Single-test system won’t work

Dear Governor Ige;

The successful quarantine system established on Kaua‘i in the months since the outbreak of the pandemic has once again saved Kaua‘i.

Kaua‘i has thus far escaped the worst ravages that other islands have faced during this pandemic. Now we need assurance that we don’t lose those gains. And our concerns extend to the residents of O‘ahu and the other neighbor islands.

A current case in point, just announced yesterday, proves both the efficacy of the quarantine system, and the inability of the 72-hour pre-test to prevent seeding of the virus into our several communities and allowing community spread to take hold.

This week Dr. Janet Berreman announced in detail the two cases that are the only-known, currently-active cases on Kaua‘i. Each was a person who had entered Hawai‘i from the mainland and respected the quarantine upon arrival. In each case the person was asymptomatic, and unaware that he/she was carrying the virus. When the individuals fell ill they both tested positive. In both of these cases, a single pre-test would have failed entirely to contain a potential seeding. The quarantine, however, saved us.

Governor Ige, a large number of medical experts have been explaining that the single-test plan is highly flawed and likely to lead to tragic results for many of the residents of the state. In the opinion of physicians, emerging-disease specialists, neurologists, cardiologists, pulmonologists, it will be a fatal mistake.

Allowing free circulation of visitors from the mainland or other countries on the basis of a single test done 72 hours prior to the flight will bring in new seedings of community outbreak and spread onto each island that accepts those visitors.

The people of Hawai‘i are counting on you to take the necessary time to assure that a safer plan, with all its elements, is in place before it is too late to undo the damage.

As for the argument that the economy requires “opening,” you, yourself, stated not long ago that the economy will not recover until the health of the state recovers. The economists were supporting your view. I am sure you were right then, and now you would be right to assume that it is essential to avoid seeding new cases into the state population.

Thank you for your attention to this very serious matter.


Phyllis Albert, Ph.D., is a resident of Koloa.

  1. Mainlander Tax Payer October 5, 2020 3:13 am Reply

    Wow. Where to begin…your state is part of the UNITED STATES IF AMERICA and does not have the constitutional right as already ruled by the Supreme Court to decide what citizens come in and don’t come in. More importantly, why should your state get any federal funding for emergencies like a global pandemic if you won’t let AMERICAN citizens in? “Your” island is as much our island as it is “yours.” Evey word that comes from the people of Hawaii is so clearly dripping with fear and lack of experience it’s almost comical. Your state had how much time to figure out what they wanted to do and less than 2 weeks before we bring our money back to your state and Eco omg you get off island time and decide to voice up on a makeshift plan with logistical holes riddled throughout. What a mess, what a unprofessional, immature, naive reaction to this situation. Governor Ige, please do not listen to this local who knows nothing about stately matters or economic decisions for the greater good. Please ignore them they obviously have no real knowledge of how to survivor today and if they can’t protect themselves like the MAJORITY of mainlanders have then…

    1. T October 5, 2020 7:43 pm Reply

      Thank you Phyllis for taking the time to write your letter to Gov. Ige. In response to angry responders who feel they are getting stripped of their right’s to visit Kauai…You have the right to visit but you have to quarantine for 14 days. This is not an unusual mandatory requirement. Many states across the United States and other countries have come to the same conclusion. It is a necessary step to take to protect the health and safety of the community so that we can rebuild the economy safely. Reopening is not an easy task. It should not be undertaken before we have appropriate safety measures/procedures could and probably will jeopardize all commerce and send everyone back into lockdown. Texas, Florida, Oahu and many other places tried failed. It spawned more restrictions and some AMERICANS paid for their mistake with their lives.

      1. Angry Responder 1 October 6, 2020 4:11 pm Reply

        You don’t know what you are talking about. Thankfully Governor Ige made the right choice and DENIED the mayor request and this wanna-be medical doctor’s fear based appeal to selfishly protect themselves without any REAL knowledge of living in a high infection rate environment. The damage you and this Phyllis person does to your own economy will be felt by the lower socioeconomic classes of Hawaii while the higher ones go one to stick around and make more money with less competition because MORONS like you think all I am is angry. Leave the island, please.

      2. Koloa Dan October 6, 2020 8:26 pm Reply

        Well Said!

    2. Pua October 6, 2020 5:14 pm Reply

      Uhmm. Respectfully, “Mainlander”, Kauai does not have the capacity, number of physicians, nor the facilities to treat moderate/serious COVID cases in the same way that most of the mainland states in the US have at their disposal. Therefore, the way Kauai determines “how to survivor today” (your words)(?), is actually a matter of practical logistics.
      Trust that most of Kauai would welcome hoards of tourists with its typical aloha. Our Mayor and Dept of Health leaders are trying to balance our aloha with capacity. I find it insensitive and obtuse for you to post something so condescending and, frankly, offensive.

      1. Mainlander here again October 7, 2020 8:26 am Reply

        In my community when there is a peak of over 500 new cases per day the national guard built an emergency hospital. What our nation is capable of is mine blowing. Your tiny itty-bitty little perspective it’s like a grain of sand on a gigantic beach one in which you think you are on. Your elected officials have many many millions of dollars for federal emergency reasons and being part of one of the greatest superpowers of all time Hawaii will not be left behind. The concept you present is fear-based and absolutely destructive to your own environment. Ridiculously selfish.

  2. randy kansas October 5, 2020 3:36 am Reply

    we also need to worry about the meth problem on our island and the fact that most of the teens, cannot read or write even near their age or grade level….Covid is the least of our problems around here…

  3. Major Lee Hung October 5, 2020 6:03 am Reply

    First off, the two current positive cases, out of 1,800 in quarantine, being asymptomatic upon flying and somehow that is proof a 72hr pretest would miss them is beyond flawed thinking. Considering you are a PhD you should know that a PCR test which consists of at least 30 to 35 cycles will amplify the viral RNA by10 billion.

    The 14 day quarantine saving Kauai? Do food lines look like salvation? We had months of people flying here without being tested at any point and a total of 59 reported positives, including long stretches of no reported positives and I believe either no hospitalizations or a few cases, and no deaths. The quarantine did help spread the virus to close household members of those infected.

    You fail to mention mask use, distancing and cleaning, all of which are believed by professionals to be essential in mitigating the spread.
    This isn’t going away, we need to live with it. Similar to how we live with a 50 mph speed limit that if were dropped to 5 mph would save lives.

    1. Doug October 5, 2020 8:40 pm Reply

      Actually, what’s happening at the White House right now is proof it won’t work. They were being tested everyday.

  4. nobody October 5, 2020 6:04 am Reply

    Didn’t Tahiti have a second test? And it also failed?

    The opinion to open now or not probably depends on in what field your Ph.D. is in. Medicine or Economics.

    Looks like the virus is not going away soon and we will have to face it. Maybe we should concentrate efforts to isolate the ones we love with underlying conditions until this passes.

    Tahiti opened up to tourism because they didn’t want to face going back to subsistence living.

    1. Doug October 5, 2020 8:44 pm Reply

      Yes but no quarantine. Hence the failure. Take a test 4 days after landing and wander around the island while you wait. It’s the same thing we’re going to do but we’re a bit worse. So, we’ll have tons of cases soon.

  5. KauaiFarmMan October 5, 2020 6:17 am Reply

    No economy won’t work!
    Open up everything, end mask wearing, open tourism without restrictions.
    Guess what people it will be years before there’s an effective vaccine that will available to everyone. What will we do, hide until then? Wake up Sheep! Stop this charade.

    1. Dt October 5, 2020 6:01 pm Reply

      My fear is all that effort to flatten the curve was misplaced. We should have constructed a makeshift hospital inside the Kmart building. Whatever materials went unused can be used for the second pandemic. It looks like we did nothing during that period we shut everything down.

      1. Moneytalks October 6, 2020 4:16 pm Reply

        Your politicians excepted federal emergency money in the many many millions. As a result there is a good amount of capital left to deal with emergencies. Nevertheless, if the great State of Hawaii needs its mainland partners to support it with more troops, the Red Cross, or National Guard we are ready and willing to help. This is why closing your borders to us was about as stupid as it gets. Shutting us out is shutting out your only hope to stay afloat in coming years.

    2. Doug October 5, 2020 8:45 pm Reply

      People aren’t going to vacation here if COVID is widespread. It’s going to cause far worse economic problems than a lockdown.

  6. William Norton October 5, 2020 6:57 am Reply

    Ms. Albert doesn’t say her occupation or her source of income but I suspect it has nothing to do with small business, private enterprise or the tourism industry. And that, folks, is no accident.

  7. alien October 5, 2020 8:24 am Reply

    Interesting perspective from someone who is still receiving a paycheck, we have not escaped the ravages of the virus, only the people who have not lost everything to the lock downs have that perspective. Why don’t you donate your life saving to charity and try live on $300 a week.

  8. John Forrest October 5, 2020 8:44 am Reply

    If your goal is to stop tourists from coming to Kauai then the 3 day quarantine will do just that. My wife and I have a trip planned for October 18, but we will change our plans if your plans are implemented.

  9. living in fear is no way to live October 5, 2020 8:45 am Reply

    if testing is so flawed, we do we cite all the positive cases? maybe those are faulty, too, since so few result in hospitalization.
    granted, we must do more to isolate and protect the vulnerable. but restricting everyone else is simply unsustainable.

  10. WestsideResident October 5, 2020 9:02 am Reply

    Some many factors not in your equation Dr.

    For example welfare of children and young adults..

    Open up. Protect the vulnerable. Free the young!

  11. Dr. Jim October 5, 2020 9:31 am Reply

    We don’t need to look any further than the Whitehouse to see that a single test is meaningless. A single test was done the day of the event. 11 of approximately 300 people were infected. Around 3% of those attending!!! That event was outdoors for the most part. Imagine if those people were on a plane for 5 – 10 hours. And then the now freshly, and unknowingly, infected people got off in Lihue without restriction.

    I understand the economic impact this quarantine is having on peoples lives dependent on tourism. I also understand that there will be significant impact on the economy, and our local society of having an epidemic on the scale of New York, Arizona, Florida or now in the midwest going through our population. Once we have exceeded the capacity of our testing system, contact tracers, and medical system, there will be no going back to the “normal” we are experiencing now.

  12. Makani B. Howard October 5, 2020 9:35 am Reply

    Excellent post. Well written and to the point.

    I hope someone in power will see this and respond. Somehow I doubt it, though.

  13. Paulo October 5, 2020 9:58 am Reply

    Thank you for re-emphasizing all the pertinent points Dr Albert.

  14. Stephen October 5, 2020 11:24 am Reply


    A couple of points: Many people, including myself, rely completely on tourism for income. We are being devastated financially – as well as mentally and physically from the stress and anxiety of not knowing how we are going to pay our bills. The state is also going broke without tourism income and its associated tax revenues.

    If the goal is to have ZERO covid cases on the island at all costs, then completely shut down all arrivals until the pandemic is over. Is that a realistic way to handle this? Of course not. So what is the right answer – pre-arrival testing? Pre and post-arrival testing? Mandatory quarantine? Even if you pre-test, post-test, and quarantine – there will still be some false negative tests and there will be those that break quarantine and there will be some cases on the island.

    We have to have a rational plan that will prevent MOST cases from arriving on island, while allowing tourism dollars to save our citizens from impending poverty. A pre-arrival test will catch MOST cases. Or, better yet, include a rapid test on arrival at the airport to catch those that get infected in the 72hrs between the pre-test and arrival. Yes, some cases will slip in. Some citizens will become infected. But the numbers will remain low. If we continue with a mandatory quarantine, tourists will not come, and the economic suffering will continue to worsen. We have to do something, we have to take action! We can’t just continue to hide under a rock while our economy collapses all around us! We can keep ourselves safe while inviting tourism back to save us financially!

    1. Doug October 5, 2020 8:48 pm Reply

      People who rely on tourism should be putting pressure on the federal government to give them funds to survive – they certainly took care of corporations.

      The choice should not be to open and have our most vulnerable die or lose businesses and job. All other countries in the world ha does this problem – except the US.

  15. Mainland Man October 5, 2020 12:06 pm Reply

    Ridiculously opinionated fairly baseless and wildly inaccurate. Being a doctor you look foolish, single minded, bias, invalid, and simply selfish. Many many many Hawaii natives don’t agree with this perspective and more importantly the news, like the garden island is suppressing these opposing opinions reporting bias comments in support of keeping your state in lock down. In April of this year Gov. Ige accepted many many many millions of followers of federal, yup, FEDERAL money for emergency relief. Much of it he hasn’t used. But by accepting our money, money that is THE PEOPLE’s, you accept that not letting other Americans in your state when it feels good is unconstitutional and not going to happen. Gov. Ige made his choice when he accepted the money. Next convo…NEXT!

  16. Dr. Bob October 5, 2020 4:57 pm Reply

    Email sent this evening.

    Dear Mayor Kawakami and Council Members:

    I have sent a letter of support to Governor Ige regarding the pre-travel COVID testing protocol that allows those traveling to the State of Hawaii to be exempt of a quarantine if they have evidence of a negative COVID test within three days prior to boarding their flight. I have a trip planned to Kauai for the Thanksgiving week to stay in our family’s home on your beautiful island. I am aware that Mayor Kawakami has requested that Governor Ige approve an alternate testing protocol that involves an additional COVID test no sooner than three days after arrival and requiring a quarantine during this waiting period and the number of days required to receive a result of this second test. Such a protocol would essentially negate the pre-travel test program. Mayor Kawakami, this second test protocol comes from a fear-based orientation from those advising you. I offer an evidence-based support for the single pre-travel testing protocol approved by Governor Ige.

    I am a physician that works at Southern California Kaiser Permanente. I do not speak for the organization but can relay valuable information in support of the pre-travel single test protocol. Our organization began using a pre-admission COVID test protocol for surgery and other hospital admissions in early May. Since that time tens of thousands of patients have received care and undergone surgery using this protocol that has resulted in no spike in COVID cases in our hospital staff, physicians nor patients. If a patient is COVID negative no heightened protective equipment is used (apart from standard masks) during surgery or their hospital care. As healthcare providers we are in much closer, intimate contact with our patients than would occur in the normal activities a visitor to Kauai would engage in with local inhabitants. As such, Governor Ige’s pre-travel COVID test protocol can be expected to protect Kauai’s residents as well as, or better than, we have been able to protect our valuable colleagues, staff and patients within our large hospital/healthcare system.

    In summary, please abandon the additional post-arrival COVID test and quarantine protocol you have requested be approved, as the evidence does not support such a restrictive program. Current mask use and social distancing, that is being practiced in virtually all other US states and other countries, combined with a negative pre-travel COVID test is highly unlikely to result in a threat to the safety of Kauai’s residents. Much needed return to economic activity on Kauai and all the islands of Hawaii will contribute to the emotional, psychological and general well-being of your citizens.

    Thank you in advance for your attention.


    Roberto A. Cueva, MD, FACS
    Southern California Kaiser Permanente
    Clinical Professor, Voluntary
    University of California, San Diego

    1. kauaidoug October 6, 2020 11:39 am Reply

      Just one rub there, Dr Bob. The patients testing for covid will go right home and be very diligent as to exposure I would assume. I recently had a procedure(postponed twice due to Covid) and that is what I did even more than usual and stayed home.
      The 3 day pre traveller is not so concerned with their health but are running around doing last minute trip errands etc and not staying home, again I would assume. My objection to the three day pre test has always been that you are much more likely to contract the virus in your travel than your day to day life. I am also assuming we are talking about people who wear a mask. If no wear mask then all bets are off.
      And Doc, isn’t part of the appeal to coming here is so you can run around with a low risk of covid? If we don’t protect our covid free status then we do not have a safe refuge for you or me. Just to be clear we have been wearing masks since March, some happier than others but we protect each other.
      Anytime you visit another place, culture the good traveller respects local mores and customs. Yes, we are a part of America but we have 9 beds for ICU and that it is a 90 mile helicopter flight to Honolulu. We are on an incredibly beautiful island so we, or you, can’t just be driven by ambulance to the next hospital! If you don’t want to abide then maybe Kauai isn’t the place for you to vacation this year and being an American good luck with that.

    2. Robert Weiner M.D. October 7, 2020 8:13 pm Reply

      Reply to “Dr Bob”
      What kind of evidence is this? You can’t compare elective surgery patients to tourists. Could it be that elective surgery patients are all screened by a doctor and have a history and physical prior to surgery? Ah! I suspected as much. We can’t do this with tourists so we’ll administer a random pretest where the patient can make his own copy and present. If he forgets to do it he can still get in by agreeing to quarantine in a situation with little to no oversight. How many places have “opened” with poorly thought out plans only to have surges of death and disease.
      R. Weiner M.D.

  17. I saw a Vampire once October 5, 2020 5:30 pm Reply

    Well all you got to do is open up the 4 games at UH Aloha Stadium and use that as a preliminary statistics to happen. For the worse. Then see if there are contact tracing and there are evidences in attendance to be made aware that this event caused the COVID-19. Then you have your answer. As a platform to how the virus is spread.

  18. Carol Bagley, RN, PhD October 5, 2020 9:05 pm Reply

    Please know that the protocols that Dr. Cueva state work indeed. They are the same as used in Alaska with great success.
    Thank you Dr. Cueva for your expertise and examples you have given.

  19. Morris Bacon October 6, 2020 4:07 am Reply

    Decide on a program and stick to it for more than 2 weeks. The uncertainly is killing any hope of a recovery. No one can afford to change travel plans 2 or three times due to the inability of the county and state governments to agree on a plan. Businesses cannot effectively plan to reopen if the county and state continue to move the goal posts. If the county does not trust testing then opening schools was a foolish move. If testing is so unreliable why is anything open? How long can the citizens of Kauai survive with no income? Federal money is not coming, congress is not passing any further financial relief. You are on your own. Good luck.

  20. LTEreader October 6, 2020 12:31 pm Reply

    To the Mainland folks grumbling:
    Kaua’i has 9 IUC beds, 18 ventilators, and a total of 111 hospital beds. Even without COVID beds are usually 60 to 67% occupied throughout the State. And you have the audacity to insinuate we’re avoiding tourism just for the heck of it? Think again!
    BTW: If we run out of beds here your medical insurance won’t cover for an Air Ambulance if you need to be transported to O’ahu – providing of course they’re not overwhelmed like they were just last month.

    For those complaining about Federal funds Hawai’i has received:
    Pre-COVID we had the LOWEST unemployment rate in the Nation. so yes we’ve paid our fair share of taxes, and as such are entitled to some Federal funds for emergencies too!

    Shame on you! I’ve been appalled with many of the comments in our newspaper this year. It’s been very revealing as to the lack of respect some visitors, and investors have for us in Hawai’i.

    KauaiFarmMan: Get your head out of the soil for a minute and educate yourself.

    I’ll leave you with this as you prepare to hop on that petri dish with hundreds of others –
    Oct. 2, 2020: “A daily tracking graph from the New York Times shows 24 States where new cases are higher and staying high. On Friday, the Nation recorded 54,000 new cases, the highest 1-day total since August 14.”

  21. Koloa Dan October 6, 2020 8:24 pm Reply

    “opening” only to close in a few weeks , a few months, serves no one’s interest.

    1. Koloa Dan October 7, 2020 2:22 pm Reply

      I’m wrong. The mayor should open up. Everything Being sad is based off of fear with no real experience. It’s such a bubble here on the island it’s crazy. Talk about groupthink. Wish we had realized this earlier and hadn’t screwed ourselves over. Hope the mayor makes the right choice and opens up.

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