New virus cases likely the tip of the iceberg

The story about the visitor to Kaua‘i who tested negative twice — on the pre-travel test and the voluntary post-arrival COVID test — but then turned positive days later (TGI 10/29) was not unexpected. It was predictable.

This is because the incubation of the coronavirus often takes four to 10 days from the initial infection before it will show up on tests. Additionally, the patient could have become infected before or after the first or second test, especially since no quarantine was involved.

The big question now is: How many other visitors and returning residents with COVID-19 are slipping into Kaua‘i and the state undetected and spreading the virus?

Since the one-test reopening, the frequency of new cases on Kaua‘i has increased noticeably. It is good that Kaua‘i County is providing voluntary post-arrival tests, but because so few of the visitors and returning residents are taking the tests, the new cases are likely to be the “tip of the iceberg.”

Over the week of Oct. 30 to Nov. 5, Kaua‘i County identified eight infectious travelers (four visitors and four returning residents) and one resident infected by a traveler. When the eight infected travelers are measured against the weekly average of 3,836 travelers arriving on Kaua‘i, we are already identifying twice the estimated one-infected-traveler-per-1,000 our state leaders use to justify the single-test reopening plan. Notably, at least three of these travelers actually tested positive on pre-travel testing but results were not provided until after arrival.

With only 2% of the visitors and 20% of returning residents volunteering for a second test, scientific data ( suggests at least two to three times more infections have entered our island undetected.

A more-accurate way of detecting the virus coming in with travelers and protecting our community is the protocol of a PCR pre-travel test, a six-day quarantine, and release on the seventh day based on a second negative PCR test. Such a plan was proposed in mid-June of this year.

Instead, the state and counties reopened with a scientifically-questionable, one-test plan, welcoming travelers from the continental United States where COVID is surging in many jurisdictions.

The reopening plan is putting everyone at risk — hotels, visitor-industry workers, businesses, families and schools. If the travel-related infections create a surge, it may be too late to prevent another shutdown.

It is urgent and important that Kaua‘i reopen, but we must do so SAFELY — not only to protect our community but also to achieve sustained economic recovery.

Economic recovery will not come if we compromise safety. Sustained economic recovery will only happen if we make safety a priority, as Mayor Kawakami has striven to do thus far. As economist Paul Brewbaker said, ”The epidemiological problem is the economic problem. You don’t solve the economic problem until the epidemiological problem is solved, until we mitigate and contain spread of the novel coronavirus.”

If Mayor Kawakami would go back to the governor and propose the six-day, shortened quarantine and two-PCR-test protocol mentioned above, citing the unfolding data on Kaua‘i, a lot of Kaua‘i residents would back such a courageous and innovative move — a move that will keep Kaua‘i the safe, COVID-free, economically-sustained kipuka it can be, like New Zealand. Such a proposal would likely find favor with the new Department of Health director, who has acknowledged the increased safety of a two-test plan.

It will be better than a shutdown. And, as visitors adjust and a new vision for tourism emerges, the visitor industry will grow stronger — just as all of us have changed and evolved to keep ourselves, our loved ones and our community safe and well.


Robert Weiner, MD, is a retired, board-certified general surgeon who worked at Wilcox Medical Center and Kaua‘i Veterans Memorial Hospital. He and his wife Linda Weiner started and operated the Kalaheo Clinic for 28 years. He also worked for Kaua‘i Hospice, where he continues to volunteer. JoAnn Yukimura is a former Kaua‘i County mayor and councilmember. She helped to start The Kaua‘i Bus and Kaua‘i Island Utility Cooperative, and was instrumental in stopping high-rises on Kaua‘i.

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