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The last three weeks of widespread testing for COVID-19 on Oahu has given city and public health officials confidence that while the virus is still spreading it’s confined to specific populations and neighborhoods rather than being everywhere on the island.

That’s good news because, health officials say, they can target these hot spots with extra testing and better keep the virus in check.

The surge testing program, which ended Monday, has resulted in 60,274 people getting tested as of Monday afternoon, according to Honolulu Mayor Kirk Caldwell.

All told, 92,000 tests were allocated for the program, which is different in that residents were encouraged to get tested for free regardless of if they have symptoms or any known exposures to people infected with the virus.

As of Sunday, 0.6% of surge tests had returned positive during the prior week. By nearly every measure, this marks a favorably low seven-day positivity rate for community surveillance — a meaningful guidepost in the fight to contain the virus’ spread, which infected more people in August than the previous five months combined.

The federal surge testing drive was free and available to everyone, regardless of symptoms, travel history or exposure to someone who tested positive for COVID-19.

By casting a wider net, this approach to testing is intended to help state health regulators spot the virus in unknown places. It also allows people to get tested for peace of mind, even though they may feel fine and not have any known risk factors.

Caldwell and others leading the state’s COVID-19 response say the 0.6% positivity rate provides a sharpened indication of where the virus is lurking in the community at a time when Gov. David Ige is considering another delay in lifting the 14-day quarantine for travelers arriving in Hawaii.

At a press conference Monday, he said the Pacific Islander and Filipino communities were examples of populations that have been identified as needing more targeted testing. Kalihi, he said, would be a geographic area that is being pinpointed by the surge testing.

The federal government is allowing Honolulu to keep about 30,000 unused tests and use them free of charge so long as they get used up by the end of November. He said those tests would be used for more focused testing rather than using them for the open-to-all drive-thru events of the last three weeks.

“We just want to know where that virus is and we know that the spread, while it is in different parts of our community, it’s not spread evenly throughout our entire community,” Caldwell said.

A More Targeted Approach

Ray Vara, president and chief executive of Hawaii Pacific Health, said that while he believes Oahu was experiencing uncontrolled community spread at the onset of the stay-at-home order nearly three weeks ago, the low positivity rate of 0.6% produced from the surge testing program indicates that asymptomatic carriers of the virus do not appear to be responsible.

The data, according to Vara, shows that community spread can be largely traced back to people who have symptoms or who have had known contact with someone else who tested positive for the virus.

“In the life of the virus this is an important distinction because if, in fact, there’s a broad-scale asymptomatic spread in the community, that means it’s sort of everywhere — and it does not appear that that’s the case,” he said.

Instead, Vara said the data indicates that there is uncontrolled spread of the virus within certain at-risk populations. This is a positive revelation, Vara said, because it means that it’s still possible to track the location of the virus from people who test positive with symptoms or with known exposures to positive COVID-19 patients.

For example, statistics show that the Pacific Islander and Filipino communities are being at rates that are disproportionately high for their population size.

Non-Hawaiian Pacific Islanders make up 30% of the state’s positive COVID-19 cases, but they represent just 4% of the population. While Filipinos account for 20% of the state’s documented coronavirus infections, they make up 16% of the population.

When asked by a reporter for more information about where clusters are occurring, Caldwell pointed at workplace lunchrooms as another significant source of the virus’ spread.

The challenge going forward, according to Vara, is figuring out how to pinpoint and publicize more of these sources of community spread so that testing and contact tracing efforts can be accordingly deployed to hotspots, and people who live and work in these spaces can make informed decisions about their behavior.

The DOH does not provide data to the public about where clusters are happening.

“I don’t know whether or not the Department of Health has that information or not,” Vara said. “So I can’t tell you where those clusters are.”

While the decision of who should get tested for COVID-19 has created much debate among medical professionals, Vara said the surge test results indicate that people who are asymptomatic should not be prioritized for testing.

“We have a finite number of tests available to us,” Vara said. “So we need to be very strategic about how we go about testing our community. I think they should be prioritized based on those who are symptomatic, those who’ve had exposures and those who are members of vulnerable populations. I think that is the big takeaway from the surge test results.”

Caldwell: Oahu Is Ready For Pre-Travel Program

Before the end of this week, Caldwell said he plans to announce the reopening of some businesses, including retail stores, when the stay-at-home order expires on Sept. 24.

At that time, Caldwell said he would also like to reopen the island’s beaches, parks and hiking trails to gatherings of up to five people. These activities are currently allowed as a solo activity only, which has drawn criticism from families with young children who require supervision.

On Monday Gov. David Ige said he will likely of the state’s oft-delayed pre-travel plan that would lift quarantine rules for trans-Pacific arrivals if they provide proof of a negative COVID-19 test.

Ige made the remarks during a and said he would announce a new timeline in the coming days.

Caldwell, who questioned the efficacy of the tedious-to-enforce 14-day quarantine for incoming visitors, said he has encouraged Ige to get the pre-travel program up and running as soon as possible. Unveiled in June, the program was originally slated to launch on Aug. 1.

“Right now people are coming into Oahu, sometimes in the thousands per day, all agreeing to quarantine,” Caldwell said. “But there’s no guarantee they are quarantining. And it becomes increasingly hard to enforce against quarantine breakers.

“A pre-travel test program, knowing more people are tested and proven to be shown negative, protects all of us and it’s a program I would like to see start sooner rather than later.”

Caldwell also announced he is nearing a formal agreement with the state Department of Health that would allow the city to pay for 80 new contact tracers who would join efforts at the DOH immediately. He said the city plans to eventually provide the DOH with a total of 250 contact tracers using market research workers.