illustration of people being contact traced

This editorial by University of Hawaiʻi at Mānoa’s Marguerite A. Butler, Victoria Y. Fan and Thomas Lee ran in The Star Advertiser on January 3, 2021.

Recent news from the United Kingdom and South Africa reveal new mutated strains of SARS-CoV-2 with substantially higher transmissibility. These strains bring the prospect of a 2021 pandemic worse than what we have already experienced, one that spreads more quickly. Has this mutated COVID-19 already been imported into Hawaiʻi?

The short answer is that we do not know, as of this writing. But we can find out through a now widely-available technology called genomic sequencing, which determines the complete DNA or RNA sequence of an organism’s genome at once. Whereas this technology was hard to come by before the last decade, it is now widely available at the University of Hawaiʻi, and acquired this year at the Hawaiʻi’s Department of Health.

The immediate public health benefits of genomic sequencing of COVID-19 samples are enormous. We could discover new “variants” and monitor the state’s risk for higher transmissibility. It would give us a genetic “paper trail” to learn from where and how the disease is spreading. We could definitively know whether cases are locally transmitted or imported, part of a superspreader event, or further extend the contact-tracing trail when memories fail.

In short, we can prepare against more infectious strains and strengthen the public health arsenal against COVID-19, including informing contact tracing, isolation and vaccination strategies, as well as monitoring for reinfection or changes to vaccine efficacy.

Time is of the essence in fighting a pandemic. The world only learned of the new strain through the UK’s proactive genomic surveillance consortium. With information sharing, it was rapidly detected around the world. The first confirmed U.S. case was discovered in Colorado on Dec. 29: an individual in his 20s with no travel history, indicating community transmission. Information is more powerful when it comes early, well before wide community spread.

What additional capacity is required for genomic sequencing? It turns out not much. With an existing high-quality sample—saliva or nasal swabs—collected for a PCR test, it is a small additional effort to prepare that sample for the genomic sequencing machine. Following a simple molecular recipe, the additional cost is human effort and the cost of reagents, estimated at $50 to $100 per sequence.

While labor may be in short supply in the state Department of Health, the University of Hawaiʻi has graduate assistants, volunteers and interns who can help with genomic sequencing—for public health purposes. The university could also assist with data cleaning and many types of analysis, all completely deidentified without any linkage to personal identifiers.

All of the resources are available in the state, but what is vitally needed is coordination, partnership and optimization for surveillance. Many samples are collected by private labs, academic labs have personnel and capacity but no access to samples; the state has some of each. Collaborative partnerships coordinated by the state are absolutely necessary for success in the face of a complex pandemic.

Laudably, the Hawaiʻi Department of Health began genomic sequencing efforts in the last few months and recently posted genomes to public databases. Additional support would be a wise investment. When will the results be shared with the public? With a new and yet undetected strain, how many samples and from which localities are needed to detect a case (the “sampling strategy”)?

Mutations of COVID-19 sound scary like something from an X-Men movie, but do not have to be. Information about the virus is now more accessible than ever and can help us to make better decisions and policies. Hawaiʻi’s position in the Pacific between multiple continents exposes us to multiple strains.

With the World Health Organization now indicating that COVID-19’s destiny is to become endemic and may worsen, genomic surveillance empowers Hawaiʻi with critical information about virus mutations. Hawaiʻi has an opportunity to become a U.S. leader in genomic surveillance as an essential public health strategy.