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.

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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.