Hawaii COVID-19 cases, hospitalizations expected to climb with wave of new subvariants

Hawaii’s COVID-19 trends reflected a reversal this week, with higher average counts and positivity rates reported for the first time following weeks of decline.

The Hawaii Department of Health on Wednesday reported the seven-day average of new cases rose to 574 compared with 558 reported July 13 — an increase for the first time following six weeks of consecutive decreases.

Also, the state’s average positivity rate increased to 15.1%, up from 13.8% reported the previous week — the first increase following five weeks of decreases, matching the positivity rate on July 6.

Hospitalizations, meanwhile, fell to 159 patients with COVID-19 in Hawaii hospitals, according to the state dashboard, down from 177 reported the previous week. Of the 159, 15 were in intensive care and five on ventilators.

The seven-day average of hospitalizations over the week also declined to about 135 per day, with about 25 new COVID-19 admissions per day, according to data from the Healthcare Association of Hawaii.

On the other hand, DOH reported 4,329 new COVID-­19 infections over the past week, lower than the previous week, bringing the total since the start of the pandemic to 321,869 cases.

Tim Brown, an epidemiologist at the East-West Center in Manoa, said a flattening of total cases is expected as Hawaii transitions from omicron subvariants BA.2 and BA.2.12.1 to BA.4 and BA.5.

Brown said Hawaii is likely at the trough of this transition, but following a plateau, COVID-19 infections and hospitalizations are likely to rise again as the BA.4 and BA.5 epidemic kicks in at higher levels.

“Hawaii hospitalizations have been only slowly declining, which is what we would expect as the number of new cases fell,” he said. “However, I would expect these to start rising again as the BA.4/BA.5 wave takes over.”

Hospitalizations lag behind case trends by about two weeks, said Brown, but COVID-19 case reporting is also becoming increasingly problematic as more people shift to home testing, results of which are not included in the data.

The extent to which hospitalizations rise will depend on the rate at which BA.4 and BA.5 spread, he said, and the severity of the new omicron subvariants. In many European countries, BA.5 has given rise to a rapid increase in case numbers, followed by a doubling of the number hospitalized with COVID-19 a few weeks later.

In the U.S., daily average cases and hospitalizations are on the rise again in most states as BA.5, considered the most transmissible variant yet, grows in dominance.

BA.5 alone now makes up about 78% of new COVID-19 cases in the U.S., according to the Centers for Disease Control and Prevention, edging out BA.4, which makes up 12.8%. Subvariants BA.2.12.1 and BA.2 make up 8.6% and 0.6% of new cases, respectively, in the U.S.

A new variant report from DOH was due out Wednesday, but was not posted by 5 p.m. All four of the state’s major counties — Kauai, Honolulu, Maui and Hawaii — now have BA.4 and BA.5 present in their communities.

Brown said he believes that the proportions in Hawaii are likely similar to the rest of the nation.

Kauai County’s wastewater data, posted by Biobot Analytics, which is contracted by CDC to gather it as part of a national surveillance program, shows an upward trend in coronavirus levels. Sequencing of Kauai’s wastewater samples shows about 61.3% of cases there are BA.5.

DOH’s own wastewater program, slated to begin this summer, is not operational yet.

“Community risk will remain high for the near future,” said Brown. “So, the bottom line is we can expect to see continued and potentially even rising rates of community transmission in Hawaii over the next few weeks as the more transmissible BA.4 and BA.5 variants start their rise.”

Brown advises continuing layered mitigation strategies for BA.4 and BA.5, including the use of high-quality masks along with avoiding crowded spaces, staying up-to-date on COVID-19 vaccinations, and improving ventilation with open windows and doors and HEPA filters whenever possible.

Those who are immunocompromised should ask their doctors about Evushield, he said, a monoclonal antibody that adds another layer of defense against infection. Also, those who are older or at higher risk should make sure they know how to get a prescription for Paxlovid, an antiviral medication.

Hawaii officials, meanwhile, are taking a hands-off approach to the pandemic, with practically no restrictions or mandates left in place — instead emphasizing personal responsibility and “living with COVID” with tools available.

State officials have announced that masking will be optional when public schools start in August, but will be “strongly encouraged” when Hawaii counties are at medium and high community levels.

CDC has ranked most Hawaii counties as high-level, orange communities since about mid-May, which prompted no new rules or changes in mitigation strategies.

While Kauai and Hawaii counties have moved between medium-level, yellow and high-level, orange rankings, Honolulu and Maui counties have consistently been ranked high-level communities for the past two months.

Under CDC guidelines, those living in high-risk communities should wear a well-fitting mask in public indoors and on public transportation, regardless of vaccination status.

Los Angeles County has announced plans to reinstate an indoor mask mandate at the end of the month if hospitalizations continue to rise, the county health director said. The University of California, Irvine, also brought back universal indoor masking, along with the San Diego Unified School District.

The Los Angeles Public Health Department said in a news release Tuesday that the highly infectious BA.5 subvariant is fueling the rapid spread of COVID-19, leading to an increase in cases, hospitalizations and deaths, with residents in areas of high poverty being hospitalized at a higher rate.

Los Angeles Director of Public Health Barbara Ferrer said that getting infected with COVID-19 for a significant number of people can be dangerous, even if the dangers of being hospitalized and dying are much lower due to vaccinations, boosters and therapeutics.

“Many of those infected experience long COVID, others require care from medical providers and hospitals, and tragically, a small number of people die every day,” she said.

When asked about the rise of BA.5, Honolulu Mayor Rick Blangiardi said on the Honolulu Star-Advertiser’s “Spotlight Hawaii” Monday that his understanding was that hospitalizations remain low in the state.

“I can’t predict anything on this,” he said. “I think like everybody, we’re trying to move forward as best we possibly can. We’re planning on moving forward versus having anything get in our way here that becomes an obstacle. I wish that for all of us as we now get ready to see kids going back to school … and all the efforts we’re making to rebuild businesses.”

As of Wednesday, DOH reported 77% of Hawaii’s population had completed the primary series of COVID-19 vaccines, with about 44% boosted once and 10% boosted twice.

Approximately 3% of Hawaii’s 80,000 keiki under 5 — now eligible for the vaccines — have received their first COVID-19 shots.

The federal government has also approved Novavax, a more traditional protein vaccine for COVID-19. DOH said it is waiting for more information on its distribution to states.

By island, there were 3,096 new infections reported on Oahu, 538 on Hawaii island, 418 on Maui, 183 on Kauai and nine on Molokai. An additional 85 infections were reported for out-of-state Hawaii residents.

DOH also reported 13 more deaths, bringing the state’s coronavirus-related death toll to 1,548.