It's here, Hawaii's first coronavirus case. What happens next depends heavily on the steps taken by local, state and federal officials as the potentially fatal, financially disruptive epidemic infects the islands.
The limits of the state government's ability to curtail the spread of COVID-19 were laid out by Gov. David Ige and health officials Friday as they announced the details of the state's first patient testing positive locally for the virus.
The Hawaii resident, who was not identified, took a tour to Mexico on the Grand Princess, the latest ground zero for coronavirus cases in the United States. The man flew back home to Oahu and then fell ill.
He was treated at Kaiser-Permanente, according to the Star-Advertiser, assessed and tested for coronavirus. His results turned up positive on Friday. He is now at home in quarantine as are the doctor and medical workers who treated him. The man is showing mild to moderate symptoms and is doing fine, according to officials.
State officials did not reveal if the man traveled with anyone else or is living with others. They did say they have not identified anyone that the man had close contact with since returning home.
"So that's good news for us," said Deputy State Epidemiologist Sarah Kemble at Friday's press conference.
The task now for the state is tracking down dozens of passengers who disembarked from the Grand Princess when it traveled to Hawaii Feb. 26 to Feb. 29 after the Mexico trip and before the coronavirus cases on the ship were detected, officials said.
The cruise ship stopped at Nawiliwili Harbor, Kauai on Feb. 26, Honolulu Harbor on Feb. 27, Lahaina, Maui on Feb. 28, and Hilo on Feb. 29. Roughly 50 passengers disembarked, among them as many as four Hawaii residents.
"We're going to be contacting everyone who disembarked from the vessel, asking them to self-quarantine. And we'll be following up to get a detailed history of their activities while they were here. We'll be identifying close contacts, and, of course, following up with all of those individuals," Health Director Bruce Anderson said.
The Grand Princess sits off the California coast as of Saturday, barred from docking in the San Francisco-Bay Area. After the ship left Hawaii, passengers began falling ill with flu-like symptoms, prompting officials to drop test kits to the vessel.
Twenty-one of 45 people screened have turned up positive in tests, 19 of them crew members and two who are passengers. The ship is in limbo as officials locate a non-commercial port where it can dock. Passengers would then be tested and quarantined.
The governor was asked Friday about banning cruise ships that frequently stop in the islands and have proven to be breeding grounds for the quickly spreading COVID-19.
"We don't have the authority to ban cruise ships. The Coast Guard is pretty strict about what they are looking at. As you know, they did ban any cruise ships that sailed in China and I'm certain that the CDC and the Coast Guard are talking all the time about increased restrictions on both cruise ships and air travel," Ige said.
So far, Kemble said it doesn't look like asymptomatic transmission is occurring, so health officials have been focusing on individuals showing symptoms like fever and cough while traveling.
Newly expanded criteria for when people can be tested will allow more screenings that had been limited to those who had traveled to heavily affected countries like China, South Korea, Italy and Iran.
Now, patients who visit their doctors exhibiting symptoms can be referred to the health department for testing. The department received three test kits, making it possible for lab workers to test up to 250 samples per week and double that amount if needed. State officials say they can order more kits.
Federal officials have also cleared the way for private labs to begin testing, although the health department will still need to approve the tests and the labs could charge for the service, which could cost about $160 per test.
Anderson said once private testing is available, it may resolve concerns among doctors that they can't get health department clearance to test their patients who they suspect may have the virus.
The state has not yet banned large gatherings, although organizers of events large and small -- from the Honolulu Festival to Damien High -- have voluntarily canceled or restricted attendance.
Ige said people with respiratory illness including the elderly should take responsibility and talk to their doctors if they have traveled to the impacted countries or to states where there's been community spread.
"I know that we could test everyone in this room and it's not really a smart use of resources," Ige said.
The governor said officials don't believe there is community spread of the virus in Hawaii. Still, doctors and healthcare workers have raised concerns that the health department has disapproved tests even when patients are symptomatic.
Testing is priortized, according to Anderson, with those who are severely affected and those who travel to suspect countries given preference. It's not necessary anymore to have the travel history that was required earlier to be tested, he added.
The state had planned to conduct so-called sentinel survey tests of about 200 people in the community next week to see if people showing lower respiratory illness may be suffering from undetected COVID-19.
That plan may now be placed on hold with the presence of the first coronavirus case that could be the first of others to come.
As of Friday, there were seven people in Hawaii who tested negative in Hawaii and 77 others who are self-monitoring with health department supervision.
