Opening the island safely

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.

  1. nobody September 15, 2020 6:24 am Reply

    Not sure how long the federal government will keep supporting the residents of Kauai after the election. Things just aren’t that bad, yet, so it’s easy to say we just just continue with our isolation plan. Hopefully we get the silver bullet.

  2. Randy Wolfshagen September 15, 2020 8:50 am Reply

    Aloha Dr Evslin. I appreciate your well thought out criteria described here for each county’s reopening.
    While we all acknowledge the potentially serious physical complications that people with underlying conditions may experience from being infected with this disease, there is very little being discussed about the mental harm associated with the current lock down, especially for our keiki.
    From my perspective there appears to be very little critical thinking being shared with the public about how kids are being hurt by this forced remote learning. They need the social and physical nourishment they get from playing and learning at their schools. I must applaud Sheena Leigh Figueira Galbraith for taking the initiative:
    So since you (and many others of us) agree that Kauai HAS met a valid set of criteria for re-opening to residents, I ask you to go public and show support having our schools opened immediately.
    Mahalo for what you do. With support from you and the others in our medical community we can act not from fear and misinformation, but from well thought out actions to protect our local citizens – especially our kids.
    – Randy Wolfshagen / Kekaha

  3. Kama'aina September 15, 2020 8:51 am Reply

    Oxford University’s Centre for Evidence-Based Medicine (CEBM) reviewed multiple studies and determined that “masks alone have no significant effect in interrupting the spread of ILI [influenza-like illness] or influenza in the general population, nor in healthcare workers.”
    “It would appear that despite two decades of pandemic preparedness, there is considerable uncertainty as to the value of wearing masks,” wrote Tom Jefferson and Carl Heneghan, the authors of this article for CEBM.
    Let’s also recall that the World Health Organization, in its June 2020 guidance memo, stated that “there is no direct evidence (from studies on COVID-19 and in healthy people in the community) on the effectiveness of universal masking of healthy people in the community to prevent infection with respiratory viruses, including COVID-19.”
    Still, there’s even more evidence pointing to the ineffectiveness of mask mandates.
    BMJ Open is a medical journal that addresses research on clinical medicine, public health, and epidemiology. In 2015, they published a study that cautioned against the use of cloth masks, stating that “moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection.”
    The New England Journal of Medicine (NEJM) published an article May this year characterizing the chances of catching the CCP virus from a passing interaction in a public setting as “minimal,” the authors writing, “The desire for widespread masking is a reflexive reaction to anxiety over the pandemic.” They also concluded that “universal masking alone may, paradoxically, lead to more transmission of Covid-19 if it diverts attention from implementing more fundamental infection-control measures.”
    The NEJM article also concluded what many in our panic-fatigued public have already realized, which is that “masks serve symbolic roles” and are “talismans,” which increase a “perceived sense of safety.”
    According to a separate study published in 2010 in the journal Epidemiology and Infection, there’s little data to support the use of masks to prevent becoming infected by the influenza virus.

    1. J.D. September 16, 2020 6:22 am Reply

      A friends two children were sick. She brought them to get checked for covid. The tests for covid were negative but the doctor said they had developed a bacterial infection from the masks.

  4. Kauaidoug September 15, 2020 8:54 am Reply

    As a resident who will offer tours and interact closely with tourists I would want visitors to take a spit test upon arrival and wait at the airport for results. A 72 hr pretest sounds worthless for my safety.

    1. Pearl September 18, 2020 7:53 pm Reply

      Opening the Island will be a temporary period. Within 4-6 weeks this Island will be in a state of seasonal flu & Covid-19 outbreak. Medical employment will definitely pick up for all the wrong reasons. For all the residents on Kauai please wear masks,wash your hands and of course social distance yourselves.

  5. J.D. September 15, 2020 9:15 am Reply

    It is a virus. It will not be under control. We need herd immunity.

    1. D.A. September 16, 2020 2:00 pm Reply

      Do you know how herd immunity is achieved? By allowing a substantial portion to die off. You want to be first in line to establish this?

  6. Steve Monas September 15, 2020 12:39 pm Reply

    Maybe we should do a clean background checks as well, before anyone enters the island and a clean driving record from a DMV printout. This way we see that we invite people who will comply.

    1. Irene September 16, 2020 6:20 am Reply

      Steve Monas. Loved your response. As a “tourist” that used to live there but now spends two months every year for the past few years, this whole topic is most disheartening. How much is enough to prove we are “acceptable”. No city can EVER be assured of being virus free. Put safety measures in place but common sense says you can’t lock down indefinitely. Sounding more and more like prison. So your comments show the humor on how this is getting out of hand.

  7. judi glass September 15, 2020 3:08 pm Reply

    Dr Evlsin makes very valid points and I have agreed with his thoughtful information these past few months He is a voice of reason and I am not sure that our residents would feel comfortable being sick with the virus because the island opened too soon and people were back to work. Let’s keep working together to help our neighbors so no one is going hungry.

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