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Why the difficult decision to opt out was the correct one

Mayor Kawakami’s decision to opt out of the Safe Travel’s program was a difficult one, I am sure, but it was either do that or most likely face the economic and social consequences of another complete lockdown, including the closing of all schools. Closing schools not only creates economic hardship but could affect a generation of children. Please note closures and lockdowns are now happening all over the mainland and people from those areas are coming here. Predictions that Covid could become much worse on Kaua‘i with the current Safe Travels program come down to four main points:

• There is very good evidence that the number of infected people in a place like California is at least three times greater than the 1.5% of the population that they know are infected by their testing programs. And at least 40% of those people have no idea they are infected and may travel. It should also be noted that the California case count has jumped dramatically in just the last three weeks and apparently the governors of all three states on the west coast have called for a 14-day quarantine for all people coming into their states due to the nationwide surging.

• A single pretest before flying has been well proven to miss 30-40% of those infected because they are too early in their illness for the test to pick it up. A pretest will also miss everyone infected after their test including those becoming infected during their travels.

• The state leadership has been predicting 1 case per 1000 arrivals will be infected and not detected when they arrive here. We have consulted with experts at the University of Washington and UH and they believe that the number that will come in infected and not detected will be 7 or more people per 1000 arrivals. If we have 30,000 visitors per month on Kaua‘i that would mean that at least 210 people per month could land here infected.

• The numbers on Kaua‘i may end up being predictive for the state. The State’s testing program of visitors to Kaua‘i who were tested at 4 days after arrival (after a negative pretest) had 5 test positive out of 331 which suggests that up to 15 per 1000 arrivals could be arriving infected. This result of the state’s testing on Kaua‘i is 15 times higher than the state predicted. State testing done at four days after arrival (including all islands) averages to about 7 per 1000 missed by the single pretest. Please note that 7 infections missed per 1000 arrivals is the same number as the experts we consulted with predicted would be missed and is still 7 times higher than predicted by the state. In a little over six weeks since the reopening, Kauaʻi had double the number of cases we had in the first 7 months of the pandemic: 61 cases and 0 COVID deaths in the first 7 months rose to 131 cases (total) and a death in a little over six weeks—and almost all travel related.

The problem with so many possibly coming into the state infected and not detected as that they can act like kindling for a forest fire. Each visitor may give it to just a single person on Kaua‘i but if that person takes it home to their family, the family spread can be rapid and widespread. Returning residents, with a false sense of security after their single pretest, may also bring it directly to their families.

Opting out was not the Mayor’s first choice. His first choice was very similar to what the CDC is now considering as their new formal recommendation. The CDC stated last week that they are considering new guidelines including decreasing the 14-day travel quarantine to seven days with a second test. That would be a safe way to reopen and I am sure the Hawaii DOH will be considering these new CDC guidelines for quarantines in general and travel quarantines as they are created. The CDC specifically is not recommending eliminating quarantines with just a single pretest and every place that has opened with a single pretest and no quarantine has had a huge surge in cases.

Support our Mayor. A vaccine is coming, treatments are getting better. Let’s open correctly and stay safe.

Be safe Kaua‘i, wear your mask, and we will get through this.

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, M.D. 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.
Source: The Garden Island

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