Honolulu’s COVID-19 Recovery Framework

The City and County of Honolulu (“City”) has a new plan for reducing the spread of COVID- 19 in City, with criteria set for loosening and tightening restrictions on businesses and activities to keep the residents of Honolulu healthy (“Honolulu’s COVID-19 Recovery Framework”).

This document outlines Honolulu’s COVID-19 Recovery Framework.

Goals

The City’s new framework is based on increased knowledge of disease transmission, vulnerability, risk factors, community compliance, and is driven by the following goals:

  • To simplify the framework and communicate clear reduced disease transmission benchmarks for the City and its residents to work towards;
  • To reduce positive case transmission in the City to mitigate the current burden on our local healthcare delivery system (and the future anticipated burden of influenza and COVID-19 infections in the late fall and winter); and
  • To reduce the likelihood of having to impose drastic restrictions (e.g., stay at home / work from home orders) on City residents’ activities outside of their homes/dwellings.

The framework

The foundation of the framework rests on four tiers. Each tier is based on the level of community spread of COVID-19 within the City, which is determined by two criteria: (1) the number of daily cases reported; and (2) the positivity rate, using 7-day averages for both metrics over two or four week periods, as explained below.

The four tiers are:

Tier 1 — representing a high level of community spread that is testing the limits of the public health system to test, contact trace, and isolate/quarantine; and puts some strain on the healthcare system.

Tier 2 — representing a level of community spread that is substantial, but still allows the public health system to adequately test, contact trace, and isolate/quarantine; and does not overburden the healthcare system.

Tier 3 – representing a moderate level of community spread that allows the public health system to fully test, contact trace, and isolate/quarantine; and does not overburden the healthcare system.

Tier 4—representing a low level of community spread that is easily handled by the public health system and healthcare system.

The matrix of allowed and closed businesses and operations at each tier is attached.

The two determinative metrics for the four tiers are set forth below:

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  • Datafrom U S. Surgeon General’s surge testing and other broad surveillance testing shall be included.
  • In the case ofsubstantial traceable and documented spread within certain business sectors, such sectors may be closed notwithstanding thisframework.
  • In the case ofuncontrollable and rapid spread ofCO VID-19 that overwhelms hospitals and/or the public health system (as guided by other mefries in the HIPAM dashboard, including hospital capacity), it may become necessary to implement resfrictions not contemplated by thisframework, including broad stay at home mandates.

Weekly Assessment: Data for the two metrics will be disclosed publicly by the Hawai’i State Department of Health (“DOH”) daily, and evaluated on a weekly basis for purposes of tier advancement or retreat as outlined below, beginning on September 24, 2020 with the first assessment occurring on October 1, 2020 (each a “Weekly Assessment”).

Advancement: In order to advance to the next tier, the City must:

(1) have been in the current tier for at least four consecutive weeks; AND

(2) meet the First Metric criteria for that next tier for two consecutive (and most recent) Weekly Assessments; AND

(3) meet the Second Metric criteria for that next tier for two consecutive (and most recent) Weekly Assessments.

The City may only move forward one (1) tier at a time.

Retreat: If, for two consecutive Weekly Assessments, the data for the First Metric indicates the City should be in a lower tier, the City falls back into that tier. The City may move backward more than one (1) tier at a time.

Action to effect tier advancement/retreat: The City will issue a new order within three days of the date that an advancement or a retreat is indicated by the metrics, which either relaxes restrictions and/or reopens additional businesses/operations — in the case of advancement; or adds restrictions and/or closes certain businesses/operations — in the case of retreat.

Openings of parks/beaches/trails with restrictions: On September 10, 2020, parks, beaches, and trails (and their respective parking lots) were opened for any lawful individual activity (e.g., exercise, reading, sunbathing, etc.). This was done to provide individuals a low risk outlet to engage in outdoor activities during the extended Second Stay at Home / Work from Home Order, while ensuring that uncontrolled gatherings would not take place by providing straightforward criteria for law enforcement to follow. On September 24, 2020, parks, beaches, trails will be expanded for use by up to five persons for any lawful activity (e.g., exercise, reading, sunbathing, picnics, etc.). However, a permit will be required from the City Department of Parks and Recreation to use any canopy-type structure in City parks. Rules regarding use of canopytype structures in State parks and on State beaches will be determined by the State in coordination with the City and this framework.

Framework applied to current situation

The City implemented a second stay at home / work from home order on August 27, 2020 in the hopes of knocking down the high daily case count swiftly, which has been effective. Starting on September 24, 2020 (the end date of the Amended Second Stay at Home / Work from Home Order), the City will operate under this new framework. The City will start in Tier 1 and remain there for at least four consecutive weeks 4until the City logs at least two consecutive weeks of data satisfying the criteria for advancing to Tier 2. Once this criteria is met, the City will issue a new order within three days that allows Tier 2 activities, businesses, and operations.

Risk criteria

Activities and designated businesses and operations will be opened (with mitigation measures) under Honolulu’s COVID-19 Recovery Framework using the risk-based criteria, as outlined below. Those with lower risk of spreading COVID-19 will be allowed sooner, and those presenting higher risk of spread COVID- 19 will be allowed later.

Criteria used to determine low/medium/high risk activities, businesses, and operations:

  • Ability to accommodate wearing face coverings at all times
  • Ability to physically distance between individuals from different households
  • Ability to limit the number of people per square foot
  • Ability to limit duration of exposure
  • Ability to limit amount of mixing of people from differing households and communities
  • Ability to limit amount of physical interactions of visitors/patrons
  • Ability to optimize ventilation (e.g. indoor vs outdoor, air exchange and filtration)
  • Ability to limit activities that are known to cause increased spread (e.g. singing, shouting, heavy breathing; loud environs that cause people to raise voice)
  • Ability to enforce restrictions and required mitigations measures

Schools

Public educational institutions — including public and private K-12 schools, colleges, and universities — will be allowed to operate as determined by the State of Hawai’i’s State Department of Education and the University of Hawai’i System. Private educational institutions will be allowed to operate in a parallel and consistent manner as the public educational institutions.

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City efforts to succeed under the new framework

From the start of this COVID-19 pandemic in early 2020, much has been learned from a scientific standpoint, which has informed and will continue to inform the City’s response efforts. Moreover, experience has uncovered critical areas for improvement, including testing capacity, contact tracing procedures/capabilities, outreach and support for disproportionately affected communities, and the capacity and ability to quickly isolate/quarantine and support those who cannot reasonably isolate/quarantine at their residence. Prior to and during the period of the Second Stay at Home / Work from Home Order, the City has worked aggressively on its own and jointly with the DOH to significantly improve these areas in a streamlined fashion. For example, the City has:

  • Added 130 hotel rooms for temporary quarantine and isolation through December 30, 2020 at a cost of $1,684,000 (using CARES funds).
  • Negotiating the leasing two additional properties/hotels to further increase availability of rooms for temporary quarantine and isolation (as needed).
  • Dedicated a City-owned property consisting of office space and 26 residential rooms for use as a temporary quarantine and isolation center (using CARES funds to operate).
  • Partnering with all seven (7) of O’ahu’s Community Health Centers to provide testing/contact tracing/isolation/quarantine/wrap around services to disproportionately affected and high risk communities.
  • Hired a Pacific Islander Liaison to improve services, outreach and ongoing communication with some of the people hardest hit by the COVID-19 virus.
  • Contract in place with a survey company for an additional 80 contract tracers, with negotiations underway for similar contracts to hire up to 250 total contact tracers (as needed), in coordination with DOH.
  • Hired Dr. Mitchell Rosenfeld (board certified emergency physician, with a public health background) to oversee the City’s COVID-19 response and contact tracing efforts.
  • Directed $2,000,000 in CARES funds for COVID-19 public safety multimedia campaign.
  • Conducted broad surge testing with the federal government (over 60,000 tests), which revealed a relatively low prevalence of disease among those tested (less than 1% positivity rate), which has helped inform Honolulu’s COVID-19 Recovery Framework.
  • Increased enforcement by Honolulu Police Department to reduce prohibited social gatherings and other high risk behaviors.

The City believes these improvements, along with public support, will make a difference and allow for a more sustainable, more predictable, more transparent, and better response to the COVID- 19 pandemic.

Public support is critical

The City has worked with public and private experts to develop this framework that is aimed at protecting the public health first, while allowing the economy to begin a long road to recovery. The City in coordination with the State will do its part to improve government’s role in prevention, detection, containment, and healthcare in relation to COVID- 19. However, the framework can only succeed with the public’s support. There is no doubt that COVID-19 has forced us to do things against our social norms and social nature, and that is hard. But, these sacrifices are based on science and necessary to protect our most vulnerable, while also starting to rebuild our economy. For this framework to succeed, we must support each other, hold each other accountable, and strictly follow the restrictions and mitigation measures imposed at each tier.

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* Each ‘Allowed’ business/operation shall be subject to sector standards to be approved by the City & County of Honolulu (‘City”).

** City may issue orders targeting sectors/businesses where clusters are identified.

‘“City may implement necessary restrictions not contemplated by this plan in the event of uncontrollable and rapid spread of COVID-19.

****Baseline mitigation measures/sector standards apply to all sectors across tiers

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