EVSLIN: Why the difficult decision to opt out was the correct one

Mayor Kawakami’s decision to opt out of the Safe Travel’s program was a difficult one, I am sure, but it was either do that or most likely face the economic and social consequences of another complete lockdown, including the closing of all schools. Closing schools not only creates economic hardship but could affect a generation of children. Please note closures and lockdowns are now happening all over the mainland and people from those areas are coming here. Predictions that Covid could become much worse on Kaua‘i with the current Safe Travels program come down to four main points:

• There is very good evidence that the number of infected people in a place like California is at least three times greater than the 1.5% of the population that they know are infected by their testing programs. And at least 40% of those people have no idea they are infected and may travel. It should also be noted that the California case count has jumped dramatically in just the last three weeks and apparently the governors of all three states on the west coast have called for a 14-day quarantine for all people coming into their states due to the nationwide surging.

• A single pretest before flying has been well proven to miss 30-40% of those infected because they are too early in their illness for the test to pick it up. A pretest will also miss everyone infected after their test including those becoming infected during their travels.

• The state leadership has been predicting 1 case per 1000 arrivals will be infected and not detected when they arrive here. We have consulted with experts at the University of Washington and UH and they believe that the number that will come in infected and not detected will be 7 or more people per 1000 arrivals. If we have 30,000 visitors per month on Kaua‘i that would mean that at least 210 people per month could land here infected.

• The numbers on Kaua‘i may end up being predictive for the state. The State’s testing program of visitors to Kaua‘i who were tested at 4 days after arrival (after a negative pretest) had 5 test positive out of 331 which suggests that up to 15 per 1000 arrivals could be arriving infected. This result of the state’s testing on Kaua‘i is 15 times higher than the state predicted. State testing done at four days after arrival (including all islands) averages to about 7 per 1000 missed by the single pretest. Please note that 7 infections missed per 1000 arrivals is the same number as the experts we consulted with predicted would be missed and is still 7 times higher than predicted by the state. In a little over six weeks since the reopening, Kauaʻi had double the number of cases we had in the first 7 months of the pandemic: 61 cases and 0 COVID deaths in the first 7 months rose to 131 cases (total) and a death in a little over six weeks—and almost all travel related.

The problem with so many possibly coming into the state infected and not detected as that they can act like kindling for a forest fire. Each visitor may give it to just a single person on Kaua‘i but if that person takes it home to their family, the family spread can be rapid and widespread. Returning residents, with a false sense of security after their single pretest, may also bring it directly to their families.

Opting out was not the Mayor’s first choice. His first choice was very similar to what the CDC is now considering as their new formal recommendation. The CDC stated last week that they are considering new guidelines including decreasing the 14-day travel quarantine to seven days with a second test. That would be a safe way to reopen and I am sure the Hawaii DOH will be considering these new CDC guidelines for quarantines in general and travel quarantines as they are created. The CDC specifically is not recommending eliminating quarantines with just a single pretest and every place that has opened with a single pretest and no quarantine has had a huge surge in cases.

Support our Mayor. A vaccine is coming, treatments are getting better. Let’s open correctly and stay safe.

Be safe Kaua‘i, wear your mask, and we will get through this.

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 was a former healthcare administrator on Kauai and periodically writes a column for the Garden Island.

22 Comments
  1. nobody December 3, 2020 6:57 am Reply

    Since the rest of the State is still in the Safe Travel program they, according to this article, will soon see an unmanageable surge. The Safe Travel program has been around for almost 7 weeks now with no spike of cases in the State.

    https://www.worldometers.info/coronavirus/usa/hawaii/

    Would the doctor please show us his timeline on when we can expect all of this infection to happen to the rest of the State?

    If the doctor is wrong, and there is no statewide surge, how long should Kauai continue to opt out and damage its economy?

    I hope the council and mayor asked those questions. Anyone got an answer?


    1. Bruce TRUBO December 5, 2020 6:05 am Reply

      As one concerned about our entire tourist dependent population, I don’t understand why our Mayor did not reintroduce his 3 day quarantine for all incoming travelers with a second negative Covid test thereafter. This proven compromise would at least encourage longer stay travel and bring desperately needed cash flow to our island’s failing hospitality industry and government coffers. The coming vaccines have certainly given us hope, but huge hurdles remain limiting its rapid effectiveness (the most challenging of which is that up to 70% of our country’s population must get vaccinated). Between delivery and distribution logistics coupled with far too many “anti-vaccinators”, I’m skeptical we’ll see an end to this pandemic anytime too soon.
      That means we need to find a way to safely live with this virus. With the Islands and Kauai in particular being in the envious position of safely selecting who sets foot here, I would plead with our Mayor to reconsider his economically devastating 14 day quarantine. A limited (3-5 day) quarantine coupled with a second test is the only prudent way to keep Kauai both safe and avoiding financial ruin to many.


  2. Bob December 3, 2020 9:10 am Reply

    As written by someone retired, likely with a fat retirement account, and not currently trying to make a living on Kauai. As per Lieutenant Governor Josh Green, MD and based on the states statistics, the Safe Travels program is working in the state of Hawaii and Kauai county. Also let’s remind everyone that cases don’t equal hospitalizations or deaths. Please don’t tell me to support the mayor. I can make my own decisions and I DO NOT support the mayor in his hasty decision. He is destroying the lives of so many.


    1. Doug December 4, 2020 9:31 am Reply

      Sorry, you lost me when you mentioned that idiot Josh Green.


  3. Doug December 3, 2020 9:54 am Reply

    Great article Lee. Opting out was the only choice after Ige and Green stubbornly refused to allow the Mayors second test program.


  4. kauaidoug December 3, 2020 11:09 am Reply

    MAHALO, Dr. Evslin!!!!!
    This should be a must read for every citizen. These are the facts we now face! I just emailed Senator Mcconnell and our Senators. We need Federal help to bridge us to the vaccines. All of us are suffering.


  5. steven December 3, 2020 11:27 am Reply

    We appreciate the statistics. Would someone please give # of suicides/drug overdoses/1000, #of new homeless/1000, # of residents who spread travel related infection by “quarantining” at home/number of cases

    We will soon see if the other islands survive without significant infection rates increases. The mayor will not dare to open up in December. Maybe not in January or February. Not after the backlash from closing with only 4 day notice. Requiring a 14-day may not have been the Mayor’s first choice but 4 day notice is indefensible.

    Where will we be in the summer? Living off the education and road money generated from tourism on other islands? Other islands that took the risk?


  6. Uli Roth December 3, 2020 12:21 pm Reply

    I agree with you Dr. Evslin


    1. nobody December 3, 2020 6:39 pm Reply

      Cases spike and hospitals are overwhelmed, out of control in the rest of the state, Evslin is right in his assumptions. Mayor and County Council too.

      Cases don’t spike out of control in the rest of the state, Evslin is wrong in his assumptions. Mayor and County Council too.

      I guess we will see.


  7. judi December 3, 2020 4:37 pm Reply

    Mahalo Dr Evslin
    You have presented the facts and research in a clear, concise manner. There are 14 day quarantines in many states on the mainland to protect their citizens. And here on Kauai, with no way to drive off the island, imagine if Mayor Kawakami did not take the this step to keep us safe. Patience is the key and let’s support our neighbors and local businesses in anyway we can until we can re open safely.


  8. Colin McCleod December 3, 2020 4:53 pm Reply

    The good doctor has nothing to lose with the mayor trashing the lives of working people. Why? he doesn’t need to work. Easy to make others subsidize his ill considered support of tyrannical policies put in place by political hacks that “have to do something” even if it’s wrong. The one size fits all policies put in place have no relevance. Time to examine the hard data and writings of the real epidemiologists and virologists Doc:
    https://twitter.com/ianmSC see his graphs
    https://pandata.org/ see the live feed of data
    https://gbdeclaration.org/
    https://profiles.stanford.edu/john-ioannidis?tab=publications
    https://www.oxfordmartin.ox.ac.uk/people/professor-sunetra-gupta/
    https://www.youtube.com/watch?v=Pxyc3fTHi0I&feature=emb_logo
    I have much more faith in these people than a retired pediatrician that never saw a liberty suffocating lock-down he didn’t love.
    Colin McCleod


  9. mina December 3, 2020 6:15 pm Reply

    Everyone thinks they’ll be one of the lucky ones who’s only going to show mild or no symptoms of the virus if they get it…and then they get it and end up in the ICU wondering of their next laborous breath will be their last. Everyone on Kauai has been molly-coddled into believing that this is a harmless virus, but I invite you go take a walk through crowded mainland hospitals for a clearer picture. Take a good look at the exhausted medical personnel trying to keep up with the steady inflow of deathly sick Covid patients. Spend some time in a room with a patient who is literally choking to death on his own lung fluid, because he “had the right” not to wear a mask at his family reunion. Watch the look of surprise on his face when you hear the flatline alarm on his heartbeat monitor. This isn’t a cold, and this isn’t the flu. Those two ailments never killed 275,000 Americans in less than 6 months. Don’t play dice with this virus. Put your mask on, keep your distance, and stop behaving like this killer isn’t real. Yes, you might be one of the lucky one’s who just gets the sniffles for a couple of days, or the last thing you will ever see in this world is the tiled ceiling of an intensive care unit slowly fading to black as you run out of air for good. You aren’t bullet proof because you want to be. The virus itself will make that deadly determination for you. Mask up for yourself and mask up for others.


    1. poi dog December 4, 2020 7:12 am Reply

      infected people will not end up in ICU, the 8 ICU beds will be filled, there will be no medical staff to attend. they will be in the hallway, the rest will be in the parking lot letting nature take its course, just like New York.


  10. mike December 3, 2020 7:18 pm Reply

    Just because someone has an MD after his name does not make him an expert and certainly does not make him right. Wake up Kauai!


    1. piko December 4, 2020 11:54 pm Reply

      To the Doctor, thank you for your time, and all you put into this, and personally I have full faith in you, and again I humbly thank you, Dr. Evslin.
      NOW for the rest of you that think you know better then the doctors…If you are not happy here on Kauai, if you think you know better, you want to live, you say…well the majority of Kauai residents choose to follow the guide lines. What is wrong with people like JD and Mike…so disrespectful….and Bob & Colin you are definitely unhappy here, and extremely rude. Mind your own shit. Like why do you always have to bring up someone else’s status, or income. It’s theirs not yours…they worked very hard for it, like Dr. E. … yet still out of his heart, he cares about the Kauai Ohana, and this in his letter, that he shares is of no charge, to all of Kauai, and some of us appreciate him. You (4) , are so disrespectful, and you are rude, and ignorant. Blatantly ignorant, I can almost bet you are haloe, and not Kauai born. If I am correct….I suggest if you are so unhappy …then leave. Kauai would benefit from one, or four less of your kind, that think they are better, smarter…and entitled to this way of thinking. Kauai peeps don’t like that kind of disrespect, to an older man, a Doctor, who gave years of his life to heal, and help, and still…free of charge offers his advise, because he cares for Kauai Ohana. and for the record…I don’t know Dr. Evslin personally, and I or my children have never been his patient. Never the less, I have a deep respect for him. This is after listening to him on the Mel & Charlie show, and reading his letters. You (4 ) know it all, smarter then…you should cash in, and move off the island then. Teens read this, you are a very bad example, with you disrespectful display of comments. It makes my skin crawl, you have a right to an opinion, but not to disrespect someone that is way more educated, and knows, and seen a hell of a lot more then you know. You sound like a selfish, money greedy person. By your words. Pilau you. Really you should move. Go elsewhere, or where you came from.


  11. J.D. December 3, 2020 9:10 pm Reply

    We used to be free in the United States of America. Anyone afraid to go out should quarantine. Anyone wanting to live should be free to live. If masks work why is anything closed?


    1. piko December 5, 2020 12:06 am Reply

      and. J D Free you say, you use to be free in the United States. Then why the hoot are you here, on an island in Polynesia, which is technically, and never should have been a part of this, what you call the United States. Hawaii was taken, with guns, and an army, an illegally occupied … go live there on the big U.S. island. You can be as free as you want there. Free as a bird. You behave by what you say…Your way…sucks. and I am not a minority in my thinking, your thinking is the minority. This is not your paradise, this is our home for generations, and generations ….and more. Some of us will die, saying We are not Americans, in our heart, we will never be Americans, we will die Hawaiians.


  12. Concerned parent December 4, 2020 4:18 pm Reply

    Question for retired Dr. Evslin. You are lauding the vaccine as a cure to this. I would like know will you, your wife, sons, daughter in-laws, grandchildren be taking this vaccine? If the answer to anyone of those options is a no then please do not recommend it to anyone else. You took and oath. Above all do no harm. And you can’t verify if any one of these vaccines are safe.


  13. piko December 5, 2020 12:21 am Reply

    Colin McCleod got his degree, off an IPhone at Twitter, YouTube…and any other .com .org. dot. what he wants to hear. There are double the amount saying otherwise. Grow up, get with the program. Follow the law. This is our elected officials, the people of Kauai elected them , and they respect Dr. Evslin for years of service to the people of our aina Kauai. If you work long enough, lived through what years have brought thus far to us elderly… You would not be displaying stupid remarks about someone else’s income. What have you done to help during this virus, other then being a distasteful, grumbling, troll on this site. Like you and your dime a dozen YouTube quotes and tweets. Please. NO UKA for disrespect like this, and Kokua, really what have you ever given back.


    1. Colin McCleod December 5, 2020 3:03 pm Reply

      Sorry, Belly-Button, in the late 60s I received undergraduate and post graduate degrees in mathematics and statistics from two prestigious universities. I do know how to understand and evaluate statistical data, graphs etc. I may not be an epidemiologist or virologist but I certainly know how to comprehend their work. I happen to pay closer attention to the non-politically driven like those I cited as opposed to Doc Evslin.
      Also I was born in 1944 so your drivel about elderly and income is just that drivel. I’ve worked since I was 15 and aside from years in school never stopped until I turned 75. I accumulated good savings and during my working years funded my own retirement from my investments. I, like the Doc, don’t need to work. But having grown up in abject poverty and worked my way to success, I adamantly resent the trashing of all working people by the politically motivated dopes.
      The barbaric lock-downs wreak havoc on the lives of the poor, the sick, children’s social lives and needlessly terrify people with a disease so they avoid doctor visits, sit out and die from heart attacks, cancer etc. Or they commit suicide out of desperation–great huh? Lock-downs interrupt supply chains & according to the the World Health Organization place 130 million people worldwide in danger of starvation. So I’m thrilled people like you and the Doc think lock-downs are great and will solve the problem. The fact is that they will only postpone the inevitable spread of SARS Cov2 through the entire population with little more mortality than the yearly influenza events.
      Have a good life living in fear….
      Colin McCleod


  14. piko December 6, 2020 3:01 am Reply

    Mr. McCleod,
    I had to respond just because you are way off base with the belly-button remark. Pico is how I should spell it, but Piko stuck. So the name Piko I use is not the Mary Kawena Pukui version of “piko” in the Hawaiian Dictionary. How in my name, it is making reference, or I am making reference, to a nickname, or a short version of my name, which is the same as an instrument, and it’s a name that was given to me by my grandmother, it’s really not Piko, but something else, and Piko is how I chose to spell it, in this nickname modified after the given name. You really should not open your mouth before you know for sure what it is you are yapping away about in your effort to be rude, and your remark Belly-Button, was Rude, Offensive, and sounds a little like you have a Narcissistic Disorder. Narcissistic comes to mind, becomes it comes out so much stronger then someone just trying to intimidate. One of the two, never the less you have a distasteful personality.
    I guessed Narcissistic because you had to go on, and on trying to compare your self to the Good Doctor, and again bring up personal issues like income, and blah blah all about you.
    Now back to Piko, and it’s definition.
    Hui Uncle Big Stuff…it isn’t Belly-Button as you put it.
    Mary Kawena Pukui Hawaiian Dictionary.
    1. Navel, navel string, umbilical cord. Fig., blood relative, genitals. (and eight more references of use for the word) In the first reference it states
    that Peha ko piko ? How is your navel ?
    ( a facetious greeting avoided by some because of the double meaning )
    piko 2. Summit or top of a hill or mountain: crest: crown of the hat made on a frame: tip of the ear, …on and on…much more . (8) get your self a Dictionary if you want to use, or translate the Hawaiian Language to any one in Hawaii that has a drop of Hawaiian blood. … Cause If you were trying to mock, or make a joke out of the name. It was not funny, not one bit. You offend me, my grandmother who named me, and the Hawaiian Language, which my given name is not factored of/with/(or) by anything from the Hawaiian Language but from a musical instrument from her mothers homeland. …moving on….
    Now, with all those credentials (aka) Narcissistic babble, …wait what did you call it Drivel. My drivel on the elderly. Well sending it back to you, referring to all that “Narcissistic Drivel” you felt you needed to post about your self. Income, education, poverty years , as if you are the only one that lived that era. I still think you are rude, very rude, and ignorant, blatantly ignorant. And if you disagree, the Mel and Charlie show, (that the Good Doctor has appeared on several times, along with other Doctors) have been asking (Mel & Charlie has been asking) for anyone with an opinion, that differs from/ with the statistics they have been sharing with a very large group of followers.
    Well they have been wanting to have some one come on the show, and share, the different side of what is being said/shared on the show. Other then how you share here. Remember, the letter. This all stemmed from a letter here.
    Any who. I can send them a copy of this little back and forth…conversation, back and forth drivel here, and have them invite you to come on the show. You should go on the show, it’s a great platform for you to speak your side with all that credentials you listed, including a political opinion. Go and show yourself, and speak there. I am sure the public followers would have many questions for you. I personally don’t like anything about what you represent, your disrespectful attitude, and you as a person. I don’t care for you period. However’ I guarantee you, that if you take this opportunity, and go on the show, and speak with these two men, I will enjoy this show so much, I almost have no word for just how much. I will maybe even make popcorn.
    Now for the last remark I am going to make here, and in closing, …The only reason I spoke here is it just rubbed me the wrong way, how rude some people are. I knew the Good Doctor would not put his mind with trolls like you, he is way above that… that yap yap yap here, or comments made here, or anywhere, I am guessing. He is just informing public as any Good Doctor, or any good man with an intention to help would. Why don’t you step up as well. You should go on the show, comment here, but you don’t debate or share. With a large group on Kauai. ??? The doctor would never comment here, but I on the other hand, I just can not stay quiet, when there is blatant rude disrespect types, that do nothing, it’s kind of like the last straw…during a crisis, you get the rude nay Sayers that think they know better. Talk is so cheap, go defend that talk. You are college educated right. Educated people debate, or have some kind of a face to face conference. But to do nothing but Yap Yap Yap one might say you are a real okole puka. Just another old okole puka, because for an old dude like yourself, what the hoot is it that you can’t do now, that you were already doing. Being not as old as you but close, nothings really changed for me. A few minor things, but I love alone, and gardening, and mostly wearing funny hats. I think you are the one that is scared, and it’s just that disorder of yours reaching / screaming out for help. So, I will forward to Mel and Charlie this convo, and I am sure they will invite you to come on the show. (Unless you were one of those trolls that Mel had to block from the show for being an okole puka, and just plain rude to the point it was bothering the followers, and you are now ashamed. You don’t have to worry, this is exactly who they are welcoming to come forth and debate, or share. I really wish you would. Okey-dokey bye now…you have a good day Regards,
    Pico Piko Pika Pica
    What ever, but it is not mean Belly-Button.
    It was never a Hawaiian word it was the way my grandmother said it, with her accent, and I chose to spell it…. and you are still a Narcissistic okole puka in my opinion. Prove me wrong, go on the show, and speak your side as you commented here, opposition.


  15. piko December 6, 2020 3:50 am Reply

    ….what they said I sent it twice….but lookie lookie….it is missing my response to Colin McCleod … and his Narcissistic Bio.
    Who now I can officially call a real, okole puka, for his expertise in the Hawaiian language.
    How’s that missing response of mine ….out in cyber land now.
    Guess it did not fit the criteria.
    Well long story short, …. I still think, you sir, Mr. McCleod are still a very rude, and Ignorant man. Blatantly Ignorant man, equivalent to your out going President of the U.S.
    However; in addition, now I am convinced, it’s a Narcissistic Disorder that accelerates/aggravates your condition, that makes you an okole puka. This is a problem you should have looked at.
    Is there a doctor in the house ?
    ….and I also must suggest you get yourself a copy of Mary Kawena Pukui, and look up the word piko. You are off target just a bit here sir. For that you have earned the name…”Okole Puka.”


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