Aside from a few small island nations, Kaua‘i’s per capita COVID-19 cases are the lowest in the world. Last week, it was even lower than New Zealand, whose COVID response has been exemplary.
Along with our remote location and small population, we have our Mayor, District Health Officer, and their diligent team to thank. They have held the line. We must speak up now to help them continue to do so.
Governor Ige’s recent announcements mean that all counties will reopen October 15, with just a single pre-flight test, and no quarantine. The science suggests this is a grave mistake. No country has successfully reopened with such a plan. In seeking to reopen safely, Hawai‘i is attempting to do what no country has successfully done so far.
Tahiti and Alaska both reopened offering a single pre-flight test, no quarantine, and a second test on day 4 (Tahiti) or between days 7-14 (Alaska). Both reopenings failed. Alaska, with half of Hawai‘i’s population, has administered twice the tests we have, and yet they have had an exponential spike.
Tahiti, with 290,000 people, went from “COVID free” on July 15, to over 1,400 new cases in the last month alone — a number limited by their testing capacity. Last week, Tahiti officials announced that they expect 100,000 Tahitians to become infected in the next three months. Their two test reopening has been an unmitigated disaster.
From these two distant neighbors, and multiple studies, we know that (1) a first and second test without enforced quarantine between them will fail and (2) that widespread surveillance testing is critical to catching asymptomatic carriers. We do well under 100 tests a day and essentially no asymptomatic surveillance testing necessary to detect community spread early.
New Zealand, with no known cases, was performing about 2,000 asymptomatic surveillance tests daily when they detected 4 cases on August 10. They then immediately ramped up to over 20,000 tests per day which revealed another 75 active cases, which, with robust tracing, grew to about 200 cases. Their directive is to “go early and go hard.” Had they acted more slowly, they would have found 2,000.
New Zealand also locked down 1.5 million people within 24 hours of finding those four cases, required the use of contact tracking apps, and has never budged from their 14-day mandatory quarantine in dedicated, guarded, quarantine hotels. Hawai‘i has never locked down quickly, nor, in the last 6 months, deployed any contact tracking apps.
The governor is now asking Kaua’i to swap our relatively well-enforced 14-day quarantine for a single pre-flight test. As shown above, this trade won’t work despite wishful thinking – and no serious science supports doing so.
So we are at a turning point, which comes down to this.
We either, as the only island with no significant community spread, open up as O‘ahu is doing, or find a way to continue to protect the unique gift we presently have – an essentially COVID free environment. Marketed wisely, we can be incredibly attractive to long term tourists, the ones who spend money over months, not days.
On O‘ahu, with thousands of active cases, there is a shortsighted and fallacious argument that it is possible to control community spread, and that reopening to tourism with a single pre-flight is safe and the only way to save the economy. And for O‘ahu, in the very short run (two weeks), that is possibly true. Then they lock back down.
On Kaua‘i, however, cases from travelers will make the difference between community spread establishing itself, or not. Those infected will all be “patient zeros,” who seed the community by infecting locals, who then bring it home to their families and communities, where it simmers, until, long after those tourists have left, community spread is established with just a few superspreader events.
Once community spread is well established, it is almost impossible to stamp out, even with the inevitable lockdowns. No one has done it yet.
Until Kaua’i, and I hope the other neighbor islands, has sufficient testing capacity for both daily surveillance testing and incoming traveler multi-day test protocols, we simply are not ready to open up.
And even when we do, no community has been successful, regardless of how many tests they do, when they completely remove quarantine. Kaua‘i’s pioneering effort can only be to see if we can reduce quarantine time with a multi-test protocol that at least extends across the seven day incubation period most people experience.
With travelers likely to test on their day of departure, that means at most cutting their on island quarantine to 7 days. That is half of what we have now, which will certainly result in an increase of travelers, and risk, but more dollars will be spent and we buy some time until plentiful inexpensive rapid tests become available.
Open with less than a full week of quarantine and less than a 7-day test to get out, and we’ll be inviting in eventual community spread. The science is fairly clear. PCR tests miss 100% of infected on day 1, ~67% on day 4, and on their best day (day 8 after infection), they still miss 20%. These numbers are not exact, as there are so many testing variables, but detection is obviously more successful when the viral load is highest.
A multitest protocol is the only way to proceed, coupled with a strict quarantine, and the final test no sooner than day 7. Compromise on any of these, and our reopening has a high chance of backfiring.
And let’s remember one thing. If you were going to travel to Hawaii for a week right now, which island would you choose? We’re going to get bombarded.
Steve O’Neal is an entrepreneur and former UN Disaster Response Team Lead who resides on Kaua’i.