Potential futures for COVID-19 on Kaua‘i told

LIHU‘E — State Department of Health Kaua‘i District Health Officer Dr. Janet Berreman was unequivocal when asked to forecast the future of COVID-19 on Kaua‘i during a Kaua‘i Chamber of Commerce webinar Tuesday.

“We’re going to start with the short version, and the short version would be titled, ‘What does the COVID future hold?’” Berreman said. “We would all like to know that, and that talk goes something like this: ‘I don’t know. You don’t know. Nobody knows.’”

But she was able to review a range of possibilities — including best- and worst-case scenarios — over the course of her one-hour presentation.

Any future situation will be shaped by evolution, according to Berreman, who pointed to the delta and omicron variants that developed in the wake of the original virus.

The omicron variant proved less lethal than its predecessors, she said. But that may just be coincidence.

“Viruses are evolving, not intentionally, they just evolve through natural selection,” Berreman explained. “The impact of that is a variant or a virus that can spread more easily to more people is going to replicate more and spread to more people and become dominant. So this selective pressure in evolution is for a virus that can get to more people that can make more of itself.”

A virus’ lethality is therefore arbitrary, and a rapidly deadly virus is arguably less transmissable as a result, because infected people won’t live long enough to pass the virus to others.

But in a worst-case scenario, one or more coronavirus variants would emerge that are more transmissable, can evade immune systems and are, by chance, more lethal.

COVID-19 would exist in a best-case scenario as well, but new variants would still respond to vaccinations and prior infections, and cause milder disease.

“The COVID variants of the future may wind up looking like the common cold that many of us get every year when we aren’t wearing masks,” Berreman said.

The real future will probably fall between these two extremes, she continued, noting she is almost certain of two things: The coronavirus will never go away, and the current pandemic won’t be the world’s last.

Berreman believes Kaua‘i is “reasonably well-positioned” to respond to the ongoing pandemic.

That cautious optimism is due to the county and state’s two years of experience in emergency public health measures, mass testing and vaccination and existing metrics.

To date, 72% of the Kaua‘i County population is fully vaccinated, according to state DOH data. Only Honolulu County has a higher vaccination rate in the state, 80%.

Kaua‘i’s case fatality ratio, or total number of COVID-19 cases compared to number of deaths, is also comparatively low. (Kaua‘i County has reported 27 deaths to date.)

“Our case fatality ratio is about half of what it is statewide, and our state case fatality ratio is about half of the national rate,” Berreman said.

The county and its residents must remain vigilant going forward, she concluded, reiterating the coronavirus may have surprises in store.

When asked what will trigger a “big response” to COVID-19 from state and county officials going forward, Berreman said a rapid increase in case rates would be “a warning sign to pay attention.”

Any new government restrictions would likely be less severe than prior measures, due to vaccines’ efficacy in preventing or minimizing severe disease and the omicron variant’s relative mildness.

“The cost of the preventive measure shouldn’t be more than the cost of what it is you’re trying to prevent,” Berreman said.

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Scott Yunker, reporter, can be reached at 245-0437 or syunker@thegardenisland.com.