As Hawaii’s COVID-19 cases surge, there is still no direction from Gov. David Ige on what should trigger the restrictions to help stop the virus, and when things can ease again. County officials closed bars, cut the size of gatherings and rolled back on reopening in other ways, all without a clear plan for when conditions can return to normal.
States across the country, but not Hawaii, developed statistical models that illustrate how resorting to certain restrictions could stem the spread of COVID -- models that help officials make informed policy decisions.
There are also national models out there, an example being one developed by the University of Washington, but they don’t address Hawaii’s unique conditions.
Victoria Fan, chair of the Hawaii Pandemic Applied Modeling Work Group, HiPAM, and a University of Hawaii health economist, explained that Hawaii has, “different characteristics in terms of population, an older population, a larger proportion that's Asian and Native Hawaiian and Pacific Islander. And most importantly, we're in the middle of the Pacific. We have stronger control of the interstate migration piece than other states. Other models may or may not account for that.”
Fan’s group has been working on a Hawaii model, one that could give government, businesses and residents a better idea of when COVID’s spread might trigger restrictions.
Hawaii Data CollaborativeExecutive Director and HiPAM member Nick Redding noted that a Hawaii model would allow for more flexibility.
“We can be much more adaptive and responsive to shifts that occur in terms of understanding the likely consequences of those shifts and understanding what the near and intermediate term might look like,” he said.
“What we learned earlier is if we're beholden to generalized models where they take one model and then they put each state's data into that model and report that, like the University of Washington model, it leaves us in kind of a precarious place in terms of being able to be more responsive to local questions.”
While the local modeling project sounds similar to what county officials and the business community have been asking for, the modelers say they lack crucial information.
Fan said she can’t get testing data broken down by each lab, daily COVID-19 hospital admissions or specific information about contact tracing.
“Our public agencies should really make that information available in my view,” she said.
“The contact tracing data can help us to reveal the quality of the contact tracing. How long does it take between the time the person is tested 'til the time the notification for the testing is indicated?”
UH Epidemiologist Thomas Lee, who served as the Hawaii Emergency Management Agency’s lead COVID-19 modeler and forecaster, also called for more transparency.
“I can say that it's been challenging to compile all those data sources for public use,” he said.
Cumulative numbers that aggregate cases, tests and hospitalizations since the beginning of the pandemic, for example, aren’t useful for modeling, Lee explained.
He wants the state health department to break down its daily case counts into categories like race and socio-economic levels. Doing that would help the state make better decisions based on who’s getting the virus and where and how it’s spreading.
“It helps to provide a better understanding of what we're really seeing in our state,” he said. “I know DOH reports some of the information but it doesn't provide a lot of context.”
Prevent Epidemics, a team of global health experts, ranks the states on the information it makes available, such as the number of people in isolation and the time it takes to get back tests.
Hawaii’s ranking is poor. Only seven states ranked worse in publicly reporting that critical data.
Dr. Cyrus Shahpar, director of Prevent Epidemics, noted that most of the country in general is missing critical information. While Hawaii had a 13% ranking, Minnesota, the state with the highest percentage, only had 43%.
Yet he said Hawaii is in the best position of all the states to fill those information gaps.
“Hawaii is set up to actually be kind of a model or star when it comes to data reporting and addressing some of these things around the cases and hospitalizations, and then also the contact tracing, because it's at a good point in the pandemic,” he said.
“I think this is the time where you start to say, 'Okay, we put out all this data, we have a low number of cases. Let's beef it up, so that if it gets worse later, we already have these systems in place.'”
Shahpar’s observation begs the question: what’s stopping Hawaii?
Lee thinks it’s because different departments and agencies sit in information silos and aren’t sharing what they know.
“I would say that the information does exist. It's just that the data systems or whoever's in charge are not speaking with each other, or there's a lack of a coordinating figure or authority to put this all together,” he said.
“My guess is there hasn't been a single voice that has said this type of data dashboard for public consumption is necessary. I think there are sources that are internal that capture some of this but what we've seen is a lack of transparency.”
Lee said consistent public messaging, which is crucial to slowing the spread of COVID-19, starts with presenting the facts and numbers to the public.
With a Hawaii COVID-19 model, officials would get a glimpse at different scenarios where cases balloon if restrictions are eased and where the virus is contained in a lockdown.
