We learned through the governor that coronavirus has come to Kauai. As of Saturday, March 14th, there were two identified cases, and both were visitors. It is one more wakeup call. It is not a time to panic, but it is the time for action by each of us. It is also a time for us to learn from countries and locations that have kept the virus under control.
If we do nothing, experts are saying over and over that the disease caused by this virus will very quickly overwhelm our hospitals and caretakers as it has in other places. They also keep repeating that it is possible to slow the rate of spread down dramatically.
An article in the March 13th issue of Time magazine describes how Hong Kong, Taiwan, and Singapore have been so successful in keeping their numbers and deaths down. Singapore and Taiwan are islands. All three are very close to China, with heavy traffic back and forth.
Despite their closeness to China and the fact that they had cases early in this epidemic, they took very rapid and decisive actions and have at this time very little evidence of spread. The steps they took included:
• They rapidly instituted widespread testing for the virus, with careful follow up of contacts and isolation protocols;
• Put social distancing in place; streets became empty, all mass gatherings were canceled, and schools and many non-essential businesses closed;
• Had tight border controls and screening procedures.
Our Island has proved its resilience before. I remember when FEMA came after Iniki. They were amazed at the way we all pulled together to recover. This time we need to pull apart at least for now. And we can do it. Now that cases have been identified on Kauai despite the limited testing, we need to put the social distancing in place today. I apologize for repeating some of these ideas. Just days ago it seemed we might have time, but now we need to take action.
• Recommendations in many of the cities and states affected are that anybody who can work from home, should. All mass events, group meetings, team sports should be canceled. I applaud the County for the actions they have taken regarding county parks and the convention center.
• Looking at the sweeping measures taken by mainland cities in the last two days, I believe we should do the same. Government agencies should call for the closing of restaurants, bars, entertainment venues. Restaurants might do as New York is doing and stay open for take-out which better protects all involved. All private sector and government employees that can work from home or released for several weeks should be allowed to do so.
• New York, LA, and Seattle have become ghost towns while our towns are filling with tourists taking advantage of cheap flights. I have seen $99 one way tickets from Seattle. Seattle is the American epicenter of this epidemic. New Zealand and Australia have both put in place mandatory two weeks of self-isolation for anyone entering their countries. Canada has just shut its borders to all non-citizens. We are probably more vulnerable than these countries with our limited hospital resources. I believe that we should strongly discourage tourists from arriving by plane for at least two weeks if not longer, and we should end the cheap fares now. Everything we read says slow down the spread. Opening the doors to those that may be sick is not a good way to slow the spread.
• CDC says, if coronavirus is in your community, the distance between people you interact with within the community should be far enough to avoid droplets, meaning 6-10 feet. Hugging and handshakes should not be part of our culture at this time.
• Great handwashing needs to happen all day long. Droplets can stay on surfaces such as doorknobs for days. Try not to touch your face.
• Anybody who is sick, particularly sick with a cough or fever, should self-isolate.
• Protect the kupuna. This virus is more dangerous for those over 60 and particularly dangerous for older people if they have other medical conditions. Limit visits to the elderly. Consider setting up Skype to stay in touch.
• If ill with cough or fever, call your doctor’s office for instructions, don’t just walk in.
• Try to stay home for the next several weeks.
• While you are staying home, make sure that you get sun and fresh air. Add fruits and vegetables to your diet. Do whatever it takes to remain healthy. The healthier you are, the better the chance that you can handle the infection well.
• The State and the private health sector need to ramp up testing yesterday. We cannot identify and isolate if we don’t test. Wilcox Hospital deserves special thanks for being among the first in the nation to put in place drive through testing. You will need to call your physician’s office for information about referrals for the test.
• I also suggest that the college kids returning from the mainland self-quarantine for 2 weeks. I know it’s hard when you return home to Hawaii, but please stop hugging your friends.
Italy, with its overwhelmed medical care system, should be our wake up call. Once this virus is established it rapidly spreads. This may be the most important time in all of our lives to just stay home.
We can slow this down, and we all have a major role to play.
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.
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Lee A Evslin, MD 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.
