The Hawaii Department of Health’s cluster report this week focuses on the spread of the coronavirus among restaurant workers.

Restaurant workers face greater risks of transmission because they not only interact with the public and kitchen staff, but often work in hot spaces with poor ventilation and limited space, which makes physical distancing impractical.

“The risk of transmission is high in work environments where COVID-19 safety protocols are not implemented or consistently followed,” officials said in the report.

In April, health officials investigated a cluster of 38 cases associated with a fast food restaurant on Oahu. An initial 11 out of 35 employees were diagnosed with COVID-19. None had been vaccinated.

The virus then spread to another 27 household members, including four that worked at three other fast food restaurants. Health officials identified two more clusters with seven cases at those other restaurants.

None of the employees were hospitalized.

However the restaurant employees were allowed to work with symptoms despite a pre-check requirement, according to the Health Department. Also, employees that had symptoms consistent with COVID-19 and stayed home while sick were allowed to return without testing for the virus, officials said.

Last month, officials investigated a cluster of six COVID-19 cases associated with a restaurant on Molokai.

The restaurant closed down immediately after the first employee tested positive.

Four out of 35 employees at the restaurant rested positive for SARS-CoV-2, while another developed symptoms but was not tested. A close contact of one of the employees also developed symptoms and tested positive.

None of the employees with COVID-19 had been vaccinated, but none of those infected had to be hospitalized.

Due to the heat, mask compliance was low among kitchen workers. Also, the employees carpooled to work, which increased the risk of transmission, health officials said.

To prevent transmission, they said, restaurant employers should enforce mask use and physical distancing, and improve ventilation, especially in small kitchens. They can also educate employees about safer carpooling practices, which include rolling down windows, wearing masks, and not eating or drinking in the car.

Most importantly, officials said, employers should encourage employees to get vaccinated by offering paid time off to get the COVID-19 vaccine or other incentives such as gift cards, event tickets and cash.

“Vaccination can prevent COVID-19 transmission, and vaccination eliminates the quarantine requirement after exposure,” said health officials in the cluster report. “These two vaccination benefits can help restaurants and businesses stay open and reduce the negative financial impact on employees and owners.”

The report, published Thursday, reflects clusters under investigation for the past two weeks.

>> On Oahu, officials are investigating a cluster at a correctional facility resulting in 35 cases and two clusters from social gatherings that resulted in 44 cases. Another two clusters are in the “other” category, resulting in another 44 cases, are also under investigation. The “other” category can include offices, retail establishments and first responders.

>> On Maui County, officials are investigating two clusters in construction and industrial settings with 27 cases, a cluster at an educational setting with 14 cases, and a cluster at a restaurant with four cases.

>> On Hawaii County, officials are investigating a cluster with 89 cases at a correctional facility. The Associated Press reported today that a coronavirus outbreak at the Hawaii Community Correctional Center in Hilo has grown to a total of 99 inmates and 13 staff.