The daily average number of COVID-19 cases reported over the Thanksgiving holiday week remained steady, but health officials are keeping a close eye on trends in following weeks.

On Wednesday the state Department of Health reported the state’s seven- day average of new COVID- 19 cases at 137 — a dip from 149 reported on Nov. 23. The state’s average positivity rate, however, increased to 6.3% compared with 5.5% the previous week.

Hospitalizations of COVID-19 patients this week were higher than last week, with a seven-day average of 62 compared with 56 the previous week — but lower than the average of 66 in mid-November.

Across the nation, a triple whammy of respiratory viruses is circulating: respiratory syncytial virus, or RSV, influenza and COVID-19 infection.

Health officials have warned parents of younger children of an early rise of RSV in Hawaii, and to call their pediatricians if they have concerns. Signs of distress to watch out for among children under age 5 are difficulty breathing and trouble staying hydrated.

Influenza-like illness activity, which includes the flu and other viruses that cause fever, cough or sore throat, was also on the rise heading into the Thanksgiving holiday. For the week of Nov. 6-12, 4.4% of outpatient visits across the state were related to influenza-like illness, higher than the previous week and higher than Hawaii’s historical baseline, according to DOH’s influenza diseases surveillance report.

For the week, a total of 4,066 specimens were tested for influenza, with 6.7% yielding positive results — up from 5.8% a few weeks ago. There have been at least 10 influenza-like illness clusters reported to DOH this season so far.

Health officials have been urging people to roll up their sleeves for bivalent COVID-19 boosters and flu shots, which can be administered at the same time, in advance of the holiday season.

The Centers for Disease Control and Prevention now has real-world data showing that adults ages 18 to 49 who received bivalent boosters were 43% less likely to get sick with a COVID-19 infection compared with those who were unvaccinated, DOH said in its weekly newsletter. Those ages 50 to 64 were 28% less likely, and those ages 65 and up were 22% less likely to get sick with COVID-19 than the unvaccinated group.

Even as officials seek to get the bivalent booster — which targets both the original strain and omicron subvariants BA.4 and BA.5 — into American arms, newer variants continue evolving.

BA.5 has been on the decline for several weeks, while the more immune- evasive subvariants BQ.1 and BQ.1.1 have grown in dominance.

BA.5 made up 19.4%, while BQ.1 and BQ.1.1 together made up 57.3% of new COVID-19 cases in the U.S. as of Nov. 26, according to the CDC’s Nowcast model.

XBB, another immune- evasive subvariant, has been added to the list and now makes up 3.1% of new COVID-19 cases nationwide.

All three subvariants — BQ.1, BQ.1.1 and XBB — have been detected by way of whole genome sequencing of test specimens in Hawaii. BQ.1 and BQ.1.1 have been detected in Hawaii wastewater samples.

The Food and Drug Administration on Wednesday said the monoclonal antibody bebtelovimab is no longer authorized for emergency use in the U.S. because it is not expected to neutralize omicron subvariants BQ.1 and BQ.1.1.

To date, 78.3% of Hawaii residents have completed their primary series of COVID-19 vaccinations, according to the Health Department. A total of 220,241 residents have received the new bivalent booster, representing about 20% of the state’s eligible population.

All residents ages 5 and older are eligible for the bivalent booster if at least two months have passed since receiving the final dose of the primary series or previous booster.

Local pharmacies, health clinics and hospitals continue offering the free bivalent boosters. Kaiser Permanente continues to host community vaccine events, including Saturday at the Filipino Community Center in Waipahu.

DOH also reported five more deaths, bringing the state’s COVID-19 death toll to 1,737. The recent deaths were male Oahu residents who ranged in age from their 40s to 80s.