Health experts say it is too early for Hawaii to reopen businesses, arguing that the state does not have a sufficient public health workforce to identify new coronavirus cases, trace contacts and ensure those infected are isolated to stop the spread of the disease.

Under pressure to reopen the economy, Gov. David Ige gave the green light for Kauai and Hawaii island shopping malls and “low-contact” retailers to reopen Thursday, but expects an uptick in infections as large numbers of people come back out into society. Mall and retail reopenings for Oahu and Maui were delayed.

The state Department of Health has yet to expand its workforce to deal with a surge in cases. It currently has 50 staff and about 30 volunteers to do the labor- intensive work of following up on close contacts of COVID-19-infected cases. The National Association of County & City Health Officials suggests that in an emergency, teams of 30 — including epidemiologists, disease investigation specialists, public health nurses and community health workers — per 100,000 should be in place for contact tracing to be effective. In Hawaii’s case, that means 420 staff — 300 on Oahu alone — would be needed for a population of 1.4 million. Nationally, North Dakota plans to increase staffing to 66 contract tracers per 100,000 people, though the average among 41 states surveyed was 12, according to National Public Radio.

Photo Gallery: Residents show up for Kalihi coronavirus drive-thru testing

“Opening malls is brain-dead. That’s just inviting crowds. That’s just foolish. One thing we know about the virus is it loves crowds. The last thing we want to do is bring people together,” said Dr. Tim Brown, an infectious-disease modeler and senior fellow at the East-West Center. “Right now the number is basically down because most people are sheltering in place, but once we open up, the number of (cases and) close contacts is going to rise very rapidly. The streets are a lot more crowded; people are already effectively starting to lift the lockdown even though they’re technically supposed to be in lockdown.”

Ige said at his daily COVID-19 briefing Tuesday that the state would be scaling up its public health workforce, but did not provide specific details. The Health Department has reassigned workers, including public school nurses, to help with contact tracing, while looking to expand agreements with the University of Hawaii John A. Burns School of Medicine and UH School of Nursing and Dental Hygiene to help in that effort. It is also working with the university to establish targeted training programs for additional personnel, including the Hawaii National Guard, in case there’s a second wave of infections, he said, adding that the state has a new online program that will allow it to keep track of more people with fewer workers.

“One of the most important capabilities that allow us to reopen our economy is the fact that we have ample testing capacity,” with public and private labs able to complete more than 3,000 tests per day, Ige said. “That’s a critical part of why we believe we can open our economy.”

However, Honolulu Mayor Kirk Caldwell said at his own news conference that the state needs to furnish detailed plans on testing, contact tracing and follow-up and doesn’t have 300 tracers for Oahu. State Health Director Bruce Anderson didn’t respond to requests for details on the DOH workforce expansion plan.

“Without that it’s very difficult to know that you’re gonna be OK as you go forward. If we don’t do aggressive testing, contact tracing and quarantine, then we don’t know where the virus is,” Caldwell said.

“All of these things need to be in place as we open up. It’s the only way we can do it safely,” said Caldwell, who is targeting the reopening of businesses for May 15 to allow more time to be prepared. “Now the challenge is holding down the curve as we open up.”

Hawaii’s coronavirus cases climbed by four to 625 on Tuesday, with the death toll standing at 17. A total 551 patients have recovered since the start of the outbreak — more than 88% of those infected. More than 34,500 coronavirus tests have been conducted by state and clinical laboratories with about 1.8% testing positive.

Dr. DeWolfe Miller, an epidemiologist, UH professor and fellow in the American College of Epidemiology, agreed that public health capacity is critical in order to safely reopen.

“The testing, the contact tracing and follow-up is an essential part of the control of the epidemic,” he said. “The capacity building here within Oahu, Maui or the rest of the state is way under what it should be. We always emphasize the need to build this capacity, and we’re not anywhere near it.”

The workforce should have already been trained and ready to work immediately because every delay gives “more opportunity for the virus to spread,” Brown said, referencing the large outbreaks at Maui Memorial Medical Center and at several McDonald’s locations on the Big Island, where dozens of people were infected.