When daily coronavirus case counts rise, the number of COVID-19 patients landing in hospitals rises as well, typically in the following seven to 14 days.

Hawaii hospitals are bracing for an uptick in COVID-19 patients in coming weeks and are already scrambling to rearrange spaces and bolster staffing for another wave of hospitalizations.

“We believe the next three to four weeks will be a critical time in health care,” said Hilton Rae­thel, president and CEO of the Healthcare Association of Hawaii, a nonprofit representing acute-care hospitals.

On Friday the state Department of Health reported 628 new confirmed and probable infections and two coronavirus- related deaths statewide, bringing the totals since the start of the pandemic to 45,245 cases and 540 fatalities. Those numbers did not come down much from the single-day record high of 655 on Thursday.

The number of COVID-19 patients in the hospital also rose sharply — to 184 on Friday, compared with 117 on July 30 — and nearly five times higher than just 38 on the first Friday of July.

A recent COVID-19 results briefing by the University of Washington’s Institute for Health Metrics and Evaluation projects that Hawaii hospitals will experience a high level of stress by September, with 10% to 19% of hospital beds occupied by COVID-19 patients, and extreme stress, with 20% or more beds occupied by COVID-19 patients, by October.

Hospitals are already under stress, according to Rae­thel, and concerned primarily about staffing shortages.

“We’re not under extreme stress, but we are at a point where we do not have enough staff,” he said. “We’re running into staffing shortages because the COVID patients continue to climb.”

Twenty-two hospitals, including three on Kauai, have now requested an additional 550 relief health care workers, including critical care nurses and respiratory therapists, from the mainland to care for COVID-19 patients.

The association is working with the state Health Department and Hawaii Emergency Management Agency to bring in these additional relief workers later this month. Funding would come from the Federal Emergency Management Agency.

Daniel Ross, president of the Hawaii Nurses Association, described the current situation at hospitals as “insane” and said the shortage was due to hospitals not hiring over the past year and a half.

“We’re short-staffed everywhere in the state,” said Ross, a registered nurse at The Queen’s Medical Center who was converting a space into a COVID-19 unit. “We’re in a staffing crisis at Queen’s, and Straub’s has been in desperate straits for staffing for quite a while. At Kapiolani they’re short, also.”

Many nurses are working extra shifts, he said. Queen’s is also offering incentives, including a bump up in pay, free parking and a meal for taking extra shifts, but many nurses are too burned out to take on the extra work, he said.

“This was very predictable,” he said. “We saw what was happening. It started on the mainland before here, with the delta variant. We saw that the delta variant was here, and the Fourth of July happened where there were a lot of parties, and about three to four weeks after, you put all those things together, and it’s very predictable.”

He is seeing younger COVID-19 patients in their 20s to 40s in the hospital, the vast majority of whom are unvaccinated, and pleads with them to be careful.

”Please don’t go to gatherings,” he said. “Please, it’s not over. Wear your masks, social-distance. I know everyone’s sick and tired of doing that because we want it to be over, but it’s not.”

Kelly Johnson, chief nursing officer, said The Queen’s Health Systems is currently caring for 72 COVID-19- positive patients.

“There is no doubt that capacity is a concern; however, we are committed to caring for all patients in need of our services,” said Johnson in a statement. “High quality care and safety are our top priority for our patients and caregivers.”

During the height of the pandemic last summer, hospitalizations reached a high of 315. Although Hawaii has not reached that point yet this year, hospitals said the overall volume of patients is greater. Many hospitals were devoid of other patients last year but are now full of regular patients in addition to incoming COVID-19 patients.

Johnson said health care workers have learned a great deal throughout this pandemic but that this surge is different because Hawaii is still open for business, and there are trauma cases and increases in emergency room admissions in addition to the impact of the delta variant.

“This has created a unique and increased need for nurses in a short period of time both locally and nationally,” she said.

Queen’s has requested 140 supplemental nurses and respiratory therapists to treat COVID-19 patients as part of the FEMA request but is also bringing in more contract nurses later this month.

Unfortunately, there is no sign that the delta variant’s transmission in the community is slowing down. Based on the current trajectory, Raethel does not think Hawaii has yet reached the peak of infections.

In June, Raethel said, the positivity rate was 1.4%, followed by a jump to 4.7% in July. In just the first five days of August, the positivity rate was at 8.4%.

“There’s no indication that we’ve reached the peak of our positivity rate or our infection rate yet because it keeps going up and it’s continuing to go up,” said Rae­thel. “And we do know there’s a lag between that and hospitalizations, so we know our hospitalizations are going to increase.”

Eventually, hospitals will have to postpone elective surgeries, tests and screenings, which some have already started to do, he said, but health care providers would like to avoid doing that because of the consequences of pushing them off.

“So the question is, Will enough additional people get vaccinated to slow down this chain of transmission before we hit extreme stress in our hospitals?” he said. “We certainly hope that’s going to happen, but we are doing everything we can to support our hospitals.”

On Friday the Health Department reported having administered 1,774,560 doses of COVID-19 vaccines, about 3,000 more than the previous day; 60.6% of the state’s population is fully vaccinated, while 67.8% has received at least one dose.