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Infectious disease expert says stricter measures are needed to stop the delta variant in Hawaii

                                Hundreds of people waited in line Saturday to be tested for COVID-19 at Aloha Stadium.
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Hundreds of people waited in line Saturday to be tested for COVID-19 at Aloha Stadium.

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Oahu residents get tested for COVID-19 at Aloha Stadium amid high testing demand, rising infections

Infectious disease expert Tim Brown believes that far more stringent measures are needed to stop the upward spiral of daily new coronavirus cases in Hawaii.

The Delta variant is a game changer, according to Brown, given the median viral load is up to 1,000 times higher than the original COVID-19 strains, making it almost twice as transmissible as the virus that drove last year’s epidemic.

“I would like to see the state become proactive instead of reactive on this. We have to get ahead of the virus,” he said. “If we’re going to keep playing catch-up, we’re never going to deal with it. We’ve really got to think about where do we want to be two to three weeks from now and act now to make that happen, not wait until it happens and then try to react over the next two to three weeks.

“That’s too late and our hospitals will be overwhelmed.”

On Friday, the state Department of Health reported a record high of 1,167 new daily coronavirus cases. Although the tally included some cases from previous days due to a lab reporting glitch, the three-day average of new infections from Wednesday through Friday breached a new level at 729.

Saturday’s tally exceeded that number, with DOH reporting 791 new confirmed and probable infections and one new death, bringing the state’s totals since the start of the pandemic to 548 fatalities and 50,355 cases.

Brown, who recently offered a virtual presentation, “Living in the Shadow of Delta: The Virus Strikes Back,” for EWC Insights, told the Honolulu Star-Advertiser about a month ago, when the seven-day average of new cases hit 128, that it was time to tighten restrictions again.

It wasn’t until Tuesday that Gov. David Ige announced new limits on social gatherings: no more than 10 indoors and 25 outdoors.

Brown said the new precautions won’t be effective in the battle against the highly contagious delta variant, since fully vaccinated people with the delta variant carry just as high a viral load in the first five to six days of infection as unvaccinated people, he said.

After that initial period, a vaccinated individual’s immune systems kicks in and the viral load drops off.

“But during those first five to six days, basically, the vaccinated can probably transmit just as efficiently as the unvaccinated,” Brown said. “This is why we’re seeing these super clusters of vaccinated people, for example, in Provincetown, (Mass.), and other places.”

State Health Department Director Dr. Elizabeth Char said Friday that fully vaccinated people have a 0.02% chance of getting infected with COVID-19 — or 2 in every 10,000 vaccinated people — and that to date there have been more than 1,000 of these “breakthrough” cases in Hawaii. This was later corrected to a 0.2% chance of getting infected with COVID-19 — or 2 in every 1,000 vaccinated people.

Health officials have consistently said in past weeks that visitors make up only 2% of positive coronavirus cases in the state, with the overwhelming majority a result of community spread.

Brown believes a number of vaccinated individuals who are infected with COVID-19 — some of whom are asymptomatic — are going undetected, including a larger share of visitors who are not likely to get tested while on vacation. If it were up to him, Brown would require a short quarantine for visitors and returning residents, with required testing before coming out of isolation.

If 10 people from five different households gather indoors with one infected person among them, then they can potentially bring the delta variant home and infect their own household members, according to Brown. A more effective approach would be limiting seating groups to members of the same household, as was done last year, he said.

Brown also believes the 50% capacity limit for restaurants will do little to stop the spread of infections if unvaccinated customers are in the mix.

“With delta, 50% capacity is a joke,” he said. “I look at these restaurants and I see 40 to 50 people inside a restaurant, sitting around unmasked, all eating food. With delta, that’s just a feast. Delta’s feasting more than the people are in those restaurants.”

He recommends that Honolulu follow New York City, San Francisco and other cities in mandating that people be fully vaccinated before patronizing restaurants and bars.

If only fully vaccinated individuals gather in a restaurant, there may still be transmission, he said, but there will likely be fewer serious illnesses or hospitalizations. Also, the mandate could help drive up the state’s vaccination rate, which stands at 61.2%.

Masking is not to be discounted either, added Brown.

“Vaccinated people have to wear masks,” he said. “It’s not vaccine or mask, it’s vaccine and mask. Both are absolutely essential now.”

This includes when outdoors browsing at a farmers market, for example, waiting in line at a restaurant or even when walking past a person who is not a household member.

The state also should offer more quarantine rooms for infected individuals who need to isolate from their families, he said.

As of Aug. 5, about 59 of the 64 quarantine rooms at designated hotels were filled and others were being cleaned, according to Health Department spokesman Brooks Baehr. There is a waiting list for those 64 quarantine rooms, with people living in group settings, such as shelters, treatment centers and care homes, given priority.

The state does not have enough facilities to meet the demand, in part, because many hotel rooms that were used for quarantine are now filled with tourists.

Baehr said the Health Department is looking to expand the number of quarantine rooms on all islands.

Brown recommends that hotels be required to set aside a total of 300 to 500 quarantine rooms because residents need them even more this year than last year due to the prevalence of the delta variant.

Also, vaccinating 70% of Hawaii’s population of about 1.4 million is no longer enough to reach herd immunity, he said. Only vaccinating as close to 100% as possible will help prevent serious illness and death.

Although that’s not what people want to hear, the delta surge is probably going to last until at least October, according to Brown. And the COVID-19 pandemic will likely extend well into 2022 and beyond unless there is global cooperation on vaccinations and as long as other variants don’t emerge.

“People are burned out on this,” he said. “They want to go back to the way it used to be. But they have to understand this is going to be with us for at least two to three more years, probably, and we have to learn to live with it, which means masks need to be part of our life going forward.”

Correction: The viral load from the Delta variant is 1,000 times higher than original COVID-19 strains, which makes it twice as transmissible. An earlier version of this story said the delta variant is 1,000 times more transmissible. Also this story was updated to reflect that the Hawaii Department of Health clarified that Elizabeth Char on Friday meant to say fully vaccinated people have a 0.2% chance, not 0.02% chance, of getting infected with COVID-19.
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