Updated: 3/6/2020, 6:02 p.m.
The state of Hawaii has its first case of coronavirus, officials announced Friday. Gov. David Ige said this was not a case of community spread but rather a passenger on the cruise ship Grand Princess who had been on a trip to Mexico. The patient, a resident here, tested positive and is now under quarantine.
The announcement came as state health officials expanded the criteria for when patients can be tested, removing the travel requirements that had limited the number of screenings.
The changes follow evidence on the Mainland that the illness is spreading in communities and infecting those who had not visited China and other impacted countries.
The Hawaii resident was a passenger on the Grand Princess when it visited Mexico Feb. 11-21. He flew home, then fell ill. He saw a doctor and was assessed; his test came back positive Friday.
Officials say the man is quarantined at home and is doing fine.
"And we know that the person did not have close contact with anyone here since falling ill. So that's good news for us," said Sarah Kemble, deputy state epidemiologist.
Several other cases of coronavirus were confirmed among the passengers after the Mexico trip concluded. One California man died.
The Grand Princess is now off the coast of California, on its way back to San Francisco from Hawaii. Because people began falling ill, passengers and crew members were tested and 21 people were found to be positive for the coronavirus -- 19 of them are crew members.
There is growing evidence that the vessel was the breeding ground for a cluster of cases during its Mexico voyage, the Associated Press reported.
The same ship visited the state between Feb. 26 and 29, stopping on Kauai, Oahu, Maui and Hawaii Island.
State Health Director Bruce Anderson says roughly 50 people disembarked. At least four are residents, who may not have gotten back on the ship.
"We're going to be contacting everyone who disembarked from the vessel, asking them to self-quarantine," Anderson said. "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."
The cruise company has canceled an upcoming Hawaii trip, which was scheduled to commence on Saturday. All guests will be receiving a full refund.
EXPANDED CRITERIA FOR TESTING
To be tested now, a person must show signs of lower respiratory illness and fever, and his or her doctor will need to have checked the patient for other diseases. The doctor can then refer the case to the state health department, where officials would then decide whether to test for coronavirus.
Prior to the latest change, only patients who had traveled to China, Iran, Iraq, Japan, South Korea and Italy within the last 14 days or had direct contact with an infected person would have been eligible for testing.
Lt. Gov. Josh Green said the expansion was a needed improvement to local testing.
“Now, it's just based on symptoms because there's so many people that have traveled,” he said.
The state will not test individuals who have turned up positive for the flu.
Anderson and state Epidemiologist Sarah Park have both acknowledged that it is possible to have both the flu and coronavirus, but that is very unlikely, they said.
“The focus of many of us in public health is to look for a specifically coded COVID-19 separate from a flu virus,” Park said.
Green called it a “a fool’s errand” to conduct the coronavirus test after someone is positive for the flu.
“We know you’ve got the flu, nobody’s going to have both, or it would be unbelievably unlikely,” he said. “It’s (the coronavirus testing) not necessary.”
The state health department lab's in Pearl City has about five people trained to properly administer the coronavirus test, according to Edward Desmond, the department's state laboratories administrator.
“They (the trained technicians) ran the controls that came with the test kit to show that they could do the test properly,” he said. “We can train more people if we need to.”
PRIVATE LABS COULD BEGIN TESTING
The state is now capable of testing 250 samples a week, officials say. Each of the state's three test kits could screen about 600 samples. If the state ran out of needed components for the tests, it would take about a week for another kit to arrive from the U.S. Centers for Disease Control and Prevention.
The number of local labs that could test for coronavirus could be expanding. The federal Food and Drug Administration is allowing private laboratories to begin conducting the tests.
However, Green said even when private laboratories begin testing, not everyone will be able to get screened.
“You can’t just show up and get a test like that,” he said. “We will not have infinite testing. So you will still need an order for a test, and the Department of Health is still approving them.”
He estimates that a private laboratory test would cost between $80 to $120, but it likely could be covered by insurance.
During a White House press briefing Thursday, Vice President Mike Pence assured the public that the coronavirus test would be covered by “the private health insurance of every American, as well as covered by Medicare and Medicaid.”
But the Associated Press reported that those with insurance provided by their employers may still need to cover copays and absorb deductibles.
Currently, the states are administering the tests at no charge.
Hawaii Pacific Health hopes that it will eventually be able to conduct the test within each of its hospitals across the state.
“We know that in the matter of a few weeks, we probably will be able to test like we do currently for the flu or other illnesses,” said HPH Executive Vice President Melinda Ashton.
“We will do that testing probably in single locations at each of our facilities so that it’s done well and we make sure that we follow all the appropriate protective precautions for our healthcare workers that are doing the testing,” she said.