Great job so far, Kaua‘i; more vigilance required

Kaua‘i has done a great job limiting the spread, but COVID-19 is far from eliminated.

The mainland is the current epicenter of the pandemic and poses as much of a threat to us as China originally did to the rest of the world.

Certain Asian nations have contained the virus and are slowly re-opening. If we are willing to learn from these nations, act aggressively, use newer technologies, and work together, Kaua‘i could also become the example that other places try to learn from.

The general principles that have worked elsewhere are widespread testing, contact tracing, isolation of positive cases, and control of borders. I believe we should consider the following actions:

• Move forward with Governor Ige’s new plan of “safer at home” rather than “stay at home” and reopen businesses that allow for social distancing. We should still require masks in these freshly opened businesses;

• We will need to continue constant tracking of cases in Hawai‘i and understand that we may need to backtrack if there is a new surge of cases;

• We have to keep in mind that this is not a return to normal. Hugging and handshakes are not back. Social distancing, proper hand-washing and sanitizing remain vital;.

• By far our biggest risk is still from people arriving from other places, tourists and returning residents alike. This risk will remain until we have better treatments and/or a vaccine. But, with vigilance and technology, we could make Kaua‘i a safer place to live as well as to visit. We could possibly start welcoming small numbers of tourists if we can ensure that they will not bring in the virus. Until we learn more about immunity and until very-rapid and easy testing for the virus is available, we will need to continue a 14-day quarantine;

• If tourists in any number are going to start arriving, we will need a better way to enforce the quarantine. We could consider adopting high-tech measures such as one used in Hong Kong. Their system requires all incoming people to wear a wristband for 14 days which pairs with an app on their cell phone. This system alerts authorities if the quarantine is violated. As we learn more about COVID-19, we may be able to allow those with proof of recovery and negative cultures to avoid or shorten the quarantine;

• Another option would be a choice. A returning resident or tourist could go to one specially planned quarantine hotel without a bracelet or go to their home or the hotel of their choice with a bracelet;

• A new saliva (spit) test and another done by swabbing only the front of the nose have been approved and allow rapid results. Tests like these may help us screen those wishing to enter the state and will greatly help us to continue screening ourselves.

Extensive testing, isolating those who have the virus, and tracing all their contacts is a vital part of containing epidemics. This has traditionally been done by hiring many public-health workers. The voluntary use of specially designed phone apps could revolutionize contact tracing. Apple and Google are working together to create such a “contact tracing tool.” To ensure privacy, the app does not show where the contact happened or who the contact is. It only shows that the two phones were near each other for some period of time. For these apps to be effective, reportedly 60% or more of the population of an area needs to use them.

I am sure in America, apps like this will be voluntary and controversial.

Speaking personally, if I had an app that told me that a member of my family had contact with an infected person and we could then act quickly to minimize that risk to ourselves and to the island, I would use the app without hesitation.

Opening our county to all of us who live here and limiting tourism to only those that are proven to be healthy will provide us with a unique opportunity to work on Kaua‘i. We need to fix our overdependence on tourism, lack of affordable housing, and expensive imported food. This could be an important turning point to help our island become more self-sustainable.

Obesity, hypertension, and diabetes all make death or severe illness from COVID-19 much more likely. These conditions are strongly linked to processed foods (foods made in factories) full of sugar, fats, additives and pesticides. This is the time to dramatically enhance Kaua‘i’s organic-food-growing capacity.

I think we all feel a little safer on Kaua‘i right now, but one infected person can still spread this widely. We need to be open to new ideas to contain a threat which is unlike anything we have faced in our lifetimes.

If we open up too casually or too quickly, we will be back in danger.

If we open carefully, slowly and thoughtfully, we could end up with an island that is better than it was before the epidemic.

This column represents a sharing of information. No content on this column should ever be used as a substitute for direct medical advice from your doctor or other qualified clinicians.


Lee A. Evslin, M.D., is a board-certified pediatrician and fellow of the American Academy of Pediatrics. He is a former health-care administrator on Kaua‘i and periodically writes a column for The Garden Island.

  1. Lisa May 11, 2020 6:46 am Reply

    There need to be some relaxations soon for residents. I am on the mainland and cannot even return home since the 14 day quarantine is not feasible for my business (deemed essential) and my children. So here I stay. Safer at home, absolutely. Mandatory 14 day lock in in my own home with ankle bracelet is simply not feasible if the county is going to try not to collapse.

    1. Curious May 11, 2020 11:30 am Reply

      If you can stay on the mainland this whole time, how is that easier on the business than staying in your island home for 2 weeks?

  2. Dude May 11, 2020 6:51 am Reply

    If you feel safer a home then, by all means, stay at home! If you feel safer by getting outside and getting fresh air, sunlight and heat, then by all means, go outside!

  3. mina May 11, 2020 8:10 am Reply

    How about this…ban tourism forever. Get the people who make their living by fleecing visitors out of their money off this island for good.

    1. Da Shadow May 11, 2020 10:27 am Reply

      great idea. my aunties and uncles will be thrilled about having no jobs, and no income once unemployment runs out.
      silly tourists, supporting the islands. phew.

  4. kauaidoug May 11, 2020 10:53 am Reply

    MAhalo , Dr. Evslin for those measured and insightful words. My business is fleecing visitors when they choose to come visit Kauai and I interact one on one in a vehicle so my contact allows for the easy transmission of this virus. The only way I see me being able to do business is if I am assured the visitor cannot transmit the virus to me or vice versa. Seems like there will need to be a way to give people a clean bill of health, vaccine or therapeutic treatment. Until then we must social distance, wash our hands and pay attention.

  5. Rev Dr Malama May 11, 2020 12:41 pm Reply

    I have to wonder if the good doctor realizes how arrogant he comes across with suggestions for magical things like organic food and self sufficiency that only those who live in his elitist class can afford and subscribe to, including apps to trace all persons who move about for travel no matter how much our civil liberties are violated?!
    Funny I don’t see Evslin or his family on the bus, or at the free meals and food box distribution of all the processed foods that are increasingly popular for mere survival in the short term but hard working poor that I socialize with and serve daily.
    Perhaps the feet on the ground efforts would be more in line with the ER Doctor’s advice than a feel good weekly article about the benefits of eating dandelions and spurilina….?

  6. GardenGirl May 11, 2020 1:01 pm Reply

    As usual, Dr. Evslin, you are a welcome voice of calm, intelligence, and reason. Mahalo nui loa! If reopening our businesses too soon leads to more people dying, that will not improve our economy or make us feel more free–and we will definitely not feel those deaths are worthwhile if they happen to those we love. As for getting outside into the sunshine, I’m all for that, just please don’t abuse the situation. We’re all so grateful to be able to walk and hike the beaches and state parks again, but I also see people hanging out in groups again, eating and drinking, and that puts the rest of us at risk of losing our ability to be out exercising in our beloved Kauai nature. Please be respectful. Even if you think the restrictions are ridiculous, most of us do not. They have the backing of the majority, so please be respectful of that. I would just like to end by saying how grateful I am to all of my neighbors and friends and even complete strangers who have been so supportive in this time of struggle for so many. We WILL get through this together.

    1. holl May 11, 2020 9:42 pm Reply

      GardenGirl…you definitely can not be assured and know for a fact that “Even if you think the restrictions are ridiculous, most of us do not.” You can’t speak for anyone but yourself!! Did you take a poll? I was not asked! Nor my friends or family. It is people like you who are shaming others into keeping quiet due to fear of being tattled on to the “tattle line” that Kawakami has set up. Pure insanity. I know MANY people who think the restrictions are RIDICULOUS in this county where NOT ONE PERSON HAS BEEN DIAGNOSED WITH COVID-19 in over 5 WEEKS!!! Keep living in fear if that suits you. You stay home and wear your mask and let others live their lives, which may include going to the beach with others (oh no!! get on that tattle line quickly!!) or making a living that is desperately needed. Oh and that saying “we will get through is together” is ridiculous and so untrue…unless you are gong to open your home and back account to others, and until the mayor and county council members do the same, WE ARE NOT IN THIS TOGETHER!!

  7. Everythingisawesome May 11, 2020 4:27 pm Reply

    Dr. Evslin,
    In your medical opinion, are tourists MORE contagious than residents? A tourist has to quaratine for 14days upon arrival because we assume they are sick. We also wear masks and keep 6 feet apart because Mayor Kawakami has told us that we must assume that WE are all sick. If social distancing and masks actually protect us from an infected person, why aren’t those mitigation measures adequate to protect us from a tourist? Not a trick question. Just want to know your medical opionion. Maybe masks and distancing, maybe just distancing, are enough to “slow the spread”.

  8. Sammy Dog May 11, 2020 5:18 pm Reply

    Dr. Evslin,

    ‘’Obesity, hypertension, and diabetes are strongly linked … to pesticides.” If you wish to be taken seriously, then check your facts.


  9. WestsideResident May 12, 2020 7:38 am Reply

    Yeah, great job Kauai, you’ve destroyed your economy, get ready for the uncomfortable phase.

  10. Westside Boy May 12, 2020 9:05 am Reply

    Tourism is all we have. The days of planting sugar cane and pineapple are gone forever. Wake up! We need to open up tourism soon. We can do it in a smart and safe manner. Trust in the people!

    1. Sammy Dog May 12, 2020 6:17 pm Reply

      Westside Boy: Yes, Sugar cane and pineapple economy gone. We can do this smarter and safer. More smarter.

  11. Jim Mayfield May 12, 2020 9:06 am Reply

    Opening our island to returning residents and tourists and allowing Kauai residents to travel off-island and then return to Kauai without going through quarantine is something that needs substantial discussion, now. Dr. Evslin’s Letter-To-The-Editor above is a good example of such discussion as are the replies. My thoughts:
    First, Kauai needs to open to tourism. Individuals and families have already or will soon run out of cash. Without cash, what happens? At some point the free meals and food boxes will start coming to an end. While at this time government has stepped in to prevent evictions, in time our politicians will come under much more pressure to modify these rules. Jobs sustained by business owners but with little revenue; July/August? Unemployment; Federal money, August? SOH, December? My belief is that is that every month that goes by between July and December, Kauai’s social fabric will start to fall apart.
    Once we begin to allow residents to return and travel without facing quarantine, we will have new cases of Covid. At what point does the Governor/Mayor need to take action? Does it need to be with the first case? I do not know but when the Mayor/Governor does, I question the requirement that we lock down for 28 days. What does the actual data show is appropriate? Does the data show 28 days? Or does the data show 14 days? 10 days? 7 days?
    Will almost all businesses need to shut down again? What does the data show? Should a golf course be treated the same as a popular bar?
    Should all residents have to suffer the same shut-in fate? Should a healthy 25 year old face the same fate as a 70 year-old Kupuna with pulmonary issues?
    In summary, our Hawaii/Kauai leaders will have to take additional risks. We he have to reopen to tourists. But let’s use logic, experience and data to minimize the risk and guide us to the appropriate level of risk.

  12. Jack Frisbee May 12, 2020 12:07 pm Reply

    So liberal Hawaii who supports Democrats and their agenda of open National borders, now want their state and county borders closed to fellow US citizens because of their fears of what these outsiders might bring. Seems kind of racist to me. Or xenophobic maybe? That is my biggest criticism of liberals. They are quick to mandate what others should and shouldn’t do, and defy common sense in order to portray themselves as being on higher moral ground, but when it comes to their own personal well being, will create their own set of rules to suit their own selfish needs. Hilarious. Predictable.

  13. hutch May 12, 2020 7:24 pm Reply

    Total elitism, start to finish. Open the #%$#@ island.

  14. Miguel May 12, 2020 7:53 pm Reply

    No community can long hide from the virus and survive. The lock down measures have a profound social/emotional effect on a person’s sense of worth and well to go long with the economic effects. To remain with these measures in place will have a much more dire toll than the virus itself. There is risk and there will be new cases eventually that we must prepare to deal with. In short, the virus is something we need to prepare to live with and deal with as it comes because there is no such thing as absolute safety from it.

  15. Scott May 17, 2020 9:39 am Reply

    Thank you Dr. Evslin for the promotion of organics and avoiding processed foods for health sake. Any thoughts about hydroxychloroquine (HCQ) as pertains to CV19? According to one family story, I learned I have a distant relative somewhere in Hawaii that was succesfully treated for CV19 using a “malaria drug”, antibiotics, and perhaps another drug that may have dealt with inflamation. No ventilation required. I was not able to ascertain the exact meds prescribed but the story piqued my curiosity so I looked into what it could have been. I found HCQ is a “malaria” drug. HCQ seems quite controversial, being valued at a local level by front line doctors both in the USA and abroad, but often scorned by media experts and at the national and policy levels here in the USA. Thanks again.

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