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’

*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

Image for post
Image for post
Image courtesy of Luke McKeown @waikatospear

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

Image for post
Image for post

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

Image for post
Image for post
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 ?

Image for post
Image for post
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

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

5. GLOBAL CONSENSUS THAT ONE TEST IS NOT ENOUGH

Image for post
Image for post
adapted from https://www.cnn.com/2020/11/03/health/covid-test-negative-contagious-wellness/index.html?fbclid=IwAR2UcIOa7HfjMd6J45whxXG3bUmGh0YtC4NwXNS-kHwAaL9F0g9Y_2iYofM
Image for post
Image for post
adapted from https://www.nytimes.com/interactive/2020/09/14/opinion/politics/coronavirus-close-borders-travel-quarantine.html
Image for post
Image for post
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
Image for post
Image for post
adaped from https://www.washingtonpost.com/travel/2020/11/20/new-zealand-flight-covid/

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

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

7. WHAT ARE OTHER COUNTRIES & STATES DOING?

8. What about the “Surveillance Testing” In Hawaii

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

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

Image for post
Image for post
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

Image for post
Image for post

11. Masks are Crucial, but so is a Fence

Image for post
Image for post
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.

Image for post
Image for post
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

Written by

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

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store