Once again, the state is talking about possibly reopening to tourists, and suggesting dates for such an opening. State officials are also saying that the fourteen day quarantine might be eliminated if the visitor can show evidence of a negative PCR test taken within 72 hours of arrival. The reason for this attempt to drop the quarantine is obviously that businesses are in deep trouble and the hope is that the return of tourism will make everything better.
But here’s the problem: as Paul Brewbaker, the state’s leading economist, has shown when cases go up, the economy goes down. And of course, more people will get sick and more may die. Therefore, an island should not open up until their epidemic is under control. In addition, a recent study by researchers from the University of Washington (two live on Kaua‘i) demonstrates that by only requiring a single test prior to arrival, 30 – 40% of cases will be missed. The reason so many will be missed is that the test only becomes positive four days or more after one contracts the virus. So, if your test was done in the one to four days after your contact with someone who is ill, the test may not yet show the virus and of course, if you should catch the virus during your travels to Hawai’i, that certainly will not be picked up by a test done before you leave your home state. If only 1% of the people coming to our state have COVID, that would still mean there would still be 30-40 people per every 10,000 guests who have the virus (and who were missed on their single pretest) and who would then be visiting our shops, restaurants etc.
When we open, it has to be done safely with thoughtful guidelines. I believe the guidelines need to include the following:
• Counties should open further (including opening schools) one by one as they meet strict guidelines based on data rather than on a strict date.
• Criteria for opening could include requiring that there be less than 0.5 cases per ten thousand residents, evidence of very minimal to no community spread, and a testing positivity rate of less than 1%. Kaua’i actually does meet all those criteria at this time.
• The final step should be agreement for loosening restrictions by the mayor and head of the Department of Health for each county as they are uniquely positioned to understand the full situation in their own county.
As tourists are increasingly welcomed, they should have a choice consisting of :
• The safest method, which is still a 14 day quarantine,
• A shortened quarantine if they agree to one COVID pretest 72 hours before arriving in the state and second test done on day 7 of the quarantine. If both tests are negative, they could be released early from quarantine.
Phone tracing apps should also be required for all visitors to the state and they should remain on the visitors’ phones for at least 14 days after arrival.
Newer, less expensive, and easier to perform tests may be available in the next few months. These will probably include paper based saliva tests (spit tests). This could dramatically change everything as it would make it so much easier to know who is infectious. Hard to predict exactly how we would use them but they will be a welcome addition.
Life is not going to return to normal until this virus is much less prevalent and unfortunately, we do not know when that will be.
Perhaps what we used to think was normal will never return. For now, we need to think outside the box. My hope is that when the pandemic finally releases all of us from its grip, we will have learned from it and made our state and world better places.
Be safe, wear your mask.
Lee A Evslin, M.D. is a Board Certified Pediatrician and Fellow of The American Academy of Pediatrics. He was a former healthcare administrator on Kauai and periodically writes a column for the Garden Island.