Hawaii Department of Health officials reported 248 new coronavirus cases Sunday, adding to a surge of COVID-19 cases that health officials warn is putting a strain on the health care system, especially hospitals.

Hawaii’s daily new-case count hit triple digits for the first time in late July, and has remained there for most of August, with the vast majority of confirmed infections on Oahu. On Aug. 13, the state’s daily new-case count reached a record 355.

There are now 253 COVID patients currently in the hospital, occupying about 9% of the hospital beds.

Hawaii Lt. Gov. Josh Green, an emergency room doctor, said the challenge comes if the patients need intensive care, since 120, or 49%, of the state’s ICU beds are filled. He said generally about 20% of COVID-19- related hospitalizations will require intensive care.

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Sunday’s statewide COVID-19 hospital count is up from 105 the first weekend in August and Green said six days ago the count was at 171. If the trajectory continues, Green said “two weeks from now we could see 400 in the hospital with COVID.”

Dr. Jim Ireland, a community physician on Oahu, warns, “We’ll be close to capacity very shortly if things don’t start changing. I don’t go to every hospital on Oahu, but most and I’m seeing increases everywhere.”

Ireland said if the current rate of increase continues, “we’ll be in trouble in a matter of days or at least a week or two.”

Altogether, there have been 6,600 infections since the start of the pandemic in the islands in late February. Sunday’s new COVID-19 cases include 228 on Oahu, 12 in Maui County and eight on Hawaii island, according to the state Department of Health’s Sunday tally.

Of all the confirmed Hawaii cases, 396 have required hospitalizations, with 19 new hospitalizations — 18 on Oahu and one on Maui — reported Sunday, health officials said.

Green said the state has a baseline of 2,773 hospital beds and 244 intensive care unit beds.

Some 219 of the COVID-19 hospitalizations are on Oahu alone, he said.

The current hospital capacity issues impact Oahu the most since that’s where a majority of the COVID-19 increases have been; however, there also have been new coronavirus infections on the neighbor islands. Also, Ireland said, when Oahu hospitals are full that impacts neighbor island patients who have critical illnesses since they won’t be able to transfer here for care.

“If Oahu’s capacity is reached, it will impact the health care of the whole state,” Ireland said. “I strongly recommend staying home or working alone and minimizing contact with anyone not in your family. We must all stay safe the next two weeks.”

As of Sunday, the DOH reported that there have been 396 hospitalizations within the state.

The statewide coronavirus-related death toll remained at 47 Sunday, after seven new coronavirus-related deaths were reported last week. A total of 39 deaths have been on Oahu and seven on Maui, while one was a Kauai resident who died on the mainland.

As of Sunday, 4,410 infections in Hawaii are considered active cases, with a total of 2,143 patients now classified by health officials as “released from isolation,” or about 32% of those infected.

Sunday marked two weeks and one day since Gov. David Ige and Mayor Kirk Caldwell closed Oahu beaches and parks to the public, limited social gatherings and shut down team sports, playgrounds, camping, hiking trails and botanical gardens.

Green recommended last week that Ige reimpose a stay-at-home lockdown for Oahu. Instead, on Tuesday, Ige and Caldwell took a more targeted approach, which mostly just prohibited Oahu residents from gathering in groups of more than five.

Green said the current restrictions aren’t strong enough and that he’ll recommend further tightening.

“I felt the number of cases warranted going to fully safer at home status at least,” Green said. “I think the piecemeal attempt that the mayor is taking is both confusing and inadequate. I’d like to see them simplify and strengthen the restrictions to get over this once and for all and to put this virus down.”

DOH director Bruce Anderson indicated that the surge in COVID-19 cases might be “plateauing” Wednesday. However, Green noted cases, over the past several days, have remained consistently high.

“There’s this desire to be optimistic and then there’s the reality,” he said.

U.S. PIRG, the federation of state Public Interest Research Groups, is calling for Ige to “shut down, start over, and do it right this time to save lives.”

The advocacy group said earlier this week that at least 1,300 health professionals nationwide, including at least seven from Hawaii, have now signed an open letter to Ige and other decision- makers.

“Lives are at stake and half measures aren’t going to cut it,” Sydney Riess, Public Health Fellow with U.S. PIRG, said in a statement. “Governor Ige needs to make the hard call to protect the health (of) Hawaiians, and right now that means shutting down to slow the virus’s spread and ramping up testing and tracing capacity to contain future outbreaks.”

According to U.S. PIRG, Hawaii should close non- essential businesses, limit restaurant service to take-out and delivery, and mandate that masks be worn in all indoor and outdoor situations where people are interacting with each other.

The advocacy group said those steps should remain in place until the positivity rate, the percentage of COVID-19 tests coming back positive, is at 3% or lower on average statewide, and the rate of new daily cases is less than 1 per 100,000 people in the population.

Hawaii DOH officials counted 2,640 new tests Sunday, with the 248 positive new cases representing 9.4% of the total tested.