Viruses have a way of ruining sunny predictions. Not even a week after county officials on Oahu announced the island’s exit from the pandemic, the news of another coronavirus variant cast a bleak shadow over the holidays. This shouldn’t surprise anyone. The struggle against COVID-19 is not won in Hawaii until it’s won everywhere.
South African researchers, working swiftly, discovered the omicron variant early in its epidemiologic life-span. In science we teach students not to speculate, and to paraphrase Socrates, “know what you don’t know.” However certain decisions can’t wait for perfect information, and there is reason to worry about the new variant.
South Africa cases are increasing faster than during their delta wave. It’s not yet clear if omicron is spreading quickly because it’s more transmissible, or because it evades the immunity gained through natural infections. But either scenario is bad news.
Researchers studying omicron are concerned because of the pattern of mutations in its genetic sequence. Many of omicron’s mutations help it evade existing immunity. A complete outwitting of vaccine-induced immunity is unlikely, but a drop in effectiveness is expected. Another concern relates to monoclonal antibodies, one of the best tools in the previous wave, which will likely lose efficacy against omicron.
Quotes from a few South African physicians have been taken out of context to conclude that the disease caused by omicron is “mild.” However hospitalizations in the province are rising, and it would be foolish to assume it will cause a much milder disease.
Israel and Japan have already closed their borders. Should Hawaii do the same? The Safe Travels Hawaii program, without modifications, will not prevent omicron from arriving. A single, pre-travel test has failed to keep out, or even delay, the arrival of any previous variant.
If Hawaii did not have 30,000 people arriving on its shores daily, these problems would be less acute. But omicron changes the situation. A recent flight from Johannesburg to the Netherlands had 10% of its passengers test positive for COVID on arrival. High volume travel will create an opportunity for the virus. Failure to use the Pacific Ocean, a vast strategic advantage, would be a blunder.
Improving our border control should be an immediate priority. This will buy time to vaccinate more residents, distribute rapid antigen tests, and gain access to new antiviral medications. This could prove critical in lowering the impact of the coming wave.
Returning to a mandatory 14-day quarantine is unsavory. Fortunately, there are other options. Harvard’s Dr. Michael Mina, a national testing expert, recommends daily rapid testing for five to seven days after travel in lieu of quarantine. The Centers for Disease Control and Prevention is considering requiring post-arrival testing and limited quarantine for all international travelers. Regardless of whether that happens nationally, we should implement this system in Hawaii.
Pretending the pandemic is over is not a strategy, and saying “we can’t do that” has always been a poor excuse for inaction. Hawaii has proven that it can accomplish great things in the pandemic, once politics are set aside.
Even if this variant turns out to be as bad as it appears, it won’t be a reset to square one; the medical community, now well into its second year of the pandemic, knows what works. The interventions we propose — post-arrival testing, providing rapid tests for every home, increasing vaccination numbers (including third shots), and deploying new antiviral medications — will help Hawaii with any circulating variant.
The task is getting everyone to work together — and quickly — toward a successful outcome.
Jonathan Dworkin, M.D., is a clinical infectious diseases specialist based on Hawaii island; Darragh O’Carroll, M.D., is a Honolulu emergency physician, writer and CNN medical analyst.