Hawaii’s coronavirus death toll rose to 22, with three new fatalities reported Monday as the number of cases continue to surge locally and on the mainland.

The latest fatalities are a “tragic reminder of the impact of COVID-19 on individuals and their families,” health officials said, and include an elderly Kauai resident who died in Arizona while receiving treatment for several months for underlying medical conditions and a female who previously resided in a care home but died in an Oahu hospital Sunday morning. An elderly Oahu man with underlying medical issues was also added to the death count after reviewing his health history.

“We all extend our heartfelt sympathies to the family and friends of these three people. The best tribute to their lives and to the lives of all 22 people who’ve lost the fight against coronavirus is getting everyone in Hawaii to take personal responsibility for their own health and the health of everyone around them,” Health Director Bruce Anderson said in a news release before speaking at a COVID-19 briefing at the state Capitol.

Along with the deaths, the state also reported 23 new COVID-19 cases Monday, including 19 on Oahu, one each on Hawaii island and Maui, and two diagnosed outside the state, bringing the statewide total to 1,243 since Feb. 28.

The new cases include a Nuuanu YMCA employee and a household member, who also belonged to the facility, which was unrelated to a cluster involving two Oahu gyms. An employee of Kona Community Hospital on Hawaii island also contracted the disease.

Most of the 86 cases recorded since last Friday were linked to previous “community spread” clusters, including 44 cases from a training activity at Hawaiian Airlines in which “a person infected during these meetings is linked to a cluster of 20 cases involving two undisclosed Oahu gyms.”

“This clearly shows how easily and quickly this virus can spread from person to person and from place to place when people are not practicing physical distancing, not wearing masks, not staying home when sick, and possibly not washing their hands frequently and thoroughly,” state Epidemiologist Sarah Park said in the release.

Other clusters reported are a result of pau hana gatherings, businesses, urgent care and long-term care facilities, and birthday parties, Father’s Day and Fourth of July celebrations and religious events.

There are 310 active infections in Hawaii, and a total of 911 patients now classified as “released from isolation.” The state’s highest single-day number of confirmed cases — 42 — was reported on Saturday.

Health officials are urging the public to remain vigilant to break the disease chain that “not only impacts people’s health, but will likely delay our state’s economic recovery.”

So far the spike in cases is manageable to identify and isolate new cases; however, community spread is increasing on Oahu and travel-related cases are rising on the neighbor islands. If the spike surpasses 100 new cases a day, state resources would be strained, Anderson said.

An uptick in cases is expected as thousands of students at schools and universities are set to resume classes starting Aug. 4, putting additional pressure on state officials to stop the disease from getting out of control.

The message of prevention must get across to children and young adults who aren’t following the rules in order to keep infections manageable so that health care capacity isn’t overwhelmed, leading to another state shutdown, officials said.

“If we want to open our schools and we want to see colleges open up here we have to have a safe environment,” Anderson said.

Of all the confirmed Hawaii cases since the start of the outbreak, 128 have required hospitalizations, with an estimated 30 individuals still in the hospital, he said.

Of the 96,079 coronavirus tests conducted so far by state and clinical laboratories in Hawaii, just over 1.3% have been positive.

“Community spread of the coronavirus is increasing, and many of these cases are clusters or groups of cases caused by people who chose not to wear a mask or participated in a gathering without physical distancing,” Anderson added. “Disease activity, particularly in Honolulu, is widely circulating and we anticipate hundreds of new cases and additional deaths in the coming weeks if everyone does not increase their use of masks, staying 6 feet apart and staying home when sick.”