The availability of COVID-19 quarantine and isolation facilities has been drastically reduced since the state handed over the responsibility for providing them to the counties of Hawaii.

It had already been declining prior to the omicron surge, but even more so now, according to advocates for keeping them. For some, like Hawaii County, publicly provided quarantine-isolation facilities are no longer available.

Dr. Ka‘ohimanu Dang-Akiona says she has been left struggling to find options for the placement of COVID-19-positive patients on Hawaii island.

Akiona, volunteer medical director for Hope Services Hawaii, a nonprofit serving the homeless, has had a dozen patient referrals, some of whom are discharged from the hospital with nowhere to go for isolation. She and others are scrambling — with sometimes creative solutions — to find them places to isolate.

“There’s no support,” she said. “There should be more support from the city and state. Part of this burden should be handled by the state.”

In mid-December the state Department of Health announced it was ceasing statewide operation of isolation-quarantine facilities Dec. 31. This was due to Gov. David Ige’s proclamation turning over direct responsibility for emergency management of the pandemic to each respective county.

“It is likely anyone who tests positive will have infected household members by the time they get test results,” said DOH in a news release, warning the delta and omicron variants are highly transmissible. “Therefore, they are advised to self-isolate at home.”

DOH instructed anyone who tested positive for COVID-19 and their close contacts to follow its “Home Isolation and Quarantine Guidance,” which has since been revised to five instead of 10 days.

Akiona, also a doctor with Premier Medical Group, said her philosophy is that if you take care of the most vulnerable and marginalized, you improve the health of the whole community.

Recently, Akiona said she tested a Hawaiian single mother of five young children in Hilo for COVID-19. She was positive but the kids were not.

The mother had family who could care for her kids while she isolated, but nowhere to go. Eventually, most of her kids tested positive, too.

Options had been limited even before the delta surge last summer, said Akiona, but since this transition from state to counties, Akiona said “it’s just been radio silence” on quarantine facilities for patients.

Hawaii County spokesman Cyrus Johnasen said the Big Island’s DOH-funded isolation-quarantine faci­lities — which served residents, travelers and vulnerable populations — ceased operations Dec. 23.

In the meantime the state has organized a working group to plan for future isolation-quarantine facilities, he said in an email, “but nothing is in stone just yet.”

“They recognize each County is affected, and the entire population, from residents to travelers, would benefit from a facility,” he said. “In addition, homeless facilities use offsite facilities away from their congregate facilities to house infected persons.”

But advocates say the need is growing as cases surge statewide, driven by the highly contagious omicron variant, increasingly so on neighbor isles. For many Hawaii residents, including not only the homeless, but those sharing crowded apartments or with multiple generations under one roof, isolation at home is not a realistic possibility.

And without options, COVID-19-positive individuals are more likely to end up infecting their families or going out in the community, circulating and further spreading the coronavirus.

On Oahu large tents recently went up at Sand Island to house homeless individuals in need of isolation and quarantine since shelters are full, according to the Institute for Human Services.

The number of quarantine-isolation beds on Oahu dropped to 56 today from about 400 in 2020, mostly at Waikiki hotels.

The City and County of Honolulu took over operations of the Harbor Arms Hotel in Aiea on Jan. 1 as an isolation-quarantine facility, according to spokesman Tim Sakahara. It offers 30 units with 56 beds, he said, and has been 90% to 100% full.

“The criteria for admission did not change and people can call 211, which is providing screening,” said Sakahara in an email. “However we are prioritizing patients discharged from hospitals so we can help free up hospital rooms.”

Based on current projections, Sakahara said there is an anticipated decline in the need for isolation-quarantine resources in the near future.

Some health experts, however, think there is a need as long as there is still an ongoing pandemic.

Victoria Fan, associate professor of health policy at the University of Hawaii at Manoa, said isolation- quarantine is one of the key pillars for controlling COVID-19, along with testing and contact tracing.

She estimates approximately 10% of Hawaii’s population shares a bedroom and is therefore unable to safely isolate from other household members with a COVID-19 infection.

In 2020, DOH ran an effective quarantine program through its behavioral branch, according to Fan, who oversees Hawaii CARES, a state-funded, UH-managed 24/7 call center for substance use and mental health intervention. That year, Hawaii CARES also became a coordination hub for isolation-quarantine facilities.

From Aug. 12 to Dec. 10, Hawaii CARES fielded more than 4,100 individual requests for isolation- quarantine as well as testing, transportation, food assistance and other services, with 79% receiving at least one.

More than 350 families were placed in external isolation-quarantine facilities with an on-site case manager.

The public behavioral health system can play a central role in a state’s COVID-19 response, said Fan, who shared details of the program in the Journal of Travel Medicine.

“Having a place to isolate and quarantine externally is so crucial for many people who lack sufficient space, and who may be in relatively crowded housing conditions,” she said.

Prior to the summer delta surge, however, the number of state isolation-quarantine rooms had already dropped significantly — by more than half — when the state did not renew contracts at Waikiki hotels. Hawaii Cares’ contract to coordinate isolation-quarantine also ended last fall.

Hawaii families are likely still experiencing a high level of stress, she said, particularly now, with omicron more contagious than previous variants.

Kauai County said it continues offering isolation facilities to residents who need them on a limited basis. Maui County did not respond to questions about quarantine facilities by press time.

Tim Brown, an infectious disease modeler at East-West Center, said it is still in the best interest of public health to provide quarantine for those infected, particular for vulnerable Filipino and Pacific Islander families living in more crowded settings.

“They are front-line workers, and so they are the people that multiple people run into on a daily basis,” he said. “It is in the best interest of public health to provide them safe quarantine opportunities.”

In addition, Brown said those infected with omicron could suffer from long-term effects, as was seen with previous variants. Rather than giving up, the state should continue to prevent any infection that can be avoided, with isolation- quarantine for those who need it, he said.

“It’s one of many failures of the current response here,” he said.