Critical race between the three vees: vaccinations, variants, vacationers

Kaua‘i was leading the nation in COVID-19 safety and in percentage vaccinated on April 5.

That was the day we opened with the single pre-test Safe Travels program.

Three weeks later and our cases have gone up by over 6,000%, and our risk status as reported by The New York Times has gone from low to high.

We went from virtually zero cases to 73 active cases by May 2, and a second death.

The state also tragically reported the first death of a child from COVID (a visitor who died on O‘ahu). It was reported by the DOH on April 30 that 40 of the Kaua‘i new cases are unvaccinated people, and four of those new cases are fully-vaccinated cases.

The only good news is that our Kaua‘i data is similar to data from around the world, showing that those who contracted COVID after being fully vaccinated were reported to either have no symptoms or very mild symptoms.

In contrast to the spiking cases on Kaua‘i, much of the U.S. mainland is experiencing a marked improvement from conditions earlier in the year.

The number of cases and deaths are going down over much of the country, and more than 230 million immunizations have been administered.

Other nations, such as India and Brazil, that have not yet widely immunized or been careful with precautions, are doing terribly. Even Canada, which has been slow to roll out vaccines, is having surges.

Variants are being blamed in many of these out-of-control epidemics and, very worrying for all of us, some of these variants are being found in the U.S. and in Hawai‘i.

So why have we gone from great to scary, and what can we do about it?

It has been shown that screening for infected travelers by just a single pretest will miss 30 to 60% of those infected, because all tests are negative in the early days of a COVID infection.

Kaua‘i’s mandatory post-arrival test, which was implemented between December and April 5, was designed to detect those who were missed on their first test.

After our post-test was eliminated (with significant pressure from the state), travel exploded in early April, both with returning residents and tourists.

Some of those coming in are carrying the variants. The variants are more infectious, and they appear to sicken younger people more often.

Raising the risk, the immunization rate on Kaua‘i also slowed down significantly in recent weeks. There are open slots now in almost all the immunization centers, and we still have large numbers of people over 16 who are not vaccinated. Many of those not vaccinated appear to be on the fence or outright deciding vaccination is not for them. There is, unfortunately, a lot of false information out there about the COVID immunizations.

Here are some facts:

• Over 230 million doses of COVID vaccines have been administered in the U.S., and serious side effects appear to be very rare;

• Studies show that the Moderna and Pfizer vaccines prevent about 95% of fully-vaccinated persons from developing even mild symptoms, and appear to be almost 100% effective in preventing those who are fully vaccinated from dying or becoming seriously ill from COVID;

• While the public-health world was initially cautious to avoid claiming that the vaccines reduced transmission because at the time there hadn’t yet been any testing looking specifically at transmission rates among the vaccinated, there is now clear data showing that vaccination dramatically decreases one’s ability to spread the disease. Recent evidence shows that the vaccines prevent 90% of those vaccinated from catching the disease (you can’t spread it if you don’t have it) and, of those who do still catch it while vaccinated, their chances of spreading it are significantly reduced;

• Because these vaccines are so effective, the CDC is telling people that if you are fully vaccinated, you can meet inside safely unmasked with other fully-vaccinated people, travel in the U.S. at low risk, can take off masks outside, and most fully-vaccinated people do not need to quarantine even if exposed to a COVID positive contact, etc.

I can’t say for sure why Kaua‘i is doing so badly recently. My suspicion is that much of the increase can be attributed to an increase in travelers and residents without a second post-arrival test bringing in more-contagious variants which are rapidly spread by gatherings of unmasked, unimmunized people particularly in indoor gatherings such as bars and restaurants.

One final point is that we have all been relieved that children have seemed safer from the virus. But children do get it. There have been 3.7 million cases of COVID in children in the U.S. Severe illness is still rare in children, but does happen, and appears to happen more frequently with the variants. And most hospitalizations for COVID in the U.S. now are very-sick adults under the age of 50.

I see it as a true race between the three vees: vaccinations, variants and vacationers. If we want to allow in vacationers and residents without a requirement for a second test after arrival, we are going to need to vaccinate most of the population over age 16 and vaccinate the children when the vaccines are cleared for those under 16.

Pandemics with huge death tolls are a part of human history. All the previous pandemics have killed enormous numbers of people. Most of the original Hawaiian population of these islands died from illnesses brought in by travelers and colonizers. Vaccines could make this pandemic less lethal, less disruptive, and shorter than previous pandemics — but only if they are used by almost all of the eligible population.

I know vaccinations are a personal choice, but the science is clearly showing that the vaccines are much, much safer than COVID. Our entire extended family over the age of 16 is now fully vaccinated, and all of us are really happy to safely gather again while being protected from either catching COVID or giving it to another.

Please vaccinate, Kaua‘i.


Lee A. Evslin, M.D., is a board-certified pediatrician and fellow of The American Academy of Pediatrics. He was a former health-care administrator on Kaua‘i, and periodically writes a column for The Garden Island. 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.

  1. Mark May 4, 2021 2:06 am Reply

    Excellent message here, especially with focus on vaccination, which is something people can control. All that said, it takes 6 weeks to reach the level of efficacy Dr. Evslin is quoting (with admittedly still very good efficacy after 4 weeks).

    I personally condemn our political leadership for creating this current “race” situation at all however. If they were going to open up again without requiring a second test, 5 April was too early to do so. Even the at risk people from group 1C weren’t given an opportunity to get fully vaccinated ahead of the 5 April window, so of course anyone in group 2, who are the ones currently spreading the variants introduced by travelers, weren’t positioned to perform well in the “race” that our politicians have created for $$$$.

    Nice message Dr. Evslin. And good on you for focusing on the leg in the race that you can influence – vaccination. I, on the other hand, will call a spade a spade and highlight that Mayor Kawakami combined with our state politicians took a situation that could have been much more manageable and made it much worse in order to squeeze out a bit more monthly revenue for the large hotels. They abandoned science and ignored a readily observable trend of increasing variant infection of young people around the world, and they refuse to own up to that or take any responsibility, instead putting blame back on behavior of people who at the time weren’t given an opportunity to pursue the real solution of vaccination. At least politicians like Gov. DeSantis in FL (and don’t get me wrong, I find him detestable) have enough integrity to openly state what they are doing. Can’t say the same for Mayor Kawakami who is obviously playing both sides here.

  2. randy kansas May 4, 2021 2:47 am Reply

    not trusting our government is high on the list of reasons for the reluctance to get a shot….early morning raids, fake news, shady elections, unequal treatment under the law …to name a few…

    knock, knock….we are here from the government and here to help you…

    1. Citizen Cane May 4, 2021 5:48 pm Reply

      r.k.: “Fake news” was a term applied to the emerging firehose of lies perpetrated by Trump during the provably corrupted (see 30+ indictments and convictions) presidential campaign of 2016, until he learned the art of projection. Now he’s trying to co-opt “The Big Lie;” well there’s none better at it. Demonstrably the most corrupt (Drain the swamp!) and mendacious president in our history. So yeah, let’s turn over the ballot-box keys to that guy.

  3. Sandman Kalapaki May 4, 2021 3:16 am Reply

    This was a bomb lying in wait. We were in Kauai from November through the end of February. Kawakami did a great job “protecting” the citizens, but the population became like sheep to the slaughter. With no exposure to the virus everyone became at risk. Flattening the curve (or eliminating it as in the case with Kauai) simply moves the cases out to a later date. Intercepting the infection is the only way to avoid the inevitable. This can be done with vaccines or hoping the virus simply dies out as everyone else gets immunity. I told people in Kauai I hope this does not surge later (2021). In Placer county, California we are now on the backside of the curve but not as far along towards recovering as the rest of California.

  4. nobody May 4, 2021 4:31 am Reply

    Thankyou for changing the cause of the transmission from “tourist” to “traveler”. Maybe “resident” is more accurate. Should we restrict travel except for tourists? The statistics points that way.

  5. Westside Resident May 4, 2021 7:11 am Reply

    Speaking of race.

    My advice to the Hawaiians today would be to count yourself fortunate that you have a choice to get vaccinated or not.

    Would you risk your bloodline by vaccinating your youth with this experimental drug? Did you know that there is a risk of harming reproductive health by taking the so-called vaccine? None of the vaccine choices are approved by the FDA. They are experimental.

    Did you know that the so-called vaccine doesn’t stop transmission? That’s why we are encouraged to continue to social distance and wear masks even after vaccination. So don’t take the risk for such a poor reward.

    Did you know that the so-called vaccine doesn’t prevent death from Covid related sickness? Many deaths are of the ‘vaccinated’. Where is the reward in this for taking the experimental drug?

    Did you know that most people survive Covid related sickness and that if you are less than 50 your chances of dying from Covid related sickness are no greater than dying from the flu? So why insert mRNA into a healthy young person? Why take the risk of cutting off your bloodline forever for no benefit?

    Don’t be fooled by the lies. If you want to perpetuate your bloodline and the chain of Aumakua therein, don’t vaccinate your children with an experimental drug. Don’t succumb to peer pressure. The guilt trip. Don’t be fooled by this social experiment.

    If the fearful want to try the drug, let them. Meanwhile, the M.D.’s should share more good news about treatments. Treatments and additional ICUs. Not experimental gene vaccinations that in the long run, over time, may have risks we are not yet aware of. The drugs were not tested over time.

    The benefits of the so-called vaccines for Covid do not outweigh the risks, particularly for those under 50.

    1. Kalaheo May 4, 2021 8:25 am Reply

      Very valid points that are made. These definitely need to be addressed.

    2. Fearful May 4, 2021 10:21 am Reply

      I’m really fearful that any Hawaiian or Polynesian readers out there might actually pay attention to this completely ANONYMOUS posting from Westside Resident which is full of MISINFORMATION, much of it started by foreign governments and/or the extreme political right. If you want to get into conspiracy theories….what better way to finally get rid of native peoples in Hawaii or other parts of the US than to promote this anti-vaccine agenda that leverages well founded distrust in authority to ultimately subject themselves to additional disease. If you’re Hawaiian and reading this, and not sure about trusting vaccinations, maybe think twice before you trust anonymously posted talking points that fit broader political agendas. Please, go find a medical professional somewhere whom you trust and discuss your concerns with them. Don’t take medical advise from the peanut gallery, myself included, posting on facebook or TGI.

      I understand TGI is open forum, but at some point they should examine their role in distributing outright misinformation in the way the Facebook and Twitter have assessed their own policies.

    3. Whichwaydidhegogeorge? May 4, 2021 11:42 am Reply

      @Westside Resident: Look if you want to disregard all the science and sacrifices required to get these vaccines out there to actually save lives, that’s fine I guess, but don’t spread your lies and disinformation when many people have literally died due believing this misinformation.

      You use scary terms like “gene vaccinations” to infer that the COVID vaccine modifies your DNA and will affect how “Hawaiian” one’s kids will be if you take the vaccine.

      Instead of letting yet another example of the Dunning-Krueger effect in TGI, how about we rely on the experts who have spent their lives studying infectious diseases instead of someone relying on Youtube or Facebook “university” for “education.”

      The CDC states that mRNA vaccines are *not* made from live viruses and that: “mRNA never enters the nucleus of the cell, which is where our DNA (genetic material) is kept.”

      But hey…you do you…if you want to keep your head in the sand instead of actually doing real research, that’s fine I guess, just stop telling lies to us fellow Kanakas. Anyone that’s ever applied true critical thinking to just about any contentious matter can easily see the cognitive bias shown with fallacies and a complete lack of truth in your opinions that you try to spew as facts.

  6. Kind sir May 4, 2021 7:11 am Reply

    Thank for you the statistics that support your pro vax stance. You could also provide numbers that justify younger healthy people not needing to take and experimental “vaccine” that has an emergency use classification by passing the long term research. Last I checked you were no longer a practicing physician. Is it ethical for you to compel everyone to get vaccinated while you have no information on any of our medical history and or health precautions. It’s irresponsible and off putting how you’ve inserted yourself into being an authoritative voice regarding this. You used to be a natural path based dr. I know this because I went to you and you we’re definitely exercising caution on antibiotics and pharmaceutical prescriptions at the time. What happened!?

    1. Mike May 4, 2021 10:44 am Reply

      If you ask me, the fact that Dr Evslyn has a history of promoting a cautious approach to use of antibiotics and other pharmaceuticals in general gives even more credence to his personal opinion that vaccines are much, much safer than COVID.

      With regard to the person who questions his ethics, Dr. Evslyn’s current and former status with respect to licensure and active practice are openly stated at the bottom of his letter. No problem there.

    2. Thinkkauai May 4, 2021 1:28 pm Reply

      It could be, that perhaps this well educated and experienced physician knows better than the rest of the google docs out there who “do their own research”. Perhaps in his years of practicing he’s seen & experienced things most others only hear about. If he has pivoted in his stance, that shows that he too can still learn, grow and adapt. Maybe hes not set in his ways” and dug in on his decisions based off political, irrational or just economic based hard stances. He’s not forcing you to do anything he’s offering an alternative voice and opinion based on years of experience and education. He should be applauded. Anyone stuck on the far opposite anti-everything stance wont change their mind anyway. Gives people on the fence or open minded people something else to think about. its a personal choice both ways, dont make it out to be anything else.

    3. all da info May 4, 2021 3:17 pm Reply

      @Kind sir: good points. We went to Dr. E in te past as well.

      Yes, there is the push to get vaccinated. Vaccines have saved lives over the course of history. But those were not rushed as this one is. We are being misled by not being informed of the real risks (severe reactions including deaths). And personal choices aside, some people can’t take the vaccine because of the risk.

  7. Marie May 4, 2021 11:01 am Reply

    Whether you believe in getting vaccinated or not. We needed to wait another couple of months before we lifted the restrictions on traveling for residents and tourists. That couple of months would have gotten more people vaccinated and given a chance for some immunity to be built up. We now have major community spread and some people are sitting ducks to get sick. The unvaccinated by choice, some people because of health reasons they can’t and all the children who can’t that are more prone to getting sick with the new variants. It’s a shame we lost a very safe community to a government that just wants tourist dollars. Our mayor caved to pressures from Green and representatives that couldn’t stand Kauai being safer than the other islands. I can’t stand seeing Green on TV anymore.

  8. Colin McCleod May 4, 2021 11:36 am Reply

    Hey Doc…I’m curious why “experts” like you seem to be immune to other more effective treatments for SARS Cov-2? Like Ivermectin, completely safe and virtually 100% effective at CURING the disease? See this:
    Perhaps it’s just too “simple” for you & your AMA dogma & so easy, therefore, to ignore.
    Colin McCleod

  9. Patrick H Flores May 5, 2021 9:57 am Reply

    Personal healthcare is exactly that, personal, not a function of any governmental body. I for one have NO trust in the integrity of Fauci.
    Patrick H Flores, Wailua Houselots

  10. Chris G May 5, 2021 9:57 am Reply

    Realistically we shouldn’t care at this point if the case numbers rise. The people that are choosing to go unvaccinated at this point are doing so with full knowledge of the risks, and with every opportunity to get the vaccine. They do not care. So let them achieve their own immunity by getting the virus and dealing with any long-term effects that may occur.

    We are all lucky to have access to super-effective vaccines, so those of us that are fully-vaccinated are not threatened by rising case numbers. Yes, there’s a tiny chance you’ll still get the virus, but even in those rare cases, the effects will be very mild.

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