Hawaii’s extraordinary success in curbing the local spread of COVID-19 has left Gov. David Ige with a dilemma unlike any in the nation. To a greater degree than any other governor, it will fall to Ige to eventually reopen the door to new infections when he finally authorizes the restart of the state’s tourism industry.

A combination of geography, a cooperative public and a two-week quarantine imposed on all travelers to the state has effectively squashed “the curve,” and Hawaii now has one of the lowest per capita infection rates in the nation. State residents and many of their political leaders seem determined to stomp out every last case of the new coronavirus.

State Health Director Bruce Anderson has repeatedly warned that eradication of COVID-19 in Hawaii will probably never happen, but the target still seems to be zero infections for much of the public. Masks and social distancing are such a fact of life now that people who ignore those precautions seem reckless and rude.

Photo Gallery: Beachgoers return to Waikiki

With just a handful of new coronavirus cases reported each day in recent weeks — there were no new cases reported Monday for the third time in less than two weeks — the zero-infection rate in Hawaii almost seems to be in reach.

In fact, it really isn’t within reach, the experts say. As Anderson explained Monday, “It’s not going to disappear. We’re going to have COVID-19 with us for many, many years to come, possibly our lifetimes. Our ability to manage the disease is going to be based on our ability to respond quickly and appropriately to new cases and contacts, and we expect that will continue.”

“As long as we can do that, it’s a disease we can live with, much like the flu and all the other infectious diseases we have to live with these days,” he said. He guessed that an effective COVID-19 vaccine may be a year away.

Meanwhile, it is becoming clear much of the mainland has already accepted COVID-19 as a fact of life. And a disease that is widespread in New York, Iowa, Arizona and Georgia will surely find its way back here soon after the two-week quarantine for arriving visitors ends.

When Ige unveiled his reopening and recovery plan Monday, he said lifting the quarantine for travelers from outside the state is not part of any of the four phases of the new plan.

“We are considering what conditions we would feel comfortable with lifting that quarantine,” Ige said. In a separate online discussion earlier in the day, Ige said that any suggestion Hawaii would open for tourism by the late summer seems “premature.”

“Definitely, domestic and international travel is one of the last things that would be brought back,” Ige said Monday.

Don’t want to wait

But the foundation of the modern Hawaii economy is welcoming visitors from other places, and a number of Hawaii leaders don’t seem inclined to wait a year or more for a vaccine.

That was underscored Monday in a presentation by Dr. Mark Mugiishi to the House Select Committee on COVID-19 Economic and Financial Preparedness that detailed how the state and the health care systems would respond to spikes in the number of COVID cases. Mugiishi is president and CEO of the health insurer Hawaii Medical Service Association, or HMSA.

During his presentation of the work of the Hawaii COVID-19 Public Health Recovery Task Force, Mugiishi praised the latest plans by the state Department of Health to expand its contact tracing capacity “to get up to the levels that we think we will need as we start to reopen.”

He estimated the visitor population will increase the state’s effective population by about 250,000 people once the state begins to reopen to travel., and said the goal is to have 300 to 500 trained contact tracers to identify people who have had close contact with people with COVID-19.

Others are more blunt about the problem ahead.

“Once we open it up to tourism, we’re going to knowingly bring in infected people,” said state Rep. Bob McDermott during a recent cable television interview. McDermott, (R, Ewa Beach- Iroquois Point) was describing a testing program he has been promoting with House Minority Leader Gene Ward.

McDermott outlined an alarming scenario where the state tourism economy returns to one-third of its former level with about 10,000 arrivals per day. If 1%, or 100, of those people are virus carriers without any symptoms, and if those people infect three others during their stay in Hawaii, “from that 100 passengers in that one day, you have 300 new infections,” he said.

“It will only take a couple of weeks or months before you see this spike again, which will be untenable, and the local people will know where the spike came from,” McDermott said. “It didn’t come from Kalihi. It came from California, New York, Chicago, and they’re not going to be happy.”

Testing sought

Ward and McDermott are promoting a plan to require travelers to be tested 72 hours before they fly to Honolulu. Those who refuse would not be allowed to leave the Honolulu airport until they take a test, he said. Those who test positive in Honolulu would be turned over the National Guard to be placed in a mandatory quarantine facility.

“We have the opportunity to drive it to zero, manage it to zero, and then imagine the marketing” possibilities, he said. Hawaiian Airlines could market itself as the “COVID-free airline,” McDermott said. “You can charge a premium for those tickets, and people will pay for them, particularly if you’re older than 60, because that’s the high-risk group, right?”

One major problem: The testing available now is not foolproof. State Epidemiologist Dr. Sarah Park last week described testing as a “snapshot in time,” because people who are infected with the new coronavirus don’t always test positive.

In some cases a person who has been infected might not test positive because he or she is in the incubation phase where the virus has not reached a point where the test result will be accurate, she said. Another possibility is the person who takes the sample does not collect enough cells to get an accurate result.

“There are so many different reasons why you could have a negative test,” Park said. That is why people who have been in close contact with someone who is ill with COVID-19 must remain in quarantine anyway.

“You could be negative at that time, but you could be incubating the virus, for all we know,” Park said. “So, we always tell close contacts of confirmed cases, if they want to get tested, go ahead, but if you get a negative, it doesn’t mean you get out of quarantine. You’re still stuck with being in quarantine for 14 days because we don’t know at what point you might turn positive if you actually got infected.”

When asked Monday whether additional infections are inevitable when tourism restarts, Ige didn’t answer directly. “As we reopen travel from the mainland and internationally, we are looking at a system of screens that would allow us to identify and separate those who may be sick from those who are healthy,” he said.

The state is planning to spend tens of millions of dollars on scanners to take the temperatures of people arriving at Hawaii’s airports, but Ige acknowledged there is no perfect system.

“Clearly, asymptomatic people would not be caught in any kind of screen because they don’t have any indications of disease, and that’s why the quarantine order applies to everyone,” Ige said.