Although it appears too soon to lift the lockdown on Kaua‘i (we must take counsel from our public health experts on this), it is not too soon to talk about how to do it. We must restart our civic life as soon as it is safely possible. To do this, we must figure out how to reopen Kaua’i in a COVID-19 infected world while avoiding reinfection and another lockdown.
The purpose of this paper is to spark community dialogue to find the best possible way to move forward safely. The specifics may change because the best available knowledge changes daily, but the principles should remain the same.
To prevent our island from being reinfected as we reopen, we must do two things:
1. Establish a process to prevent reintroduction of the virus by rigorously screening tourists, inter-island travelers and returning residents.
2. Establish an early warning system that will immediately detect screening failure and do strenuous contact tracing of the virus-carrying travelers and their contacts to prevent spread.
An effectively designed and enforced visitor screening and quarantine system will be our first line of defense. Without it, Kaua’i will risk the high human and economic costs of reinfection.
Under today’s existing locked down conditions, visitors, travelers from other islands and returning residents are still coming to Kaua‘i and we cannot legally stop them. The numbers are small, but it takes only one infected traveler to seed viral spread, and recent reports indicate that some travelers are not abiding by the 14-day quarantine.
Even if we initially intend to reopen Kaua‘i for residents only (an appropriate Phase I), if word gets out that Kaua’i has contained the virus, the numbers of travelers could grow quickly and overwhelm our screening, quarantine and healthcare systems.
Thus, we must be ready at the beginning of any reopening to register and test all incoming travelers before they leave Lihu‘e Airport (or Nawiliwili Harbor if cruise ships are allowed to return, not a good idea).
To do this, we will need a sufficient stockpile of rapid COVID-19 tests.
Those who test positive must go into isolation in a hospital or in a hotel prepared to handle such guests. Those who test negative will be asked to sign a consent form agreeing to abide by a quarantine to protect against false negatives.
They will also be quarantined in a hotel. The consent form will inform them that any violation of the quarantine will result in substantial fine and return to their home at their cost. All visitors will be charged a COVID—19 prevention fee covering the costs of quarantine and enforcement. As as been successfully done in many parts of the world, Kaua’i should require tracking apps for all travelers.
An early warning system to detect whether the virus has slipped through Kaua‘i’s screening process will be very similar to the system of detection and spread prevention in place now—only better, with more available testing and more effective quarantine protocols added to our present system of mandatory masks, prohibition of gatherings, and safe delivery of services.
South Korea, Taiwan and Iceland have proven that widespread testing is necessary to preventing the spread of the virus. Based on the interview of South Korean infectious disease expert Dr. Woo-Ju Kim, widespread testing means making tests easily available to anyone showing one of the symptoms—sore throat, cough, fever, loss of taste and smell, difficulty breathing and for the elderly, fatigue, loss of appetite and mild body aches. It would also encompass the DOH’s expanded criteria of testing anyone who had contact with persons with the disease or suspected of having the disease. It would also be available to anyone who wanted a test and was willing to pay for it.
Kaua‘i must also upgrade its quarantine and isolation policies by requiring that quarantine and isolation be conducted outside the home. If it is not safe for healthcare and first responders to be housed in their homes, it is not safe for COVID-infected persons or residents returning from travel to be isolated or quarantined in their homes—especially if there are kupuna or essential workers who are part of the household.
An infected employee at McDonalds in Kona started a viral cluster not only at work, but also at home where there were many others living, making it clear that to prevent community spread, quarantine and isolation need to be done outside the home.
Kaua’i has a unique opportunity to contain the novel coronavirus. We are able to control our borders much better than anywhere else in the country.
We have a small population of caring, courageous and creative citizens who care about each other and are pulling together despite huge challenges. We have responsible, caring leaders; we owe Mayor Kawakami and team our gratitude.
What we don’t have is time to spare. We must act quickly to ensure that the virus is contained before more economic damage is done to our families and businesses. As soon as the virus is under control, we must reopen the island in phases with stringently enforced screening and quarantine requirements to keep us all safe and to lay the foundation for successful economic recovery.
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JoAnn Yukimura is a former mayor and councilmember who has served her community for many years. She can be reached at jyukimura@gmail.com.
