Kaua‘i has done a great job limiting the spread, but COVID-19 is far from eliminated.
The mainland is the current epicenter of the pandemic and poses as much of a threat to us as China originally did to the rest of the world.
Certain Asian nations have contained the virus and are slowly re-opening. If we are willing to learn from these nations, act aggressively, use newer technologies, and work together, Kaua‘i could also become the example that other places try to learn from.
The general principles that have worked elsewhere are widespread testing, contact tracing, isolation of positive cases, and control of borders. I believe we should consider the following actions:
• Move forward with Governor Ige’s new plan of “safer at home” rather than “stay at home” and reopen businesses that allow for social distancing. We should still require masks in these freshly opened businesses;
• We will need to continue constant tracking of cases in Hawai‘i and understand that we may need to backtrack if there is a new surge of cases;
• We have to keep in mind that this is not a return to normal. Hugging and handshakes are not back. Social distancing, proper hand-washing and sanitizing remain vital;.
• By far our biggest risk is still from people arriving from other places, tourists and returning residents alike. This risk will remain until we have better treatments and/or a vaccine. But, with vigilance and technology, we could make Kaua‘i a safer place to live as well as to visit. We could possibly start welcoming small numbers of tourists if we can ensure that they will not bring in the virus. Until we learn more about immunity and until very-rapid and easy testing for the virus is available, we will need to continue a 14-day quarantine;
• If tourists in any number are going to start arriving, we will need a better way to enforce the quarantine. We could consider adopting high-tech measures such as one used in Hong Kong. Their system requires all incoming people to wear a wristband for 14 days which pairs with an app on their cell phone. This system alerts authorities if the quarantine is violated. As we learn more about COVID-19, we may be able to allow those with proof of recovery and negative cultures to avoid or shorten the quarantine;
• Another option would be a choice. A returning resident or tourist could go to one specially planned quarantine hotel without a bracelet or go to their home or the hotel of their choice with a bracelet;
• A new saliva (spit) test and another done by swabbing only the front of the nose have been approved and allow rapid results. Tests like these may help us screen those wishing to enter the state and will greatly help us to continue screening ourselves.
Extensive testing, isolating those who have the virus, and tracing all their contacts is a vital part of containing epidemics. This has traditionally been done by hiring many public-health workers. The voluntary use of specially designed phone apps could revolutionize contact tracing. Apple and Google are working together to create such a “contact tracing tool.” To ensure privacy, the app does not show where the contact happened or who the contact is. It only shows that the two phones were near each other for some period of time. For these apps to be effective, reportedly 60% or more of the population of an area needs to use them.
I am sure in America, apps like this will be voluntary and controversial.
Speaking personally, if I had an app that told me that a member of my family had contact with an infected person and we could then act quickly to minimize that risk to ourselves and to the island, I would use the app without hesitation.
Opening our county to all of us who live here and limiting tourism to only those that are proven to be healthy will provide us with a unique opportunity to work on Kaua‘i. We need to fix our overdependence on tourism, lack of affordable housing, and expensive imported food. This could be an important turning point to help our island become more self-sustainable.
Obesity, hypertension, and diabetes all make death or severe illness from COVID-19 much more likely. These conditions are strongly linked to processed foods (foods made in factories) full of sugar, fats, additives and pesticides. This is the time to dramatically enhance Kaua‘i’s organic-food-growing capacity.
I think we all feel a little safer on Kaua‘i right now, but one infected person can still spread this widely. We need to be open to new ideas to contain a threat which is unlike anything we have faced in our lifetimes.
If we open up too casually or too quickly, we will be back in danger.
If we open carefully, slowly and thoughtfully, we could end up with an island that is better than it was before the epidemic.
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 is a former health-care administrator on Kaua‘i and periodically writes a column for The Garden Island.
