Mostly virus-free Kauai hit by pandemic after travel resumes

HONOLULU (AP) - Local residents spent the first seven months of the pandemic sheltered from the virus storm on Hawaii's rural island of Kauai, where sprawling white sand beaches and dramatic seaside mountains draw visitors from around the world.
Early and aggressive local measures combined with a strictly enforced nationwide travel quarantine kept Kauai's 72,000 residents mostly healthy - only 61 cases of coronavirus were known on the island from March to September. On October 15, the state launched a pre-travel test program to get Hawaii's decimated tourism economy going again.
Kauai then had no active infections at all in the first half of October, and at least 84 new cases in the next seven weeks. The surge resulted in community broadcast and the first - and so far only - death of COVID-19 on the island: Ron Clark, who worked as a tour driver for decades.
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Despite Hawaii's cautious reopening efforts that allowed travelers who tested COVID-19 negative before flying into the state to bypass quarantine rules, the Kauai spike illustrates the difficulty of public health - even on one isolated island - to be preserved when the economic recovery is based on travel. Kauai officials have decided the cost of a vacation to paradise is too high for now.
Clark got COVID-19 in November and died about 10 days later. At the age of 84 he worked until he contracted the disease, most recently taking pilots and crew to and from the airport. Flight crews are exempt from state examination and quarantine rules.
The day after Clark's death, Kauai officials said they would oppose the state testing program and urge visitors to re-quarantine for two weeks, whether or not they test negative for COVID-19 before they arrive.
Kauai officials say the single testing program didn't do enough to protect the people living there. With just nine beds in intensive care and 14 ventilators, the island's healthcare system could quickly be overwhelmed by a major outbreak, said Derek Kawakami, Kauai mayor.
To prevent such a scenario, Kawakami suggested a mandatory second test for all passengers upon arrival. His plan would have included a brief quarantine while people waited for their second result.
"We think a negative test is a good prerequisite for getting on a plane," said Kawakami. But "once you land on Kauai ... (travelers) should be able to sit and cool off for three days."
However, the proposal was rejected by state officials. Democratic Governor David Ige said the plan needs to be funded and administered locally.
After the boom in Kauai, the Department of Health attributed most of the island's cases in October and November to returning residents and tourists who brought the virus in despite the pre-flight testing program.
JoAnn Yukimura, a former Kauai mayor and friend of Ron Clark for more than three decades, said his death rocked the community and kept thinking “that he was alone in the hospital. ... How lonely it must have been to die. "
"Ron's death seems such a minor matter to outsiders," said Yukimura. But it "hit us hard because we didn't have death and disease on Kauai - and we never want to get that far."
Prior to the pandemic, Hawaii welcomed around 30,000 tourists every day, spending nearly $ 18 billion over the past year.
In March, when the state's two-week quarantine rule was introduced, tourist arrivals and revenue declined. Since then, the number of visitors has increased with the test program, but only to about a third of the prepandemic levels.
On Kauai, 57-year-old Edwin Pascua has been unemployed since March and is concerned about contact with infected travelers - but would rather work.
"If there were security measures it would reduce everything," he said. "I wouldn't be so scared."
Pascua and his wife, who works in the same hotel, got along on unemployment benefits, but he knows people who "haven't even received a check, an unemployment check".
Despite the recent surge in infections and record deaths in the US mainland, high-ranking Hawaiian officials are insisting that the testing program work before travel.
"The proof is in the pudding," said Hawaii Lt. Gov. Josh Green. "Hawaii currently has the lowest COVID rate in the country as a result of this program."
Hawaii has relatively low hospital stays and death rates, but health experts said that because of the way COVID-19 builds up in the body over time, second tests for travelers would eradicate more infections.
Dr. Kapono Chong-Hanssen, a local Hawaiian doctor who runs a Kauai community health center, said the requirement for a single test "is against medical evidence."
"We are starting to see these big holes in the plan and I think it is a matter of time before we pay the price," he said.
According to the state health department, there have been more than 380 travel-related infections in Hawaii since the testing program began.
It is believed that the actual number of infections in the general population is far higher than reported. Many asymptomatic people who can still spread the disease are not tested.
Dr. Ashish Jha, dean of the School of Public Health at Brown University, said travel restrictions to most locations at this point in the pandemic were "either counterproductive or relatively useless" and could create a false sense of security.
"There is evidence that international travel bans are helpful in slowing things down," Jha said. But "unless you fully lock your country up and do it early on, it's pretty difficult to use as a strategy."
Kauai, isolated from the ocean and largely protected by early restrictions, had done just that.
When the original quarantine rule went into effect, Kauai residents went to restaurants, schools were open, and locals were spending their money in the community. This could happen again if Kauai reintroduces the quarantine rule and locals hope the community stays healthy.
Travel "introduces a steady stream of new infections," said Dr. Janet Berreman, Kauai's State Department of Health officer.
"This tsunami, if you will, the disease," she said, "marched across the mainland from east to west. We are just a little further west across a body of water. But everyone wants to come here on vacation."
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Dallas associate press writer David Koenig contributed to this report.
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