10.06.20 Open Letter - Sign TODAY - Medical Community Recommends Safe Reopening
Aloha colleagues:

The State of Hawai'i is pushing forward with a plan to eliminate the quarantine for all who take a single pretest and are denying the neighbor islands the right to require a second test for their incoming travelers.

This is a collaborative letter from Hawai'i healthcare providers and community members expressing concern that the proposed October 15th plan to open the state to trans-Pacific visitors is medically unsound.

We humbly ask all healthcare providers, healthcare workers, scientists, and the community to review and support the letter to Hawai’i leadership regarding COVID-19.

Click here to view signatures: https://docs.google.com/spreadsheets/d/1MlEE4oICVbI48QuVmynH_fYvf3t8nLRMyss0oDXYK6U/edit?usp=sharing

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Shareable link: https://forms.gle/N8xYCnQRpjKeqWW76

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OPEN LETTER

October 6, 2020

The Honorable Governor David Ige and The Honorable Lt. Governor Green,
The Honorable State Senators, and Representatives,
The Honorable Mayors: Caldwell, Kawakami, Kim, and Victorino,
The Honorable City and County Council members: Oahu, Maui, Kaua`i, Hawai`i Island

To Our State and County Leadership,

We are healthcare providers and members of the community who live and work in Hawai`i. We are very concerned that the proposed plan to open the state to trans-Pacific visitors on October 15 is medically unsound. We understand that many in the state and county leadership have similar concerns.

· Scientific evidence documents that a single negative pre-flight test allowing a person to avoid a quarantine when they arrive in our state does not meet the medical community standard for safety.(1,2) We also are aware that the equivalent of a single pretest before arrival has been associated with a surge of cases in many places including Tahiti and Alaska.(3,4,5,6)

· Scientific evidence documents that the mass screening of asymptomatic people for this coronavirus will miss 30-40 percent of those who are infected, but not yet exhibiting symptoms.(7) These tests do not pick up anybody in the first three days after they have become infected and they may still have a false negative incidence of 66% on day four. These pretests will also miss all of those who may get infected after the test and in their travels.

· We understand that an unknown is the prevalence of the disease in those arriving. The assumption in the modeling we have developed is that the prevalence could be 0.5-1% or higher particularly as Covid-19 is surging in so many states. We will not really know what the prevalence is until we do more sampling, but assuming it is lower could prove to be very dangerous.

· We agree that opening our state to visitors is necessary for the health and well-being of our economy, but only if it is done safely. We believe opening unsafely may lead to another shut down, possibly during the holiday seasons.

· Scientific evidence documents a safer way to open a state or country to visitors is: a 3-part plan consisting of a pre-flight coronavirus test, followed by a shorter quarantine, followed by a second coronavirus test. If the second test is on day seven, the risk is reduced seven-fold and the current quarantine time is cut in half.(8)

· Deviating from the standards endorsed by a medical community can be dangerous for any medical condition. It could be particularly dangerous for Covid-19.

We collectively are asking the leaders of Hawai`i to listen to your frontline medical care providers. Please do not open up on October 15th with a plan that may sicken many in our community and our visitors.

Mahalo for all you do and for listening to your medical community,

Healthcare providers and members of the community

References
[1] Single Preflight PCR test
https://www.nytimes.com/interactive/2020/09/14/opinion/politics/coronavirus-close-borders-travel-quarantine.html

[2] Asymptomatic and Pre-symptomatic spread
https://www.nytimes.com/2020/08/06/health/coronavirus-asymptomatic-transmission.html

[3] Tahiti’s Reopening Testing Requirements (as of July 15) - 1 preflight w/in 72 hours, and 2nd self administered on day 4. No quarantine.
https://www.travelpulse.com/news/destinations/tahiti-now-open-to-tourism-heres-what-to-expect.html

[4] Alaska Testing Options (as of June 6) - 1 preflight w/in 72 hours, or 1 upon arrival with 2nd between 7 and 14 days. Unenforced honor system quarantine.
https://www.adn.com/alaska-news/2020/06/03/read-the-full-text-of-alaskas-updated-health-mandate-on-interstate-and-international-travel/

[5] Tahiti’s Results after reopening
https://www.worldometers.info/coronavirus/country/french-polynesia/

[6] Alaska Results after reopening
https://www.worldometers.info/coronavirus/usa/alaska/

[7] PCR False Negative Detection: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240870/
https://drive.google.com/file/d/1nSA_rMoLoV8OacEYrNmNqXavMQ8z51ns/view?usp=sharing

[8] A Plan for Safely Reopening Hawaiʻi: Kauaʻi as a Model v1.3”https://drive.google.com/file/d/1phYNlE4vbBSro0_TxqEHcCim6NQbn9Yh/view
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