The average number of patients with COVID-19 dropped to a new low over the past week, but hospitals in Hawaii are still bursting at the seams.

The steady rise in the patient counts over the course of the pandemic has continued, according to Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, which advocates for a host of health care facilities and providers, including 28 hospital members.

On Wednesday, there were 2,526 patients in Hawaii hospitals, which is considered very full, translating into longer wait times at emergency rooms and demand for more health care workers still in short supply.

The average hospital census for this year so far is 2,481, which is higher than in previous years. In 2019 and 2020, the average was about 2,000 patients, roughly 2,200 in 2021 and approximately 2,350 in 2022.

“Our census actually continues to creep up,” he said. “So it’s not going down, even though the COVID numbers are going down. It’s very definitely the new normal. Unfortunately, what that means is that we have more patients who are sicker than we had three to four years ago, and that’s the reality of what we’re dealing with.”

On Wednesday, hospitalizations of COVID-19 patients declined to a weekly statewide average of 47 per day, the first dip below 50 since April.

The weekly average of COVID-19 patients in intensive care dropped to just two per day, and on two days over the past week, there were actually none in intensive care.

That is the good news, but the bad news is that the drop in COVID-19 patients has not resulted in a corresponding drop in the overall statewide hospital census since the start of the pandemic in early 2020. In fact, it’s been the opposite.

The increases have been obscured by the pandemic, according to Raethel. The assumption was that the hospital census would decline as the number of COVID-19 patients fell. Instead, COVID-19 patients have been replaced by patients suffering from other ailments.

He believes the higher number of patients could be due to a combination of factors, including deferred care, an aging population and the ongoing challenge of accommodating waitlisted patients — patients who are ready to be transferred to a long-term care facility but can’t due to lack of availability.

Many long-term care facilities, such as nursing homes, are still experiencing staffing shortages and are unable to admit new patients. So those patients — an average of 250 to 300 on any given day — end up waiting in hospital beds.

The Healthcare Association of Hawaii is working with the state Department of Health and City and County of Honolulu to obtain $7 million in funding to bring traveling nurses to long-term care facilities to provide temporary relief. The goal is to open up 100 beds to ease the number of waitlisted patients in hospitals, hopefully by early to mid-March, Raethel said.

During the delta and omicron COVID-19 surges, Federal Emergency Management Agency funds helped bring traveling nurses to hospitals but not to long-term care facilities.

“We tried very hard, but we weren’t able to get funding at the time for our long-term care facilities,” Raethel said. “We weren’t able to make the logistics work.”

Staffing shortages persist, and hospitals themselves are currently footing the bill for about 600 traveling health care workers.

But also, the pandemic has had repercussions on the general health of the community, whether it be delayed care, exacerbation of other conditions by a COVID-19 infection, or long COVID.

“There is more evidence coming out there’s direct consequence,” Raethel said. “People are still trying to figure out how much of these worsening health outcomes is directly related to COVID.”

Studies have shown a COVID-19 infection is linked to heart problems and can increase the risk of heart attack or stroke. Other studies are examining the prevalence of organ damage in those suffering from post-infection conditions.

DOH on Wednesday posted a notice on its dashboard saying it was unable to provide weekly COVID-19 case counts or other metrics due to an ongoing upgrade of its disease surveillance system infrastructure. The data will be provided next week when the updates resume, the agency said.

The daily average of new cases had been on a downward trend and declined to 89 per day on Feb. 15 while the average positivity rate remained steady at 4.7%.