The truth about the state’s Safe Travels program is easiest to see from Kauai’s data.

Prior to the Oct. 15 reopening, Kauai had one of the lowest COVID-19 infection rates in the country. Since the reopening, Kauai has experienced community spread and 65 new cases — doubling, in little over one month, the total number of cases it had in the first seven. Eighty-nine percent of the post-reopening cases are travel-related.

This is just the tip of the iceberg because most incoming travelers are not being tested between Days 5-10 of arrival when the incubating virus is most likely to show up on tests. One negative test does not mean a traveler is not infected; it often means that his/her viral load is not yet large enough to register positive on a test. Not testing during Days 5-10 would likely miss many infected travelers.

The state’s one-test program has seeded community spread (endemic transmission) in what was essentially a COVID-free island. While not as apparent, the same dynamics of infection from incoming travelers is happening statewide, more obscured, but in larger numbers.

A key factor in justifying the safety of the Safe Travels program has been Lt. Gov. Josh Green’s oft-repeated claim that only 1 out of every 1,000 travelers coming to Hawaii is likely infected. But Dr. Green has not made available the science behind his ratio, while science-based analysis to the contrary abounds (“A Plan for Safely Reopening Hawaii: Kauai as a Model”; “How Hawaii Can Get Coronavirus Right in 12 Steps”).

Green recently cited the 18 positives out of 15,000 statewide tests as data supporting the 1/1,000 prevalence estimate. But as discussed below, the legitimate data shows 7-15 positives out of 1,000.

In his surveillance methodology, a random sample of 10% of travelers was invited to be tested on Day 4, post-arrival. At a Nov. 19 press conference, preliminary numbers were shared by Green: three positive cases out of 616 tested on Oahu, zero out of 331 on Kauai (since corrected to five out of 331), one out of 392 on Maui, and 23 out of 15,931 for Hawaii island.

With 90% of the tests from Hawaii island, the results are suspect. Thousands of these tests were taken from Mayor Harry Kim’s required day-of-arrival second tests, meaning they were done sooner than Day 4 after arrival. They were also less-accurate rapid antigen tests, which miss many more infections than PCR tests. Those Hawaii County tests should not have been included in the study.

Excluding the flawed Hawaii County data, the combined Oahu, Maui and Kauai data shows nine positives out of 1,339 tested, or seven out of 1,000 travelers. Kauai’s data alone shows 15 out of 1,000. This means that for every 10,000 travelers to Hawaii, instead of 10 infected travelers predicted by the lieutenant governor, 70-150 per 10,000 are entering Hawaii.

It is no wonder that the daily number of new cases on Oahu has not been going down, and the case counts on the neighbor islands are rising rapidly. The COVID faucet has been turned on, and infected travelers are flowing into Hawaii unchecked every day at a rate that will soon make the disease impossible to control.

The failure of the Safe Travels program is endangering our residents, businesses, kids and kupuna daily. We need tourism, but it must be safe tourism that will unite us. Our leaders must make course corrections now, based on science and accurate data.

Otherwise, it will soon be too late.

Robert S. Weiner, M.D., served for 36 years as a general surgeon for Wilcox Hospital and Kauai Veterans Memorial Hospital; Kapono Chong-Hanssen, M.D., is a family physician and medical director of Kauai Community Health Center; JoAnn A. Yukimura is a former Kauai mayor and councilmember.