Quick Digest

• Cases in Hawaii rise ‚Äì community transmission confirmed
• Symptoms in many cases nationwide are mild
• Self-screen to allow those who need help the most to receive it
• COVID-19 testing requires doctor approval
• Number of testing facilities being ramped up
• Hawaii DOH asks for gatherings to be limited to less than 50 people.

Live Update April 10th: There are now 442 confirmed cases of COVID-19 within Hawaii, 334 of these cases are in Honolulu. 42 infected individuals have needed hospitalization to treat their symptoms in Hawaii. The Department of Health (DOH) is monitoring all of these individuals and supervising their isolation as well as the self-quarantine of their family members.

How to get tested for Coronavirus in Hawaii?

Gov. David Ige urged residents during news conference to prepare for more cases to be reported over the coming days, confirming that community spread is now a reality. In addition, the state Department of Health has asked that gatherings be limited and that Hawaiians practice social distancing, remaining about 6 feet away from other people.

Should I Go To The Emergency Room

The DOH has recommended individuals with mild to moderate flu-like symptoms to stay at home in self isolation until fully recovered. Isolation and quarantine help protect the public by preventing exposure to people who have or may have a contagious disease. This means no trips outside of your home (such as for work or groceries) unless necessary.

If you are sick, it is recommended that you wear a face covering to reduce the spread of disease. If you are healthy, you may also wear a cloth face covering when leaving home to buy essential items. Cloth masks may be made with a bandana or scarf and should cover the nose and mouth. Furthermore, they are only effective when used in conjunction with frequent hand-cleaning with alcohol-based hand rub or soap and water. Individuals are discouraged from wearing medical grade masks (such as N-95 masks), as they need to be reserved for health care providers.

Most individuals suffer mild symptoms, but you should call your doctor if you experience emergency warning signs associated with COVID-19. The signs are as follows:

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face*

*This list is not exhaustive. Consult your medical provider for any other symptoms that are severe or concerning.

Not everyone needs to be tested. Testing is available only under certain circumstances:

Before you contact any local health authorities, it is worthwhile to undertake a self-screening assessment by asking yourself these three questions as advised by Hawaii‚s Disease Outbreak Control Division of the DOH:

• Do you have fever or symptoms of lower respiratory infection, such as cough or shortness of breath?
• AND, have you traveled to geographic areas with sustained transmission of COVID-19 within 14 days of symptom onset?
• OR, have you had close contact with a person confirmed with COVID-19 infection?

If you meet the self-screening criteria, you should contact your local healthcare provider for further evaluation, or you can call Aloha Way at 2-1-1 to be directed as to your next course of action. If you are healthy or experiencing mild to moderate flu-like symptoms, DOH urges you to stay at home and avoid an unnecessary visit to a screening site. You should not get tested if you are asymptomatic, even if you have come into contact with someone who has COVID-19. The screening sites are only for those who are severely ill with COVID-19 symptoms.

It is now common for all of us to have increased anxiety caused by fear of the unknown, mixed with frustration and disappointment regarding cancellation of work, school, personal events, and social interaction. It is good to take a pulse on your emotional and physical health, Health Persona is providing a well-beings self-assessment tool for free.

Where to Get Tested For Coronavirus in O'ahu, Maui, and the Big Island?

If you answered yes to two or more of the self-screening questions above, you have a much higher chance of meeting the threshold for the state‚s patient under investigation (PUI) criteria.

If you do qualify, you may be able to get tested although testing kits are still limited across all islands at this moment in time.

• Tripler Army Medical Center: community testing for coronavirus/COVID 19 is a Tricare covered benefit for family members and retirees and does not require a referral from your primary care provider. Active duty ‚Äúare not‚Äù authorized to seek testing from a civilian facility. If you are asymptomatic (have not travelled outside of Oahu in the past 14 days, do not have a fever, cough or shortness of breath) you probably will not be tested. Must call: 800-874-2273.
• Windward Urgent Care: testing will be available at a drive through station open at Walgreens Kaneohe, call (808) 234-1094 head of time.
• Kaiser Permanent Hawaii: KP members get access to virtual care for triaging and make sure you‚re qualified for testing.  Oahu: 808-432-2000, Maui/Molokai/Lanai: 808-243-6000 Hawaii Island: 808-334-4400
• Queen‚s Medical Center (Punchbowl and West Oahu): Call the Queen‚s Medical physician hotline ‚Äî (808) 691-2619 ‚Äî for information on testing. If you‚re experiencing shortness of breath, call 911.
• The Queen‚s Medical Center-Punchbowl and West Oahu triage centers: Tents have been erected at the hospitals to conduct COVID-19 testing from 10 a.m. to 6 p.m. daily. Only those with symptoms who are at risk of have coronavirus should be tested.
• Queen‚s Island Urgent Care: Queen‚s Island Urgent Care is not accepting any walk-in COVID-19 testing. Call the info line ‚Äî (808) 691-2619 ‚Äî to schedule an appointment at the Kakaako, Kapahulu, Pearl Kai or Hawaii Kai locations.
• Molokai General Hospital: Queens hospital emergency department could test for COVID-19, but only for those with high risks. Call the Queen‚s Medical physician hotline ‚Äî (808) 691-2619 ‚Äî for information on testing.
• Queen‚s North Hawaii Community Hospital: Call the Queen‚s Medical physician hotline ‚Äî (808) 691-2619 ‚Äî for information on testing.
• Hawaii Pacific Health facilities: Kapiolani Medical Center, Pali Momi Medical Center, Straub Medical Center on Oahu, Wilcox Medical Center, and Kauai Medical Clinic on Kauai encourages people to call their doctor‚s office or clinic first for advice before coming in

It‚s important to stress once again that in order to get tested you must meet the criteria as set by State of Hawaii, Department of Health. You cannot walk into a hospital for a test just because you are concerned about the disease.

What to Expect When Getting Tested?

If determined eligible for testing, then you will undergo a series of procedures which will produce samples to be sent to an external lab (or internal at a hospital) for sequencing.

Nasal Swab. You will be seated and asked to tilt your head back at a 70-degree angle, the clinician will then insert the nasal swab, pushing right to the back of the nasal cavity until the posterior nasopharynx is reached. This may be a little uncomfortable as the clinicians rotates the swab to get enough material for a sample.

Throat Swab. For this test, you will be asked open your mouth before the clinician will insert the swab as gently as possible into the back of the throat toward the tonsils. They will then rub that swab over both tonsillar pillars, before removing and securing the sample.

Lower Respiratory Specimen. For the final sample you will need to rinse your mouth with water. After you‚ve done so, you will be asked to cough up a specimen of deep cough sputum directly into a sterile sputum collection cup. This will subsequently be sealed by the clinician and sent off with your other samples to the nearest laboratory

Although labs can detect a COVID-19 diagnosis within 5 hours, with pressures on the system rising, it could take up to four days to receive the results of your test. The procedures are as follows.

How Much Will Coronavirus Testing Cost?

The federal government has pledged that the costs for coronavirus tests will be waived for all Americans. You will need to work with your health care provider for more information on your specific treatment costs within Hawaii. If you do not have health insurance, you are urged to call a community health center to talk about your options.

Although there haven‚t been any personal accounts detailing the insurance experience of Hawaii residents, residents of other jurisdictions have ended up paying as much as $700 in way of a copay for COVID-19 testing.

Despite the federal promise of waiving fees, some individuals are still reporting high copay charges, while other insurance companies are waiving testing fees, but only if you test positive. So it‚s vital that you speak with your health care provider before proceeding to get tested.  

What Are Some of the Caveats?

While the US federal government has agreed with insurers to cover the “out of pocket” costs of COVI-19 testing, the insurers have pushed back to say this does not extend to treatment should a patient return a positive test. Thus, you will need to work directly with your healthcare provider to see how much you will be paying if you do return a positive result.

Healthcare Can Be Confusing, Here Are More Resources:

• How much does urgent care cost without insurance?
• Can my dogs get coronavirus?
• How to wash your hands properly?
• Everything you need to know about the Coronavirus

Reference

• Center of Diseases Control - Case report: https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html#investigation
• New York Times - How to self-quarantine: https://www.nytimes.com/2020/03/06/health/self-quarantine-coronavirus.html
• World Health Organization - When and how to use masks: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks
• U.S. Food and Drug Administration - N95 respirators advisory: https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgical-masks-face-masks#s1
• State of Hawaii, Department of Health ‚Äì COVID-19 Daily Update March 16th - https://health.hawaii.gov/
• Hawaii News Now - Lt. Gov. urges Hawaii to prepare for more cases following confirmation of community spread
• The New York Times ‚Äì How To Quarantine Yourself
• World Health Organization - When and how to use masks
• State of Hawaii, Department of Health - Disease Outbreak Control Division
• KHON2 - More neighbor island COVID-19 screening and test-specimen collection sites on the way
• Hawaii News Now ‚Äì Think You Need a Coronavirus Test? Here‚s What You Need To Do
• WBUR - The U.S. Should Make COVID-19 Testing, Prevention And Care Free To All
• Winward Urgent Care - http://windwardurgentcare.com
• Tripler Army Center - https://www.tamc.amedd.army.mil/
• Kaiser Permanente Hawaii - https://healthy.kaiserpermanente.org/
• Queens Hospital: https://www.queens.org/covid19/home