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LANAI CITY, Lanai— No one knows exactly when the coronavirus arrived on Lanai. The first recorded cases on Oct. 20 were detected in a health care worker who had traveled to Oahu and three employees of the Four Seasons Resort Lanai at Manele Bay.

But those were just the first visible cracks in a growing public health crisis that has shattered this island’s distinction as the state’s lone coronavirus-free sanctuary.

In six days the infection count shot up from four to at least 79, stoking fears that this tiny isle of fewer than 3,000 close-knit residents could be on the verge of a coronavirus free fall. Health workers say they expect the positive case count to continue to climb as hundreds of results trickle in from a massive weekend testing drive.

The virus has infected numerous kupuna, including some with preexisting health conditions, which, along with their age, make them more vulnerable to the deadly disease. At least 15 students at Lanai High and Elementary School are also infected. Some of these students brought the virus home, spreading the contagion to family members.��

With one school, one gas station, two grocery stores and less than 30 miles of paved roads, health officials worry the island could prove to be the ultimate petri dish.

As health workers rush to uncover how deeply the virus has pervaded the Lanai population, many residents say what they fear as much as the virus is the unknown. How many people have been infected? Is it even safe to hunker down with other family members at home?��

“We don’t have a plan for how we’re going to handle this,” lamented Butch Gima, a state social worker. “We’re in dire straits here and we’re still in reaction mode.”

On Monday Gov. David Ige approved a request from Maui Mayor Mike Victorino to send the island into a strict shutdown. Starting Tuesday Lanai residents and visitors will only be permitted to leave their homes or hotel rooms for essential purposes, such as grocery shopping or to see a doctor.��

Over the weekend many residents started sheltering at home preemptively. Those with second homes on the mainland boarded airplanes and fled.

“We have a friend who flew in Wednesday thinking that he’s coming to the one place in the United States that doesn’t have COVID,” said Manele resident David Green. “Of course, he had very bad timing.”

Coronavirus Free Fall

The fact that the island was COVID-free for the first seven months of the pandemic led some residents to gradually relax their vigilance. People loosened their adherence to mask-wearing and physical distancing guidelines. Some residents resumed having baby showers, birthday parties and children’s sleepovers, according to a dozen residents and health care workers interviewed for this story. A Civil Beat reporter traveled to Lanai last week to document the public health crisis that was just beginning.

“We were locked down here for so long, it felt like prison,” said Neal Byumanglag, a 59-year-old construction worker, referring to longstanding travel restrictions that kept most Lanai residents confined for months on end to the island’s 140 square miles.

“It’s like putting a dog in a cage,” he said. “What do you think that dog’s going to do when you open the cage back up? It’s the same thing with people here.”

But it was more than island fever. Many Lanai residents depend on regular trips to Maui to access cheaper prices on food and supplies at Costco and other big box stores.��

When travel restrictions eased in mid-October to allow Maui County residents to bypass the mandatory 14-day quarantine when traveling between Maui, Mokokai and Lanai, some Lanai residents resumed regular trips to Maui to shop or see family and friends.��

The return of tourism to the island on Oct. 15 signaled another psychological shift toward normalcy. Hundreds of hotel workers returned to their jobs for the first time in months.

So when the virus finally seeped onto the island, it met a population that had largely let down its guard — and it exploded.

“Good times breed bad habits,” said Dr. Lorrin Pang, Maui District health officer, during a community meeting held over Zoom on Friday. “You know, forget the mask, forget the distance, wash hands with a little splash of soap, whatever.”

“You guys had good times and so there were these kinds of bad habits,” he said. “But you’re picking up the good habits real quick now because it’s scary how fast this thing goes.”��

State health regulators have identified two large social gatherings that likely contributed to the disease outbreak. Other infections are attributed to household transmission, a challenge exacerbated by the island’s prevalence of multigenerational and multi-family households.

There are no visibly homeless people on Lanai. But there are those who don’t have homes. Families that can’t afford the going rent are routinely forced to pack into small cottages with relatives or friends.

There are households on Lanai in which as many as five people are infected with the virus while several other people in the house have tested negative or still have pending results, according to Jared Medeiros, associate medical director of Lanai Community Health Center.

The island has four isolation beds for infected residents who cannot feasibly self-isolate at home. But health workers say stopping spread of the virus between household members is improbable.

“How do I separate the pack?” Medeiros said. “I can’t. The virus is spilling and spilling and spilling.”

Worst Case Scenario

If cases continue to mount, a frightening set of challenges could be in store for the sickest patients.

The island’s only hospital is a three-bed emergency department with no critical care beds or specialists. The hospital has a ventilator, but no respiratory therapist trained to operate it. Patients who develop COVID-19 symptoms severe enough to need hospital care must be flown off the island.

On Friday, Medeiros said he tried unsuccessfully to gain clearance to fly several coronavirus-infected kupuna with less acute symptoms to Maui or Oahu, where there is readily available hospital capacity to treat them should their conditions deteriorate.

“I was told they don’t do just-in-case scenarios,” Medeiros said. “So you want us to just wait until they need to be on a ventilator to ship them out?”

There are risks involved in transporting critically ill patients. But this has always been the case when someone on Lanai suffers a heart attack or loses blood in a car wreck.

The unique quandary posed by Lanai’s COVID-19 outbreak is a numbers problem. What happens if several Lanai residents who’ve contracted the virus fall ill and need critical care all at once?

Lanai’s population is composed of the primarily Filipino descendants of workers recruited as early as the 1920s to help James Drummond Dole start up what was once the world’s most productive pineapple plantation. Also significant is the Pacific Islander population. Across Hawaii, both of these ethnic groups are being disproportionately sickened by the virus.

All told, 7% of the state’s 14,672 recorded COVID-19 cases have required hospitalization.

Porous Borders

On Thursday, as data from a second day of testing showed Lanai’s COVID-19 outbreak had grown to affect at least 20 people, a pilot for Mokulele Airlines burst out of the Lanai Airport in search of three passengers.

The passengers had disembarked the airplane and slipped out of the airport without having their temperatures checked.

The pilot would quickly learn that they had already left. They were on a shuttle en route to the Four Seasons Lanai Resort at Manele Bay.

Temperature checks and additional screening for people with COVID-19 symptoms or temperatures of 100.4 degrees or higher are safeguards implemented at Hawaii airports to help prevent the spread of COVID-19.

But on Lanai, these and other defenses are falling short, according to David Embrey, an organic vegetable farmer who helps operate Lanai Airport’s traveler screening process.

Embrey said he doesn’t have the basic tools he needs to decipher which incoming travelers must quarantine. The airport, he said, doesn’t even have an accurate count of how many people are coming or going.

About an hour after the Mokulele flight landed, two passengers had returned to the airport to have their temperatures belatedly checked by members of the National Guard.

An airport security guard called the Lanai police station to request an officer to track the third passenger, who was not answering his cell phone.

All travelers entering Lanai from the airport must fill out a mandatory online form that the state touts as critical to protecting the health of Hawaii residents and visitors.

Elsewhere in the state, the process works like this: Travelers submit their mandatory health and travel information, including proof of a negative COVID-19 test result, to the state’s Safe Travels website prior to their departure. All of that information is synthesized into a personalized QR code that gets scanned by an airport screener upon arrival.

The problem on Lanai is that the airport doesn’t have a QR code reader. So Embrey said airport screeners have improvised, asking incoming travelers to fill out an identical travel form with pen and paper. They do not review travelers’ negative COVID-19 test results.

On Lanai, the option to bypass the state’s mandatory 14-day quarantine with proof of a negative COVID-19 test hinges on the honor system.

“The paperwork is kind of B.S.,” Embrey said. “Anybody can write anything on the paperwork.”

Many Lanai residents met the return of tourism to the island earlier this month with apprehension, knowing that economic recovery could come only with the cost of greater public health risk.

Ariel Yagin, a machine operator for Pulama Lanai — the management company that oversees tech billionaire Larry Ellison’s 98% ownership stake in the island — said Lanai should have kept its borders sealed shut until the rest of the state got better control of the virus.

“I understand we thrive off tourism, but the people matter more,” Yagin said. “I have a feeling there is going to be a big cost to pay.”