In the 1800s, thousands of infectious disease patients were forced to isolate from the outside world in a newly formed settlement in Kalawao County, Hawaii. Today, Kalawao is the last county in the United States without a single documented coronavirus case.
Call it poetic justice.
In mid-May, 231 of the nation's 3,143 counties had reported no cases of COVID-19. By mid-October, only six U.S. counties reported being COVID-free. This week, as new infections surged across the continental U.S., to the tune of 160,000 cases a day nationwide -- and with 16,841 in Hawaii and 25,369 in Alaska -- only Kalawao had yet to report a single infection.
One hundred and fifty-five years earlier, in 1865, the Kingdom of Hawaii passed a law forcing patients with Hansen's disease, also known as leprosy, into an isolated settlement on the Hawaiian island of Molokai. Located on a peninsula, the Kalaupapa settlement is surrounded by the Pacific Ocean on three sides, with towering 1,600-foot sea cliffs blocking access to the rest of the island.
In 1969, Hawaii abolished the isolation laws that had imprisoned Kalaupapa patients and promised them lifelong health care, social services and the option to stay on at the settlement if they chose to. Of the 8,000 patients who came to Kalaupapa during its 100 years of operation, only 12 remain, according to Dr. Glenn Wasserman, chief of communicable disease at the state health department.
Today the secluded 75-person community on Hawaii's most inaccessible island is the only place in the United States that COVID-19 hasn't infiltrated.
"Thank you for the good news!" Wasserman said when reached by phone on Thursday.
Still, Wasserman cautioned against reading too deeply into the statistics. Kalawao County is considered a "medically underserved area" by the Department of Health and Human Services, a designation use for areas with too few primary care doctors for the population or a concentrated elderly population.
From April: Life in areas with 0 confirmed coronavirus cases
Like many geographically isolated communities, Kalawao hasn't done much COVID-19 testing. Wasserman ordered a few COVID-19 tests after learning individuals had interacted with the outside community. All came back negative.
With an average age of 86 and numerous medical conditions, the patients left at Kalaupapa are extremely vulnerable to COVID-19, so the settlement put strict policies in place to protect them. Patients and staff aren't allowed visitors and if they leave the settlement and return, they're required to quarantine. Staff temperatures are monitored and social distancing and mask wearing are enforced.
"We felt that that approach was much more reliable than lab testing everyone who came in," Wasserman said, stressing that without testing to confirm that no one has had COVID-19, it's possible an asymptomatic individual returned to the settlement and quarantined, never spreading the infection.
The strict rules haven't been easy on the patients or staff. Patients who flew to Oahu to see medical specialists before the pandemic have deferred treatment. Some staff members who live outside of Kalaupapa have chosen not to travel outside the settlement, meaning they haven't seen their families, explained Baron Chan, the health department's Hansen's disease branch chief.
And so, the story of the Kalaupapa settlement has come full circle. "When they were sent to Kalaupapa, patients were taken from their families and friends and they were experiencing loneliness," Chan said. "You're seeing that throughout the world now."
It's been hard, Wasserman said, but the diligence and sacrifices made by the community, health department and park service have prevented community spread in the settlement.
"Their sacrifice is part of the continuing legacy of Kalaupapa. We accomplished what we set out to do and we need to do it until the pandemic is over," he added.
"It's a great day."