LIHUE, Kauai— In more than 56% of Kauai households, at least one member of the household has lost their job because of the COVID-19 pandemic.

More than a third aren’t sure they can pay next month’s rent or mortgage and nearly a third include people with health conditions that put them at highest risk of infection.

Those are key data in a new Hawaii State Department of Health survey of 189 Kauai households that were randomly selected from Census data and interviewed in person on April 22 and 23. It is apparently the first such local COVID-19 survey anywhere in the country.

A preliminary report found that residents are generally able “to meet their basic needs, (but) they are very concerned for their continued ability to do so over the next few months.” The households interviewed contain a total of 635 people, according to the Department of Health.

In all, the department concluded the results raise additional doubts about whether Kauai can “reopen to tourism safely without risking a second wave of infections.” The survey results were released Thursday.

The report concluded: “Due to the vulnerability of many of our residents, and the limited ability to surge our health care capacity, a cautious approach to reopening is advised.”

The report acknowledged that, so far, Kauai has managed to avoid large numbers of COVID-19 cases, with the island total remaining at 21 on Friday over a period that now spans more than two weeks.

“As a state with a high percentage of its working population in the tourism sector, and the uncertainty regarding when it will be safe to reopen this sector of our economy,” the survey observed, “the state should focus on how to meet the resource needs of this group through job development and unemployment benefits.”

The survey utilized an approach developed by the federal government’s Centers for Disease Control and Prevention. It allows communities to use sophisticated statistical techniques to evaluate local health and environmental problems.

CDC declined to comment on the Kauai survey on COVID-19, but a CDC spreadsheet and interactive map of 266 CASPERS conducted nationwide shows no other that involved the pandemic.

Department of Health personnel said CDC officials told them Kauai’s COVID survey is the first in the nation.

Worries About Restarting Tourism

The concerns about reopening to tourism on Kauai emerged, according to Lauren Guest, the public health preparedness planner who led the survey effort, even though data show Kauai households have already suffered serious financial damage and face many more months of challenging conditions.

Guest said few, if any, of the survey findings were surprising in the context of concerns that have been widely reported on Kauai since the start of the COVID-19 crisis. But, she said, the new data present statistically validated and precise measures of problems and challenges facing the island.

The mathematical certainty that the new results mirror community attitudes, she said, can help health planners deal with the crisis.

“The situation with food and housing” on Kauai, she said, “is coming to a head and we see the repercussions of that. Clearly, we have a high percentage of households where a member is at high risk of severe disease. That is the strongest argument for why the county and state need to be very cautious in their reopening strategy.”

The survey project used a methodology called CASPER—for “community assessment for public health emergency response.”

The approach was developed by CDC to allow local public health agencies to quickly provide precise statistical data on specific situations.

The CASPER methodology has been used in Hawaii only once, in 2018, when one was conducted in Kauai County on hurricane preparedness. In other states, CASPER surveys have been used to analyze the Zika and H1N1 viruses, problems with the water system in Flint, Mich., hurricane damage and the California drought.

The survey also found that:

— One in 20 Kauai households includes at least one member who has been tested for COVID-19, a finding that roughly mirrors the statewide testing rate. None of the households had seen positive COVID-19 tests, but 4.2% included at least one person who had COVID-like symptoms but was not tested.

— A total of 70.1% of households are concerned about getting sick with the virus. A total of 94.1% of households were dealing with “medium” or “low” levels of stress.

— Nearly 32% of households include people who have suffered emotional distress because of the crisis, but 21% did not know where they could get mental health assistance.

— Slightly more than a third of Kauai households include at least one person suffering from asthma, diabetes, serious heart conditions, compromised immune systems, chronic lung disease or liver  disease, all of which place them at high risk for COVID-19.

— Fully 97.9% of households had enough cloth masks so everyone in the home can wear one when they go out, although only 82.1% of the household members did so consistently.

Although the survey did not focus closely on the success residents have had getting unemployment insurance benefits, 87.6% said they had applied. Members of survey teams reported anecdotally that many residents had difficulty with the application process or receiving money.

“More state resources and personnel must be directed to this area,” the report concluded. “The most immediate and effective way to assist Hawaii families is through direct provision of cash payments.”

It also reported that Kauai households in general “appear supportive of stay-at-home orders,” but that “survey teams reported that households expressed concerns related to what the next few months will look like and the plan for lifting restrictions.”