The number of new COVID-19 cases in Hawaii is surging, and remained in the triple-digit range for the fifth day in a row Monday.

The state Department of Health reported 132 new coronavirus cases, the fifth consecutive day of case counts above 100 following a high of 166 on Thursday. Of the new cases reported Monday, 27 were pediatric, representing about 20% of the total.

Hospitalizations are also up, and the positivity rate, or percentage of those tested who received positive results for COVID-19, also spiked to an average of 3.3%.

State and Honolulu leaders, however, are not ready to bring back the restrictions that were eased July 8 for both travelers and residents, unlike the situation in some parts of the mainland.

“We are closely watching the number of new cases, and are concerned that the 7-day average is over 100,” said Gov. David Ige in a statement. “We are also watching the number of COVID hospitalizations, patients on ventilators and in intensive care. We haven’t seen a corresponding increase in the number of hospitalizations or ICU COVID cases so far, and our healthcare capacity is not threatened at this point.”

“We continue to consistently monitor and evaluate the data,” he continued, “and will make decisions as appropriate. The mask mandate is clearly an important part of our response and effort to protect our community. I continue to remind Hawaii residents to remain vigilant.”

While Los Angeles County dropped its indoor mask requirements, only to reinstate them later, Hawaii always kept them in place. Ige has said he does not plan to drop the indoor mask mandate until the state hits a vaccination rate of 70%.

On Monday the American Academy of Pediatrics also recommended that everyone over the age of 2 wear masks in school this fall, even if fully vaccinated.

Mayor Rick Blangiardi said moving back to Tier 4, now that the city has reached Tier 5, is not an option.

“A key factor to note is the disease is still prevalent in our community and this increase in cases reflects spread among unvaccinated residents, including children who are not eligible for the vaccination because they are too young and are being infected by adult household members,” Blangiardi said in a statement. “Going back to Tier 4 is not an option. Now is not the time to remain complacent. Getting vaccinated is safe and easy and I urge all who are able to get vaccinated now.”

The surge is due mostly to the delta variant, which is highly transmissible and now present in all four major Hawaii counties, according to Dr. Janet Berreman, a pediatrician and Kauai District health officer.

She sees it as more of a contributing factor than Fourth of July gatherings, noting that the spike following this year’s Independence Day is higher than the one that followed last year’s holiday weekend. This year Hawaii also started off with a higher number of cases heading into the holiday weekend, with a rate of increase that is still rising.

The Health Department is also seeing Hawaii residents who have traveled to the mainland and back again while infected but without realizing it. Las Vegas, for example, is ripe for transmission because indoor settings draw people from all over, and masks were not recently required.

Also, Berreman said the Health Department is seeing a growing number of unvaccinated adults infecting children under age 12, who are not eligible for COVID-19 vaccines.

“The most important thing for protecting children too young to be eligible for vaccines is to have everyone around them — everyone in their household and who spends time around them who is eligible — get vaccinated,” she said. “Everyone who can be vaccinated should be vaccinated now. Time is of the essence.”

Although children statistically have not suffered as seriously as kupuna, who are at higher risk, they are not immune to COVID-19.

“There has been very severe disease in very young children including preschool age, including in our state, so children can get very sick,” she said. “Even if you have mild disease, you can go on to have long COVID and prolonged symptoms. You can have long-term consequences even if symptoms seem relatively mild.”

Health officials say COVID-19 vaccines are effective against the delta variant, now the dominant strain across the nation, which has been doubling in cases every two weeks.

The vast majority of new cases are among those who are unvaccinated.

As of Monday 59.3% of Hawaii’s population had completed vaccinations, and 65.7% had initiated vaccinations.

Health officials urge those still on the fence about getting a COVID-19 vaccine to talk to their physicians, seek answers to questions and get vaccinated to protect loved ones and the community.

Hawaii’s vaccination incentives campaign rolled out its second round of prizes Monday, including cash prizes of $1,000 to $5,000.

Vaccines are now available on a walk-in basis at numerous sites as well as at local retail pharmacies, and mobile vaccine clinics are making their way to schools and shopping centers.

Dr. Julius Pham of The Queen’s Health Systems shared during a news conference on incentives that the vast majority of patients admitted to the hospital with the coronavirus are unvaccinated.

The virus can devastate an entire family, he said. Recently, several family members from the same household were admitted to the hospital, he said, with one member dying in the intensive care unit.

“It’s a horrible disease,” he said. “It affects the whole family. As a front-line care provider … we don’t ever want to see it again. So one of the best ways we can protect our communities and protect our families is to get vaccinated.”

Tim Brown, an infections-disease modeler and senior fellow at the East-West Center, thinks the delta variant is reason enough to tighten restrictions again.

“We should rein it back in,” he said. “The governor is correct in maintaining the masking mandate, especially given what we know about delta.”

Large gatherings in enclosed spaces are dangerous now, Brown said, even for those fully vaccinated.

One has only to look at what is happening in the United Kingdom, he said, where transmission and hospitalization rates are rising despite a 60% vaccination rate.

What is concerning, he said, is that the rates of vaccination drop with each age group, which are the same ones most likely to be gathering in groups and least likely to be wearing masks.

“The combination of lower vaccination rates, an easily transmissible virus and low masking — that basically is the virus’ feeding grounds right now,” he said. “We may think we’re done with the virus, but the virus isn’t done with us.”

The state’s vaccination goal of 70% is no longer sufficient to reach herd immunity, due to the delta variant, Brown said.

“That’s not sufficient because the other 30% is basically fully susceptible to delta, and delta is extremely infectious,” he said. “The bottom line now with something as infectious as delta, we will not get there with vaccination alone. We will need a combination of vaccinations plus other interventions we’ve been using, such as masking and improving ventilation, which we don’t put enough emphasis on.”

Down the road, Brown said, there may be further variants following delta.