Hawaii Experts Disagree Over Importance Of Testing In Reopening Economy

Apr 14, 2020

Experts in academia and healthcare have unveiled separate plans for safely reopening Hawaii’s economy. Both frameworks rely heavily on testing, but the state health director says that isn’t where the focus should be.

Leaders from state government and the business community are continuing to explore ways to safely reopen Hawaii’s economy. Experts have cautioned that relaxing social distancing measures too soon could produce a spike in new infections. But according to Dr. Mark Mugiishi, president of health insurer HMSA, there are also health risks if we wait too long.

“The number one determinant of poor health outcomes is economic inadequacy,” Mugiishi told state lawmakers in a briefing on Monday. “So Hawaii does need to react quickly to restore its economy, or the ramifications to public health will be large and long-lasting.”  

At the weekly meeting of state House Speaker Scott Saiki’s COVID-19 Economic Preparedness Committee, Mugiishi unveiled a framework developed by HMSA, the state’s largest health insurer in terms of patients, that offers a possible path to reopening the local economy.

He said there are four pillars to the recovery plan: screening, testing, tracking, and quarantine.

Effective COVID-19 testing in particular has been held up by officials around the world as critical. South Korea has largely been able to avoid shuttering its economy to control the virus. Foreign Minister Kang Kyung-wha said testing was central to that success.

Tim Brown, an infectious disease specialist at the East-West Center, co-wrote a plan similar to HMSA’s with economist Sumner LaCroix of the University of Hawaii Economic Research Organization. Their plan also emphasized the importance of testing for the novel coronavirus. At Monday’s briefing to lawmakers, Brown reaffirmed the importance of testing.

“Where it's critically important from a public health perspective is really in terms of giving us the entry point for contact tracing,” he said.

Contact tracing is when health officials track down people who have come into contact with an infected person and direct them to get tested or self-isolate. In addition to testing, the process was a key aspect of both the Brown/LaCroix and HMSA plans.

But one key state official isn't sure that focusing on testing is the best approach. Bruce Anderson, director of the state Department of Health, told the committee that he doesn’t think testing should be the focus for Hawaii.

“I think there’s an undue focus on testing. Testing doesn’t change anything that we do,” Anderson said via remote conference.

He noted that decisions made about quarantining are made before test results come in, saying that tests are not a silver bullet.  

“It’s a tool, but it’s not going to be the solution to controlling the disease here. That’s going to come back to contact tracing, surveillance using antibody tests and other means, and continual vigilance on social distancing,” Anderson added.

That appears to be at odds with what other public health officials and experts have said locally and around the world. The head of the World Health Organization recommended that policy makers pursue testing, along with tracing, quarantines, and social distancing. In March, he gave some direct advice to national leaders: “test, test, test.”

Some 19,213 COVID-19 tests have already been conducted in Hawaii, giving the state one of the highest testing rates in the country on a per capita basis. A total of 504 have returned positive results.