Hawaii’s hospitals are near full capacity as the number of COVID-19 patients continues to rise, with staffing shortages still the top concern.

The number of COVID-19 patients hospitalized reached 202 on Monday, and dipped slightly to 193 on Tuesday, according to the state’s dashboard. Of those 193 patients, 24 were in intensive care and 14 on ventilators.

But hospitals are already full of non-COVID-19 patients and experiencing an unprecedented staffing shortage as nurses and other health care workers get infected.

The situation is precarious, according to Hilton Raethel, president and CEO of the Healthcare Association of Hawaii.

“We absolutely expect the hospitalization numbers to continue to rise,” he said, estimating it might increase to 300 to 400 this time. “Right now about 1,000 clinical health care workers across the state are out because of either exposure or positive COVID-19 tests.”

Meanwhile, Hawaii’s hospitals as of Tuesday had about 2,265 patients total, just 100 shy of the 2,365 during the peak of the delta surge.

The good news is that the proportion of COVID-19 patients landing in intensive care during this surge is much lower than during the delta surge, Raethel said, translating to lower average lengths of stay.

HAH is still waiting for confirmation that relief workers funded by the Federal Emergency Management Agency will be coming soon to care for COVID-19 patients. The total request is now for 930 additional personnel, he said, up from 700 prior to the holidays.

“We are expecting confirmation any day now,” he said. “We have gone through the process, and FEMA is actively working on it.”

The first wave of 100 to 200 workers will arrive, hopefully, in coming weeks to provide relief.

Daniel Ross, president of the Hawaii Nurses Association, said there is a staffing crisis that was ongoing prior to Christmas and New Year’s which has now gotten “progressively worse.”

“The problem is the nurses are getting sick with COVID, and their families are getting it,” he said. “Throughout our facilities we have a severe staffing crisis going on — not just the nurses, but everybody, the dietary personnel, the housekeeping personnel — just like with the airlines, except we can’t cancel flights.”

The Queen’s Medical Center, where he works, has about 140 nurses on sick leave or in quarantine due to COVID-19, he said, and is doubling monetary incentive for some to cancel vacations and pick up extra shifts.

Many dialysis workers are also out, he said, and therefore, patients are unable to get their treatments. The situation is worse for care home nurses, who are working two 16-hour shifts in a row.

Health care workers are also waiting for clarification on new return-to-work policies in light of the Centers for Disease Control and Prevention’s recommendations, which reduce quarantine times to five days instead of 10.

They have concerns about how safe that is, and are exhausted as they watch COVID-19 case counts continue rising.

Lt. Gov. Josh Green, who tweeted that 176 patients were hospitalized Tuesday, including 72 vaccinated, noted the dip was due in part to it being a discharge day.

He pointed out that hospitalization rates with omicron appear to yield much lower admission rates than during the delta surge.

On Tuesday, with 176 patients hospitalized out of about 28,000 active COVID-­19 cases, the admission rate is at about 0.63%, he said, or 1 out of every 159 people.

During the peak of the delta wave, 448 patients were hospitalized out of about 11,500 active cases in the state, he said, resulting in an admission rate of 3.9%. That equals to about 1 out of every 25 people.

“That means that (we are) way less likely to go into the hospital now than we had with the other surge, so do what you can to get a booster,” he said. “That’s what keeps it down.”

Green said he expects hospital numbers to continue trending up the next few weeks, then fall off at the end of the month.

As of Tuesday, 74.4% of the state completed vaccinations, with 26% boosted, according to DOH.

The Hawaii Pandemic Applied Modeling Group, meanwhile, predicted in its latest forecast that hospitalizations in Honolulu will reach about 420 by Monday, based on the assumption that omicron is 50% less likely to result in hospitalizations than delta.

On the current trajectory, however, hospitalizations would still peak at more than 900 toward the end of January.

HiPAM was in the ballpark range in its prediction of about 500 hospitalizations during the delta wave in early September, though it had predicted far more in following weeks. That peak was not reached because action was taken, according to Monique Chyba, mathematics professor.

“It is raising a red flag and showing the potential,” she said.

Hospitalizations, however, are very difficult to predict, HiPAM said, as they can’t account for human behavior, which can make a difference, and are based on available data.

Two data sources HiPAM said it would like to improve its model include the number of vaccinated in all COVID-19 cases and hospitalizations, along with ages. HiPAM said the health, vaccination status and age of infected patients would help determine the length of time in the hospital.

On Tuesday health officials reported 1,592 new confirmed and probable coronavirus infections, bringing the state’s total since the start of the pandemic to 123,456 cases. No new virus-related deaths were reported, keeping the statewide COVID-19 death toll at 1,094.

The tally included 1,231 new cases on Oahu, 120 on Hawaii island, 87 on Maui, 42 on Kauai, nine on Molokai, 11 on Lanai and 92 Hawaii residents diagnosed out of state.

Tuesday’s count is usually lower, reflecting cases reported to labs on Sunday. Some testing sites on Oahu were also closed over the weekend due to heavy rain.

The seven-day average of new coronavirus cases statewide reached 2,570 on Tuesday, which was 234% higher than two weeks ago, according to DOH data.

The average positivity rate for Hawaii reached a record high of 17.1%. In Honolulu County the average positivity rate reached a record high of 19.4%.

The U.S. coronavirus-­related death toll Tuesday was over 820,000, and the nationwide infection tally at more than 53.8 million.

This breaking news story will be updated as more information becomes available.