Health officials are warning Hawaii residents to exercise more caution as the seven-day average of new COVID-19 infections in the isles rose for the seventh consecutive week.

The state Department of Health on Wednesday reported 5,768 new coronavirus infections over the past week, bringing the total since the start of the pandemic to 258,422 cases.

The seven-day average of new cases rose to 722, an eightfold increase compared to the 87 reported March 23.

The state’s average positivity rate, meanwhile, jumped to 14.3%, up from 11.5% last week. It is the eighth week in a row that DOH has recorded an increase in the positivity rate, which is considerably higher than it was during the delta variant surge.

“I think this is a really important juncture,” said State Epidemiologist Dr. Sarah Kemble. “We talked before about watching these numbers and that case counts alone don’t tell the whole story, but we are now seeing the repercussions for severe disease and accumulating cases in our hospitals.”

On Wednesday, the state reported 91 patients with COVID-19 in hospitals, up from 66 last week. Of the 91, eight are in intensive care units and four on ventilators.

Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, in late April had said he would be concerned when COVID-19 hospitalizations closed in on 100.

“We are concerned about the increasing number of hospitalizations resulting from COVID-19,” said Raethel in an email Wednesday. “Fortunately the rate of increase in hospitalizations is slower than in prior surges, and the severity of illness of those being hospitalized is lower. However, if the numbers continue to climb, this will further stress hospital capacity and the healthcare workforce challenges we have been experiencing during the pandemic.”

For the immediate future, Raethel said the Healthcare Association of Hawaii expects the number of COVID-19 hospitalizations to continue to climb, albeit slowly.

Kemble said now is the time to exercise more caution and practice layered mitigations such as masking while in indoor spaces, staying home when sick and avoiding crowds.

Hawaii’s indoor mask mandate, along with a number of other pandemic-related restrictions, ended March 25.

In the ensuing weeks, average case counts and positivity rates continued rising, and more contagious omicron subvariants, such as BA.2.12 and BA.2.12.1, were confirmed to be present in Hawaii.

“Wearing a mask indoors is absolutely a very good idea right now, especially in crowded settings,” said Kemble, adding that it is more critical as case counts rise. “This is not the time to be in that relaxed mentality. Let’s remember that right now is a time to really be cautious.”

Requiring masks indoors at work and school makes good sense when community transmission is high, she said. Staying up to date on COVID-19 vaccinations is also crucial.

As of Wednesday, 77.4% of Hawaii’s population had completed their primary series of COVID-19 vaccinations, with about 40% boosted and 4.6% double-boosted.

Although 100% of Hawaii residents ages 65 and up have completed their primary series of vaccinations, the number that have been double-boosted is lagging. Only 18% of those ages 65 and up, and 21% of those ages 75 and up, have been double-­boosted so far.

Kemble urged those who are eligible to get vaccinated and boosted, and pointed to emerging science that shows a previous omicron infection is not as protective against reinfection as also having been vaccinated.

“If you’ve had infection recently and think that’s a reason not to get vaccinated, think again,” she said. “This is a really good time to go get the shot even if you hadn’t considered it before.”

The Biden administration and national health experts, meanwhile, are bracing for a possible fall surge that could potentially infect 100 million Americans.

The number of new average COVID-19 cases in the U.S. is at about 78,000 per day and trending up, along with, to a lesser degree, hospitalizations and deaths.

Dr. David Dowdy, associate professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, said during a webinar Tuesday that confirmed cases are a dramatic underestimate and no longer a reliable indicator of the burden of COVID-19.

He noted rates of hospitalizations and deaths in the U.S. are climbing very gradually despite substantial rises in cases, suggesting the average case of COVID-19 is becoming milder.

“But this is not just a story about the average case,” he said. “People with weak immune systems remain at great risk and deserve extra protection, and COVID-19 is still killing over 300 Americans every day, meaning about 1 out of every 30 deaths in the U.S. is still due to COVID-19.”

The U.S. is expected to mark its 1 millionth confirmed death due to COVID-19 some time this week, he said.

Kemble said she thinks Hawaii needs to be ready for a surge at any time — and might even be in one now.

“We don’t know where this will all settle out yet,” she said. “That’s part of not being in a truly endemic state yet. Preparation is really key here, keeping in mind all the tools we have to combat COVID-19. We’ve got to use them.”

DOH has said the COVID-19 case counts underestimate the number of total infections since many people are now using home test kits that are not officially counted. The upward trajectory of positivity rates indicates transmission levels in Hawaii are not only rising, but increasing at a more accelerated pace than in previous weeks.

By island, there were 3,851 new infections reported on Oahu over the past week, 718 on Hawaii island, 616 on Maui, 391 on Kauai, 40 on Molokai and 33 on Lanai. An additional 119 infections were reported out of state.

DOH also reported six more deaths, bringing Hawaii’s COVID-19 death toll to 1,434.