In just three weeks the number of confirmed COVID-19 cases on Kauai since the pandemic began had jumped from 199 to 289 as of Monday, sending residents flocking to get tested, closing at least one bar and ratcheting up pressure on residents to get vaccinated. On Sunday an employee at Kauai’s jail also tested positive for the virus, setting off mass testing at the facility and raising the prospect of yet another major coronavirus outbreak at one of the state’s correctional facilities.

The small island has weathered the pandemic remarkably well with low case numbers and just two deaths. But health officials say loosened travel restrictions, the introduction of more transmissible variants and a growing laxness among the community is likely contributing to the rapid rise in cases.

The encouraging news is that large numbers of the island’s seniors are vaccinated, said Lee Evslin, a retired doctor and former CEO of Kauai’s Wilcox Hospital. “I’m hopeful that we have protected a fair number of our vulnerable, but I’m very worried about it seeding deeply into the community and the clusters spreading on and on,” he said.

The spike coincides with Kauai’s decision to rejoin the state’s Safe Travels program last month, which meant trans-Pacific travelers no longer had to spend at least 72 hours on another Hawaiian Island before traveling to Kauai. Before entering Kauai they were also required to take a second COVID-19 test. A second option for avoiding quarantine was to go directly to a “resort bubble” upon arriving on Kauai.

Kauai District Health Officer Janet Berreman said it was “reasonable to conclude” that the easing of travel restrictions contributed to the rapid spike. More tourists have likely brought in more of the disease, including variants, though she noted that many of the new cases are associated with local residents who have traveled and community spread.

Over the weekend, Kauai County officials put out an alert that multiple COVID-19 clusters were traced back to two restaurants in Lihue, Rob’s Good Times Grill and Troy’s Bar, and urged people who visited them between April 16 and 29 to get tested. They also warned that individuals infected with the coronavirus had attended the Ekolu Mea Nui drive-in concert at Vidinha Stadium in Lihue on April 24 and the Sheraton Kauai Coconut Beach Resort Brunch Babes show in Kapaa on April 17 or 18.

Rob’s Good Times Grill has temporarily closed. The restaurant’s management, in a Facebook post, stressed that the restaurant has long had strict safety precautions in place — staff have participated in sanitation training, guests undergo temperature checks and masks are mandatory, while two garage doors allow fresh air to flow throughout the restaurant.

As cases have spiked, there’s been a dramatic increase in testing in the past week, prompting county officials to increase available appointments at the War Memorial Convention Hall to 400 from 350 a day. On Monday all of the appointments had been booked by 10:15 a.m.

As of Monday afternoon the state Department of Public Safety hadn’t reported any results of testing at the Kauai Community Correctional Center. The jail has so far avoided the mass outbreaks that in previous months spread through other facilities, including the Halawa Correctional Facility, Maui Community Correctional Center, Oahu Community Correctional Center, Waiawa Correctional Facility and Saguaro Correctional Center in Arizona, which houses Hawaii prisoners. Those outbreaks have led to 1,970 inmates being infected with the virus and nine deaths, according to data from the Department of Public Safety.

While state officials have said they prioritized vaccinating inmates early on, it’s not clear how many of the current inmates housed at the Kauai jail have been immunized.

Toni Schwartz, a spokeswoman for the Department of Public Safety, said that figure wasn’t available because of the transient nature of the jail population. The number of doses that have been administered at the Kauai Community Correctional Center also was not available.

Meanwhile, local health officials are urging Kauai residents to get vaccinated. Some 60% of county residents 18 and older have already gotten at least one shot, which is the highest rate of all the counties. But health officials are now running up against vaccine hesitancy, which is slowing the rate at which the population is getting immunized.

Berreman said she was optimistic that the county could bring the spike in cases under control, and said health officials have quickly ramped up contract tracing and investigations.

Evslin said he ultimately saw it as a “race between variants, vacationers and vaccinations.”

“If the vaccine-hesitant people will come forward and get vaccinated, then we can make a difference in putting out the fire, so to speak,” he said. “Otherwise, I think we are going to see more shutting down.”

On Monday state Department of Health officials reported one new coronavirus- related death and 74 additional infections statewide, bringing the state’s totals since the start of the pandemic to 484 fatalities and 32,654 cases.

The latest death was a Maui man in his 60s who had underlying health conditions and died in a hospital.

The state’s official coronavirus-related death toll includes 374 fatalities on Oahu, 53 on Hawaii island, 52 on Maui, two on Kauai and three Hawaii residents who died outside the state.

The U.S. coronavirus- related death toll Monday was more than 577,000, and the nationwide infection tally was over 32 million.

Monday’s new statewide infection cases include 49 on Oahu, 11 on Maui, seven on Kauai, four on Hawaii island and three Hawaii residents diagnosed outside the state, according to health officials.

The statistics released Monday reflect the new infection cases reported to the department Saturday.