Current COVID-19 trends in Hawaii appear to be heading in the right direction, with daily averages of new infections and positivity rates continuing along a downward trend.

The Hawaii Department of Health on Wednesday reported a decline in the seven-day average of daily cases to 685 compared with 832 on June 22, marking the fourth consecutive drop. The state’s average positivity rate also fell to 16.5% compared with 17.1% reported June 22 — the third consecutive weekly decline.

The Hawaii Pandemic Applied Modeling Work Group, a volunteer group of scientists, said in its recent and final update that daily cases are slowly trending down and hospitalizations are plateauing statewide. HiPAM said the average positivity rate is on the decline for Honolulu and Hawaii counties as well as Kauai, although trends there indicate a recent resurgence the past few weeks. Maui County’s rate is holding at a plateau.

In a separate analysis estimating how COVID-19 moved in and out of the state, based on sequencing data, HiPAM found substantial increases in coronavirus cases brought into Hawaii when pre-travel testing requirements were relaxed.

While the alpha and delta variants were primarily introduced here from U.S mainland locations and took months to arrive in the islands, omicron was primarily introduced from international sources and arrived within a matter of weeks, the analysis found.

“Pre-travel testing appears to be a very successful means of slowing the rate of introduction to Hawaii,” said HiPAM. An upshot was “keeping hospital resources available to the public throughout the pandemic, which helped to keep deaths from SARS-CoV-2 to a minimum.”

Hospitalizations rose to 207 patients with COVID-19 on Wednesday, according to the state dashboard, compared with 196 reported June 22. The seven-day rolling average for hospitalizations for the past week was at about 192, according to numbers from the Healthcare Association of Hawaii.

“It did start to come down a little, but now it seems to have stabilized and so — not the news we were looking for,” said HAH President and CEO Hilton Raethel. “We were hoping to see the hospitalizations continue to come down.”

More than 800 frontline health care workers on a given day continue to be out sick due to COVID-19 infections or exposures. “We thought that as these infection numbers came down we would see a corresponding drop in impact on health care workers,” Raethel said. “It stopped going up, but hasn’t materially come down yet.”

Also, Raethel is concerned about the potential impacts of omicron subvariants BA.4 and BA.5, which are present in Hawaii, and on the rise nationally.

BA.4 and BA.5 are estimated to be about 1.6 and 1.8 times more transmissible, respectively, than BA.2, with an increased ability to evade antibodies elicited by vaccination or prior infection.

The subvariants together now make up about 52% of new COVID-19 cases in the U.S., according to the Centers for Disease Control and Prevention.

In Hawaii there are at least 24 confirmed cases — nine of BA.4 and 15 of BA.5 — detected via genome sequencing by DOH’s State Laboratories Division across all four major counties, according to the latest report.

On Tuesday, Dr. Eric Topol, a physician-scientist at Scripps Research in San Diego , called BA.5 “the worst version of the virus that we’ve seen” in his Ground Truths newsletter. “It takes immune escape … to the next level,” he wrote, “and, as a function of that, enhanced transmissibility, well beyond Omicron (BA.1) and other Omicron family variants that we’ve seen (including BA.1.1, BA.2, BA.2.12.1, and BA.4).”

The genetic distance of BA.5 from earlier variants means it has more potential for immune escape, he noted, calling it “very fit.” This means, more than ever, that next-generation vaccines that are universal and variant-proof are needed to get ahead of the coronavirus,” he said.

Though current vaccines still offer protection against severe disease and death from the coronavirus, advisers to the Food and Drug Administration recently recommended that COVID-19 booster shots be updated to contain some version of the omicron variant for the fall.

World Health Organization Director-General Tedros Ghebreyesus on Wednesday said COVID-19 cases, driven by BA.4 and BA.5 in many places, are on the rise in 110 countries, causing overall global cases to increase by 20%.

“This pandemic is changing but it’s not over,” Ghebreyesus said. “We have made progress but it’s not over.” He said hundreds of millions — including tens of millions of health workers and elderly in lower-income countries — remain unvaccinated, leaving them more vulnerable to future waves of the virus.

The Hawaii Health Department on Wednesday reported 15 more deaths, bringing the total coronavirus death toll to 1,504.

The DOH encourages all eligible residents to continue getting vaccinated and boosted. As of Wednesday, 76.6% of Hawaii’s overall population had completed the primary series of COVID-19 vaccines, with 43.2% boosted and 9.1% double boosted, according to DOH figures.

Hawaii’s youngest keiki — under age 5 — are now eligible for COVID-19 vaccines, and many received their first shots over the weekend. Hawaii Pacific Health on Saturday vaccinated 585 children in that age bracket at its clinics at Kapiolani Medical Center for Women & Children and Kauai Medical Clinic.

DOH is encouraging parents to get their keiki vaccinated with their first COVID- 19 shots now, particularly with the start of fall session preschool just around the corner. Department spokesperson Brooks Baehr said, “It’s a good idea to begin the vaccination process as soon as possible to give your kids protection … before school begins.”