How Hawaii Can Get Coronavirus Right In Twelve Steps

by Darragh C. O’Carroll M.D. — Board Certified Emergency Physician, CNN on-air contributor, and consultant to the NETFLIX Docuseries ‘Pandemic: How to Prevent an Outbreak’

Image courtesy of Luke McKeown @waikatospear

*The Data from The Commonwealth of the Northern Marianas Islands was redacted on 11/30/2020, it is continually evolving and was requested to only be presented in their own Publications*

This paper has been peer reviewed and endorsed by

1. Why SARS-CoV-2 Is Unlike Prior Coronaviruses: Asymptomatic & Pre-Symptomatic Spread

Unlike the prior human coronaviruses MERS and SARS that were more easily contained, at least 50 percent of infections are transferred before there is any hint of infection.

2. CONTAINMENT STRATEGIES

adapted from L. Yang et al https://www.cambridge.org/core/journals/epidemiology-and-infection/article/estimation-of-incubation-period-and-serial-interval-of-covid19-analysis-of-178-cases-and-131-transmission-chains-in-hubei-province-china/C1B194C01268F005AAFBE8D50CB5F945/core-reader

3. HOW RELIABLE IS ONE TEST ?

adapted from DB Larremore et al https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2.full.pdf

4. FALSE NEGATIVE RATE OF OUR MOST SENSITIVE TESTS

adapted from LM Kucirka et al https://www.acpjournals.org/doi/10.7326/M20-1495

5. GLOBAL CONSENSUS THAT ONE TEST IS NOT ENOUGH

adapted from https://www.cnn.com/2020/11/03/health/covid-test-negative-contagious-wellness/index.html?fbclid=IwAR2UcIOa7HfjMd6J45whxXG3bUmGh0YtC4NwXNS-kHwAaL9F0g9Y_2iYofM
adapted from https://www.nytimes.com/interactive/2020/09/14/opinion/politics/coronavirus-close-borders-travel-quarantine.html
adapted from https://www.wsj.com/articles/u-s-transportation-officials-airlines-spar-with-cdc-over-testing-vs-quarantines-for-international-flights-11603996361?fbclid=IwAR0MiPwz1cZjYs9ygJ67-f4iYkUhOUvX8J8DrraS4ZHbPBUa9g8vK3gbMyU
adaped from https://www.washingtonpost.com/travel/2020/11/20/new-zealand-flight-covid/

6. SURVEILLANCE TESTING — It’s different than diagnostic testing.

adapted from MJ Mina et al https://www.nejm.org/doi/full/10.1056/NEJMp2025631
adapted from DB Larremore et al https://www.medrxiv.org/content/10.1101/2020.06.22.20136309v2.full.pdf
adapted from https://calculator.unitedinresearch.com/complex_dashboard

7. WHAT ARE OTHER COUNTRIES & STATES DOING?

8. What about the “Surveillance Testing” In Hawaii

adapted from MJ Mina https://www.nejm.org/doi/full/10.1056/NEJMp2025631 (Note viral curve height and tail are not to scale)
adapted from MJ Mina https://www.nejm.org/doi/full/10.1056/NEJMp2025631 (Note viral curve height and tail are not to scale)

9. To Estimate the True Number of Infected Visitors Arriving to Hawaii, Look no further than Kauai

adapted from MJ Mina https://www.nejm.org/doi/full/10.1056/NEJMp2025631 (Note viral curve height and tail are not to scale)

This is a positivity rate of 15 in 1000, a full 15x higher than the current program predicted.

10. Prevalence — Estimating How Much Virus Is Out There

11. Masks are Crucial, but so is a Fence

adapted from MJ Mina https://www.nejm.org/doi/full/10.1056/NEJMp2025631 (Note viral curve height and tail are not to scale)

To put it as succinctly as possible — Hawaii is very far from following international scientific consensus. Hawaii leaders, from both the economic and public health sector, must come together to reinstitute some length of quarantine for visitors and returning residents that strikes a better balance between public and economic safety.

Calculated by Michael Schwartz M.D., adapted from “A Plan For Safely Reopening Hawaii: Kaua’i as a Model” https://drive.google.com/file/d/1phYNlE4vbBSro0_TxqEHcCim6NQbn9Yh/view

The above governments and organizations realize controlling spread requires not only mask use, but a robust screening and prevention fence.

12. Last but Not Least, Other Very Important Measures To not Forget

Emergency Medicine and Disaster Response physician, specializing in distilling complex medical topics to media digestible by all non-medical persons.

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