The neighbor islands, with 30% of Hawaii’s population, have accounted for less than 25% of the state’s COVID-19 cases, yet the strain on hospital staff and resources from surging infections is no less acute there than at Honolulu’s much larger medical facilities.

And trends are the same too: a high percentage of unvaccinated among those admitted for care and an increase in younger patients, officials said.

At Maui Memorial Medical Center, the 31 patients hospitalized with the coronavirus as of Friday, including four in the intensive care unit, matched the record case count from February, according to Mike Rembis, CEO of Maui Health, an affiliate of Kaiser Permanente that operates the Wailuku hospital.

“Before the Fourth of July we had only two COVID patients. What a difference a month makes,” he said.

All but one of the 31 patients are unvaccinated.

“I mean, this is a pandemic that could have been avoided had everyone been vaccinated,” Rembis said.

A total of 352 COVID-19 patients have been hospitalized on the Valley Isle since the start of the pandemic, according to the state Department of Health, and while the hospital is still seeing patients in their 70s and 80s, there’s an “alarming number of people in their 20s, 30s, 40s and 50s being admitted,” including one pediatric case, he said.

Maui Memorial never did dismantle the screening tent and mobile 10-bed unit it set up outside the emergency department at the start of the outbreak early last year. So far there’s been no need for the overflow care unit.

“We’re going to keep them up. We want to be prepared,” Rembis said. “On Maui, we’re the only acute-care hospital and we don’t want to take any chances; we want to make sure we’re ready for anything.”

A key concern for hospital administrators statewide has been the stress on weary nurses and other health care professionals who have been dealing with COVID-19 patients since the start of the pandemic. The emergence of the virulent delta variant derailed the state’s progress toward containing infections and is sending far more patients to hospitals.

“These patients are very sick. It’s a lot of work,” Rembis said. “I have to tell you, I’m in awe of our staff.”

Like other health care facilities, the Maui hospital recently tightened its visitor policy after relaxing rules when COVID-19 cases in Hawaii were on the wane. No visitors are allowed except for obstetric, pediatric and end-of-life cases. That means the staff has taken on the additional duties of communicating with patients’ family members, Rembis said.

“They’re very, very tired and stressed,” he said.

The Healthcare Association of Hawaii is working with the Department of Health and the Federal Emergency Management Agency to bring in health care workers from the mainland — mostly nurses — to supplement Hawaii’s hospital workforce. Rembis said Maui Memorial is expecting an unknown number of these workers in the coming weeks.

In the meantime, the hospital continues to administer free vaccinations Mon­days and Fridays in its main lobby, but the numbers have dwindled from about 850 jabs a day when the vaccines were first widely available to a couple hundred a day.

“The most important thing, and I sound like a broken record, is that people need to get vaccinated. If they are not vaccinated, they’ve got to seriously think about getting vaccinated,” Rembis said. “It’s a game changer; that’s the only thing that’s really going to change the trend that’s going on right now.”

More than 90% of residents hospitalized with COVID-19 are unvaccinated, according to state officials. Vaccination rates on the neighbor islands are lower than on Oahu, where 63% of the population is fully immunized. For Maui it’s 55%; on Hawaii island, 58%; and on Kauai, 60%.

Maui Health also oversees Kula Hospital, a long-term care and skilled-nursing facility, which has not seen a single positive case, Rembis said, and Lanai Community Hospital, which has cared for 10 COVID-19 patients over the course of the pandemic but has none now.

AT HILO Medical Center, the largest hospital on Hawaii island, 11 COVID-19 patients were receiving care as of Thursday, all but one unvaccinated.

The 11-bed ICU is caring for three active cases plus three “long haulers,” who continue to feel symptoms days or weeks after the typical course for the disease and tend to be younger.

“Sixteen of our 50 medical unit beds are taken for COVID only, and that means we have fewer beds to take care of general medical hospitalizations, and that’s on top of already having a full ICU and everywhere else is full in the hospital,” said Elena Cabatu, director of marketing and public and legislative affairs for the 128-bed hospital.

A total of 191 patients have been hospitalized at Hawaii island facilities since the start of the pandemic, according to the Department of Health.

Cabatu said COVID-19 admittances have been hovering around the low double- digits in recent weeks for the first time since October, and have gone as high as 13 patients. Only three hospitalizations have involved vaccinated patients.

Hilo Medical Center also has had to delay discharging some patients because long-term care facilities have put a pause on admissions because they may be dealing with their own COVID-19 cases, causing a “bottleneck.”

“The level of concern is the amount of resources and staff time, and the attention that even one COVID patient requires,” she said.

Some relief is expected with Monday’s arrival of 12 contract workers, Cabatu said.

“We are pleading with the community that has not yet gotten vaccinated to get vaccinated. … What we are also asking is the community to just know they are giving it to each other; it’s no longer someone else’s problem,” she said. “The numbers speak the truth and they reflect what’s going on in our hospital. The numbers, however, are not reflecting the impact it’s having on our staff and the families that are directly impacted by COVID. People don’t know unless they see it.

“I do think that everyone’s circle is getting a little bit tighter; they know someone even closer to them that’s having COVID. … One other thing to note is that our patients are all residents. There’s a misconception out there and lots of people are blaming the tourists, but at this point it’s all community spread.”

All eight of the COVID-19 patients at Kona Community Hospital as of Friday were unvaccinated, according to Judy Donovan, regional director for marketing and strategic planning. Four are in the ICU.

The 94-bed hospital also is seeing more patients age 40 and younger, including “a couple” children who were discharged “pretty quickly,” she said.

The Kona hospital has tightened its visitor policy and set up a fully stocked, two-room mobile care tent on Aug. 5 to handle emergency department overflow if needed.

Donovan said 32 critical care nurses and three respiratory therapists are due to arrive Monday to provide temporary reinforcements.

“It’s just not a minute too soon. Just as everyone else in the entire state, we are having a pretty critical staffing shortage right now,” she said.

Ka‘u Hospital, which along with the Kona and Hilo hospitals is overseen by Hawaii Health Systems Corp., tests for COVID-19 but has yet to care for any confirmed cases in its 21-bed hospital, Cabatu said.

Meanwhile, the 35-bed Queen’s North Hawaii Community Hospital in Waimea had seven COVID-19 patients hospitalized as of Friday, and there were none at the health system’s 15-bed Molokai General Hospital.

Kauai has had 16 coronavirus-related hospitalizations in total, according to the Health Department. The 72-bed Wilcox Medical Center in Lihue, part of Hawai‘i Pacific Health, does not provide case counts for privacy reasons.

“Like all of Hawaii’s healthcare providers, we do have concerns about staffing as the number of hospitalized COVID patients increases,” said HPH spokeswoman Kristen Bonilla in an email. “Our staff has been on the frontlines of this pandemic for 18 months now and they need some relief.”

Bonilla said HPH has arrangements “for additional staff and travelers for our hospitals,” and is working with the agencies that are coordinating staffing aid for hospitals statewide.