tier advancement or retreat. In order to advance to the next tier, the city must have been in its current tier for at least four consecutive weeks. In addition, it needs to meet the case count and positivity rate criteria for the next tier for two consecutive weeks.

The city may only move forward one tier at a time, according to the plan. However, if, for two consecutive weeks, the data shows the city should be in a lower tier, the city will fall back into that tier. The city may move backward more than one tier at a time, the plan states.

“If cases surge, we move back,” Caldwell said. “If cases come down, we keep moving forward and loosening up, but in a more conservative way.”

The city will issue a new order within three days of the date that advancement or a retreat is indicated by the metrics, which will either relax restrictions and reopen additional businesses and operations or add restrictions and close entities back down.

Honolulu will begin at Tier 1. In accordance with the plan, the island has to stay there for at least four weeks until the city logs at least two consecutive weeks of data satisfying the criteria for advancing to Tier 2.

The city hopes this system will provide clear benchmarks for the reduction of COVID-19 transmission and reduce the likelihood of having to impose drastic restrictions.

The plan is awaiting Gov. David Ige’s signature, but the governor has already verbally approved Honolulu’s reopening framework, according to the mayor’s office.

In establishing what low, medium and high risk activities are, the city considered several factors including the ability to: accommodate the wearing of a face covering, facilitate physical distancing, limit the duration of exposure, limit mixing of people from different households, optimize ventilation and enforce restrictions and mitigation measures.

Balancing Health And Economic Needs

The mayor said he rejected the Department of Health’s recommendations when it came to restaurants. The DOH thought that in Tier 1, restaurants should be takeout and outdoor dining only.

“We recommended from a purely health perspective that we should be more cautious in that area,” said Janet Berreman, the Kauai district health officer for the DOH. “In the mayor’s judgment, that was an area in which he felt very strongly that it was necessary for economic and retail and employment reasons to be less conservative.”

Sarah Kemble, the acting state epidemiologist, said officials weighed the best available evidence and best practices from other jurisdictions to advise the mayor.

Among their considerations was that reviewed symptomatic outpatients from 11 U.S. health care facilities and found that adults with positive test results were approximately twice as likely to have reported dining at a restaurant than were those with negative test results.

“It was part of the reason that the public health stance was to keep restaurants closed for indoor dining in Tier 1,” Kemble said of the report.

Kemble noted that it’s only one study and there could be many explanations for the apparent association. For example, she said people that eat out may be more likely to engage in other risky behaviors.

“It’s not a single, definitive piece of data, but it’s a piece of data that weighed heavily upon us, and given what’s available, raised some concerns,” she said.

Kemble said officials also discussed the possibility that COVID-19 is airborne, meaning droplets and particles can remain suspended in the air and travel distances beyond 6 feet.

“We are still learning about the modes of transmission of the virus, and the possibility of airborne transmission remains a concern,” Kemble said. “That’s part of the emphasis on encouraging outdoor dining and other outdoor activities, because airflow is much better in an outdoor space and transmission is less likely.”

Caldwell decided to allow restaurants to have indoor dining for up to five people per party as long as those people live in the same home and tables are socially distanced.

Restaurants must either accept reservations or take down patrons’ names and addresses for virus contact tracing, Caldwell said. Masks must be worn at all times except when customers are eating and drinking, the mayor said.

“When you sit down to talk story before you order, you’re wearing your mask,” he said. “When you’re pau eating, you’re just talking story, you put on your masks.”

Even in between courses of food, when patrons are not actively eating or drinking, they should be wearing a mask, the mayor said.

Also, restaurants may not serve liquor after 10 p.m., the mayor said.

If cases surge, the city is prepared to limit restaurants again to just takeout and outdoor dining, Caldwell said.

The mayor said he made the decision to allow indoor dining keeping in mind the thousands of people who worked in Oahu’s restaurants at the beginning of the pandemic and workers in the agriculture and fishing industries that rely on a flow of restaurant business.

“It’s in the billions of dollars in terms of economic importance,” the mayor said. “For me, it was a balancing of both the public health along with the economic benefits and health of our community.”

Testing, Tracing, Isolating And Enforcement

The city’s plan highlights numerous efforts it has made to reduce instances of COVID-19 on Oahu.

The city partnered with seven community health centers to provide virus-related services to high-risk communities. That is supposed to include testing.

A partnership with the John A. Burns School of Medicine at the University of Hawaii that aims to provide thousands of diagnostic tests is slated to go online in early October, Caldwell said. However, the CARES Act-funded program has experienced various obstacles and delays.

Caldwell announced last month that the city, dissatisfied with the level of contact tracing at the state level, would fund the hiring of additional contact tracers the DOH would oversee. At the time, the mayor estimated the city would hire between 250 and 500 tracers.

However, Tuesday’s plan states the city has a contract in place with a “survey company” for only 80 contact tracers, and negotiations are underway to hire up to 250. Caldwell did not provide an explanation for the reduced hiring target.

Honolulu has also made two new hires. One is a Pacific Islander liaison to improve services, outreach and communications with some of the communities that are hardest hit by the pandemic. The other is Mitchel Rosenfeld, a board-certified emergency physician with a public health background, who according to the city’s plan has been hired to oversee the city’s pandemic response and contact tracing efforts.

To expand isolation and quarantine capacity, the city added 130 hotel rooms to use through Dec. 30 with over $1.6 million in CARES Act funds. The city is negotiating the lease of two additional properties for this purpose, as needed, the plan says.

The city also announced on Tuesday that it acquired the Harbor Arms Hotel at 98-130 Lipoa Place in Aiea for $10.5 million.

Honolulu ultimately wants to turn the property into low-income affordable rental units for families but will make the furnished rooms available in the near term for people who need isolation and quarantine rooms during the pandemic. The Department of Health will operate the facility, the city said.

Of the $387 million Honolulu obtained through the CARES Act, it has allocated over $233 million and actually spent only $76 million, according to .

That includes $2 million for a public safety multimedia campaign.

It also includes over $30 million to the Honolulu Police Department – about half of which is for overtime. HPD has been issuing criminal citations for pandemic rulebreakers at a record pace.

In the last month alone, the Honolulu Police Department has issued approximately 44,000 citations related to the mayor’s COVID-19 orders. That’s more than double the total of all criminal cases the District Court handled in 2019. Many residents have complained about being ticketed unfairly while engaging in an activity that poses little or no risk of spreading the virus.

On Tuesday, the mayor defended the enforcement and said he believes it helps to reduce cases of the virus. However, he said he spoke to Chief Susan Ballard, and she said officers may start issuing more warnings.

by jcummings4